Background: Adverse childhood experiences (ACEs) lead to high risk behaviors in adults. Annually, around 10,000 people die from alcohol-related motor vehicle injuries, and >1.1 million arrested for driving under the influence of alcohol or narcotics. An estimated 700,000 children reported abuse each year; 8.4% reported experiencing sexual abuse. Studies have reported the role of ACEs in alcohol consumption during adulthood. Additionally, evidence exists about the influence of parental substance abuse behaviors on addiction to alcohol and other substances of abuse. However, the association of adult drunk driving with childhood sexual abuse, and /or exposure to parental substance abuse behaviors has not been investigated. Objective: This study aimed to estimate the association of sexual abuse and/or parental substance abuse behaviors during childhood 2017 Appalachian Student Research Forum Page 57with drunk driving in US adults. Methods: Data were obtained from 4,374,390 adults who participated in the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Participants' self-reported responses were used to define study outcome- drunk driving (no/yes) and study exposure- childhood sexual abuse (no/yes) and parental substance abuse behavior (no/yes). Covariates included age, sex, race, income, education, and marital status. Simple and multivariable logistic regression models were used to assess the relative odds of drunk driving among US adults who reported sexual abuse and/or exposure to parental substance behaviors during childhood. Interaction models were conducted to test for joint effects of study exposures on the outcome. Results: Approximately 3.6% of adults reported DD, 10.55% reported exposure to parental substance abuse behavior, and 11.1% adults reported childhood sexual abuse. Compared to adults who didn't experience sexual abuse during childhood, those who experienced were significantly associated with increased odds of drunk driving behavior (adjusted Odds Ratio (aOR): 1.67, 95% confidence interval (CI):1.27-2.20). Adults who reported exposure to parental substance abuse behavior were found to be associated with increased odds of drunk driving behavior (aOR:1.30, 95%CI:1.00-1.68) compared to unexposed adults. Conclusion: Adults who were sexually abused during childhood and had exposures to parental substance abuse behaviors were associated with increased relative odds of drunk driving. The study findings help public health professionals identify targeted high risk groups for interventions. Appropriate public health interventions and/or policies should be developed to prevent sexual abuse and exposure to parental substance abuse during childhood. Health education and promotional campaigns are vital to minimize drunk driving cases by targeting communities and individuals with high risk behaviors.

Despite significant medical advances in HIV treatment, people living with HIV and substance use (PLWH-SU) remain left behind. Compared to people living with HIV (PLWH) without comorbid substance use, PLWH-SU are less likely to engage in medical care and to achieve viral suppression. As a result, PLWH-SU have more frequent preventable hospitalizations, higher rates of viral transmission, and greater morbidity and mortality. Although there is extensive research that explores ways to enhance PLWH-SU’s engagement in HIV care by improving patient-provider interactions, most have focused on the patient, and none have been effective. Grounded in the sociological theory of habitus, this dissertation attended to the medical provider in the patient-provider dyad and aimed to better understand how medical providers’ perceptions and dispositions towards PLWH-SU are formed, and how these perceptions and dispositions are displayed in the ways medical providers interact with and take care of PLWH-SU. Before engaging with habitus, I first conducted a systematic review on how the theory has been used to study medical providers’ clinical practices. Results of the review show that while existing literature has been limited and unclear in its usage of habitus, these studies are informative, and they demonstrate that habitus can be a suitable theoretical foundation for expanding present approaches to research on medical providers’ clinical interactions with PLWH-SU. Following the systematic review, I developed my conceptual framework of medical providers’ treatment habitus (i.e., medical providers’ dispositions towards caring for PLWH-SU) and estimated a typology of treatment habitus using survey data from 258 medical providers in Miami, Florida, Atlanta, Georgia, and the District of Columbia. My analyses show that among this sample of medical providers, there are four types of treatment habitus towards caring for PLWH-SU, and treatment habitus is associated with multi-level factors (e.g., providers’ race, study site, receipt of substance use disorder training). To further explore how medical providers came to develop and how they understand their own treatment habitus, I conducted conversational interviews with 36 medical providers who had completed the abovementioned survey. These interviews revealed medical providers exhibit a spectrum of treatment habitus that is distinguishable by their intentions (person-centered vs. provider-centered) and their methods (informative vs. directive). The interviews also revealed that there are discrepancies in how medical providers spoke about PLWH-SU and how they described their practices towards caring for PLWH-SU. Specifically, although most providers used negative terms to refer to PLWH-SU, the stigmatizing language was almost never accompanied by recollections of stigmatizing behaviors during clinical interactions with PLWH-SU. Taken together, this dissertation expanded on current knowledge about not only how medical providers act when caring for PLWH-SU, but also why they act the ways they do. Findings from this study contribute to an understudied area of HIV and substance use research and provide insights for the development of novel provider-based interventions that can improve the health of this vulnerable and marginalized population.

