The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used a 10-question Internet-based survey with a convenience sample of 95 nurses (recruited online) who were currently practicing in advanced nursing roles. Social media platforms, including Facebook, were used to recruit participants. The survey included questions about expanding the scope of practice in addiction treatment and establishing guidelines that would allow nursing knowledge and expertise to be used in outpatient opiate addiction treatment. Critical social theory and Kingdon's theory of policy analysis were applied to support the project. The Survey Monkey data analysis tool was used to generate descriptive statistics, which demonstrated respondents' support for an expanded scope of practice. If the recommendations of this project are adopted by national legislation, increased accessibility to addiction treatment services will save millions of dollars in justice system, healthcare system, employment, and societal costs. Nursing policy advocates nationally can apply these results to support efforts to expand scope of practice to include prescribing buprenorphine.

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The aim of this thesis is to explore how men in recovery from substance use conceptualize challenges and use their inherent strengths to navigate them. Estimates of substance use prevalence rates in Canada suggest that approximately one-in-five Canadians will meet the diagnostic criteria for substance use disorder throughout their lifetime (Pearson, Janz & Ali, 2013). These prevalence estimates represent a significant cause for concern as addiction is a significant phenomenon in contemporary Canadian society. A scoping literature review was conducted on nineteen research studies to investigate the state of current research. Although there is a wealth of studies on addiction, research frequently utilizes pathologizing approaches. These approaches are commonly focused on addiction in the context of a social or individual issue ripe with problematizing discourses. Six qualitative semi-structured interviews were conducted on men living in recovery-based supportive housing for this research to explore their experiences from the onset of substance use into substance use and recovery efforts. A strength-based perspective was adopted for analysis purposes in order to more accurately reflect on the inherent strengths of the participants. The men provided in-depth accounts of their experiences, conceptualized challenges to their recovery and contrary to many contemporary research discourses, demonstrated an affluence of strengths while articulating challenge navigation. The men were also proactive in their ability to anticipate future challenges and conceive methods of effective challenge navigation. Findings of this study are analyzed and discussed in the context of recognizing the magnitude of the challenges facing the men in recovery and the incredible strengths that they demonstrate in challenge navigation. The implications for current social work practice are outlined and several suggestions are tabled with the goal of improving current practice methods. Finally, suggestions for future strength-based addiction research are offered with the intention of seeking overall improvements to the research field and addressing existing gaps within the literature. / Thesis / Master of Social Work (MSW)

Master of Science / Department of Psychological Sciences / Mary Cain / Novelty-seeking and sensation-seeking are traits implicated in initial drug experimentation and relapse in human populations. To research the neurobiological substrates that are implicated in novelty/sensation-seeking that predispose an individual to drug use, a rodent model was used. Recently, 50 kHz ultrasonic vocalizations (USV) have been identified as indices of affective state and are evoked by several drugs of abuse, specifically when these drugs of abuse have their pharmacological effects in the mesolimbic dopamine path. Secondly, genetic breeding of high and low vocalizers suggests not only are they different in the calling frequency, but also to drug sensitivity, suggesting ultrasonic vocalizations may be a behavioral marker for individual differences in the mesolimbic dopamine circuit. Two sensation/novelty seeking screens and an ultrasonic vocalization screen were used in rats to predict the locomotor and 50 kHz USV response to a low (.3 mg/kg) and high dose (1.0 mg/kg) of amphetamine. Correlation analysis revealed none of the novelty screens were correlated. Simultaneous regression analyses indicated amphetamine dose-dependently increased locomotor activity acutely and chronically but did not increase 50 kHz USV. The USV assessment predicted USV response to amphetamine acutely and chronically but was not dose dependent. No interactions among any predictors were observed. Previous research has dichotomized the novelty/sensation-seeking trait and found significant differences between high and low novelty responders. The current research provides evidence for maintaining continuous individual difference variables, and suggests each screen measures a different trait implicated in addiction.