Bakgrund: I dagens samhälle är alkohol- och narkotikaproblematik vanligt förekommande. Alkohol- och narkotikaproblematik leder till negativa förändringar i vardagen. Utifrån ett samhällsperspektiv råder det stigmatisering av alkohol- och narkotikaproblematik vilket leder till att personer undviker att söka vård. Syfte: Att beskriva hur patienter med alkohol- och/eller narkotikaproblematik upplever vårdpersonalens bemötande inom sjukvården. Metod: Allmän litteraturstudie med induktiv ansats. Resultat: Resultatet presenteras i två teman vilka är bemötande som stöd och bemötande som hinder. I resultatet framkom det att vårdpersonalens bemötande upplevdes som stödjande eftersom vårdpersonalen lyssnade och bemötte patienter professionellt samt att vårdpersonalen visade att de hade goda kunskaper i mötet med patienter. Vidare framkom det i resultatet att patienter upplevde vårdpersonalens bemötande som ett hinder i vårdprocessen eftersom vårdpersonalen bemötte patienter otillräckligt och ovärdigt i form av diskriminering, stigmatisering samt maktmissbruk. Konklusion: Resultatet presenteras i två teman vilka är bemötande som stöd och bemötande som hinder. Resultatet kan bidra med ökad förståelse hos vårdpersonal som möter personer med alkohol- och/eller narkotikaproblematik vilket på så vis kan bidra till bättre förutsättningar för ett gott bemötande. / Background: In today's society, alcohol and drug problems are common. Alcohol and drug problems lead to negative changes in everyday life. From a societal perspective, there is the stigma of alcohol and drug problems, which leads to people that avoid seeking care. Purpose: To describe how patients with alcohol and/or drug problems experience the treatment of healthcare professionals in the healthcare sector. Method: General literature study with inductive approach. Result: The result is presented in two themes which are supportive treatment and obstructive treatment. In the result, it was found that the care staff's treatment was experienced as supportive because the care staff listened and treated patients professionally and that the care staff showed that they had good knowledge in the meeting with patients. Furthermore, it emerged in the results that patients perceived the treatment of care staff as an obstacle in the care process because the care staff treated patients insufficiently and unworthily in the form of discrimination, stigmatization and abuse of power. Conclusion: The result is presented in two themes, which are supportive treatment and obstructive treatment. The result can contribute to increased understanding among healthcare professionals who meet people with alcohol and/or drug problems, which can thus contribute to better conditions for good treatment.

Alcoholics Anonymous (AA) continues to be the most accepted approach for the treatment of addictions in the United States. However, due to recent evidence questioning the effectiveness of AA, the need for alternative approaches to the treatment of addictions has become clear. The following research addresses the efficacy of one such alternative, Rational Recovery (RR). Node-Link Mapping (NLM), a graphic communication technique which uses links and nodes as building blocs to facilitate and enhance communication of information as well as awareness in a counseling environment, was implemented to enhance the recovery process. Three groups of ten (10), chemically dependent, adjudicated subjects were exposed to three different treatment approaches at an outpatient counseling center. The Experimental group received RR with NLM, the Comparison group was exposed only to RR, and the Control group continued in treatment according to the protocol of the counseling agency. All subjects were given the Substance Abuse Subtle Screening Inventory-2 (SASSI-2) as a measurement of symptoms associated with chemical dependency. The subjects were also administered the Rotter Internal-External Locus of Control Scale (Rotter I-E Scale) to determine locus of control prior to treatment and any change after treatment.

The study compared an experimental group (n=26) who participated in weekly SIS sessions as an adjunct to existing treatment protocols for a period of 6-8 weeks, to a control group (n=14) who matriculated in treatment without the addition of SIS training for a period of 6-8 weeks. Subjects completed a battery of questionnaires at the beginning of the measurement period and at the end of the measurement period. The SASSI-2, The McMaster Family Assessment Device (FAD), and the Rotter Internal-External Locus of Control Scale were used to measure groups on recovery related variables at Pre-Test and Post-Test. Results demonstrated a consistent pattern of improvement over the time measure. The results of the interaction of group and time demonstrated a pattern of gains which did not reach statistical significance, partially as an artifact of the small sample size. An investigation of effect sizes was conducted to detect the effect of SIS training. The training was found to have a moderate effect size, which was consistent with other research using SIS training. Some areas for possible future research were addressed.

Mental health professionals (MHPs) play a pivotal role in enhancing treatment outcomes for drug-using populations and minimizing their harm to the public. In response to a gap in the literature, this study sought to (a) assess MHPs' attitudes about the use and abuse of substances and their perception of their role in tackling substance abuse and related disorders in Nigeria, (b) identify predictors of perception, and (c) explore regional variations in attitude. Based on the validated drug and drug users' problems perception questionnaire and the substance abuse attitude survey, a cross-sectional survey was conducted in a randomized sample of 292 MHPs practicing in neuropsychiatric hospitals and in the mental health departments of teaching hospitals from 4 geopolitical zones of Nigeria. A response rate of 81.1% was achieved. MHPs' attitude about substance use tended towards the non-permissive, stereotypical, and moralistic spectrum, and its role perception was distinctly defined. Educational attainment (O.R = 0.50, p = 0.030), work-motivation (O.R = 0.55, p < 0.0001), and role-support (O.R = 1.48, p < 0.0001) significantly predicted MHPs' role perception. The Kruskal-Wallis test showed that there were significant regional variations in the attitudes of multidisciplinary MHPs, H (3) 18.727, p < 0.0001. Step-down follow up analysis revealed that the distribution of attitude total score vary significantly between the south-southern and southwestern region (p< 0.001), the northeastern and southeastern region of the country (p < 0.028). To foster the rehabilitation of this population and its reintegration into mainstream society, a holistic approach toward the standardization of drug treatment is needed. It should take into account the cultural, religious, and ethnic differences predominating in different regions.

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This qualitative study examined the viability of traditional stories in substance abuse treatment. The subjects for this study were young women ages 18-30 who were in substance abuse treatment in a small, rural, health department. During the 4-week study, 4 traditional stories were used in group sessions that gave the women a common reference point and a common language to frame discussions. Using story in the IOP sessions helped to create a safe, supportive environment as well as creating an opening for discussions about trauma and abuse, and other significant issues. Principles of 12 Step Recovery were woven into the discussion to help the participants deal with and reframe their experiences.

Bakgrund: 2% av den svenska befolkningen har ett narkotikaberoende och 3,8% har ett alkoholberoende. Att vara beroende av alkohol och narkotika medför flera risker för både hälsoproblem och sociala problem och är mycket kostsamt för samhället och vården. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskans erfarenhet av att vårda personer med beroendeproblematik. Metod: En beskrivande litteraturstudie som baserades utifrån tio kvalitativa vetenskapliga artiklar. Litteratsökningen gjordes på databasen PubMed och artiklarna analyserades med hjälp av Evans dataanalysmetod. Huvudresultat: Resultatet visade att en stor del av sjuksköterskans erfarenheter handlade om vissa utmaningar i vården av personer med beroendeproblematik. Men resultatet lyfte även en del möjligheter för ett gott vårdmöte, samt sjuksköterskans känslor av frustration och hopplöshet i vårdmötet. Slutsats: Sjuksköterskans erfarenhet av att vårda personer med beroendeproblematik bestod av en del utmaningar, möjligheter och personliga känslor. En ökad kunskap kan utgöra en viktig del för att lättare förstå en komplex patientgrupp som denna. Ökade kunskap är nödvändig för att sjuksköterskan ska känna sig trygg och säker i sin roll att vårda personer med beroendeproblematik. I slutändan kan detta innebära att vården blir bättre och säkrare för personer med beroendeproblematik. / Background: 2% of the Swedish population have a drug addiction and 3,8% have an alcohol addiction. Being addicted to alcohol and drugs entails several risks for both health and social problems and is very costly for society and healthcare. Aim: The aim of the literature study was to describe the nurse´s experience of caring for people with addiction problems. Method: A descriptive literature study based on ten qualitative scientific articles. The literature search was conducted on the PubMed database and the articles were analyzed using Evans´ data analysis method. Main result: The result showed that a large part of the nurse´s experience was about certain challenges in caring for people with addiction problems. However, the result also highlighted some opportunities for good care encounters, as well as nurses' feelings of frustration and hopelessness in care encounters. Conclusion: The nurse's experience of caring for people with addiction problems consisted of some of challenges, opportunities, and personal feelings. Increased knowledge can be an important part of understanding a complex patient group like this. Increased knowledge is necessary for the nurse to feel confident and secure in their role of caring for people with addiction problems. In the end, this may mean that care becomes better and safer for people with addiction problems.