Patienter med ett opioidmissbruk kan upplevas ha ett socialt avvikande beteendemönster som kan leda till en social stigmatisering. Att inom sjukvården se patienter som socialt avvikande kan leda till att de får en sämre vård och behandling än vad de har rätt till. Smärta är en subjektiv upplevelse, där patienten har en individuell uppfattning om sin smärta och kan därför inte jämföras med någon annans smärtupplevelse. Syftet med studien var att belysa sjuksköterskors attityder till smärtbehandling av patienter med opioidmissbruk. En systematisk litteraturstudie genomfördes bestående av 11 vetenskapliga artiklar. Resultatet mynnade ut i tre kategorier: Attityder gentemot patienter med opioidmissbruk, Attityder till den subjektiva smärtan och Attityder i samband med erfarenhet och bristande kunskap. Resultatet visade att sjuksköterskor har negativa attityder till patienter med opioidmissbruk. Trots att sjuksköterskorna var medvetna om att patienter med ett tidigare eller pågående opioidmissbruk, som upplevde smärta, behöver en högre dos av smärtlindring än patienter utan missbruksproblem, så upplevdes de ändå som de att ljög för att få en ökad dos opioider. Studien lyfte fram en bristande kunskap hos sjuksköterskor angående missbruk och beroende, vilket kunde leda till ett dömande av patienter med opioidmissbruk. Till vidare studier behövs det ytterligare forskning om hur patienter med opioidmissbruk upplever sjuksköterskornas attityder i det vårdande mötet. / Patients with an opioid addiction may be perceived to have a socially deviant behavior which may lead to social stigmatization. To see patients as socially deviant in healthcare can lead to that they receive worse care and treatment than what they are entitled to. Pain is a subjective experience, where the patient has an individual perception of his pain and can not be compared with another's experience of pain. The purpose of the study was to examine nurses' attitudes to pain treatment of patients with opioid addiction. A systematic literature review was conducted consisting of 11 scientific articles. The results culminated in three categories: Attitudes towards patients with opioid addiction, Attitudes to the subjective pain and attitudes associated with experience and lack of knowledge. The results showed that nurses have negative attitudes towards patients with opioid addiction. The nurses were aware that patients with a previous or current opioid addiction experienced pain needed a higher dose of pain medication, they were perceived nonetheless as they lied to get an increased dose of opioids. The study highlighted a lack of knowledge of nurses regarding addiction and dependence, which could lead to a judgment of patients with opioid addiction. For further studies there is a need to study how patients with opioid addiction experienced nurses' attitudes in the caring encounter.

Doctor of Philosophy / Department of Psychology / Stephen W. Kiefer / Methamphetamine is a potent psychomotor stimulant and a major drug of abuse. There is currently no effective medication available for treatment for methamphetamine addiction. The present study investigated the role of the dopamine D3 receptor on IV methamphetamine self-administration and its effect on methamphetamine induced neurochemical changes. Acute administration of the putative D3 receptor antagonists PG-01037 (10, 30 mg/kg, ip) and SB-277011A (12, 24, mg/kg, ip) significantly decreased the break-point for methamphetamine self-administration under a progressive-ratio (PR) schedule by 45 - 70%. Furthermore, both drugs dose dependently attenuated methamphetamine -triggered reinstatement of drug-seeking behavior in the reinstatement model of relapse. As with other drugs of abuse, the rewarding effects of methamphetamine are believed to be mediated by elevated levels of extracellular dopamine in the mesocorticolimbic system. The present study utilized in vivo microdialysis to examine the neurochemical mechanisms modulating the rewarding effects of methamphetamine actions evident in the various animal models of addiction. In the nucleus accumbens and ventral pallidum, acute methamphetamine (1.0 mg/kg, i.p.,) increased extracellular dopamine by 800 - 900% and decreased GABA by 60 – 65 % in the nucleus accumbens and ventral pallidum. Pretreatment with SB-277011A (12, 24 mg/kg) potentiated the methamphetamine induced dopamine increase but attenuated the methamphetamine-induced GABA decrease. Take together these data suggest that D3 selective antagonists’ pharmacotherapeutic potential in the treatment of methamphetamine addiction may involve a GABAergic mechanism.

Dissertation submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2011. / ‘Cigarette smoking is a modern day epidemic that poses a substantial health burden’, it has been proven that smokers die on average fourteen years earlier than non smokers as a direct result of their smoking. An abundance of evidence indicates that the health risks associated with cigarette smoking can however be reversed with a sufficient period of abstinence. Thus achieving life-long abstinence must be a health priority for both developing and developed countries (Caponnetto &, Polosa, 2008). Over 80% of smokers express a desire to stop smoking and 35% of them try to stop each year. However, less than 5% are successful in un-aided attempts to quit (American Psychiatric Association, 1995). The greatest challenge facing smokers who wish to quit are nicotine withdrawal symptoms; these include dysphoric or depressed mood, insomnia, irritability, frustration, anger, anxiety, difficulty concentrating, restlessness, decreased heart rate and increased appetite or weight gain (American Psychiatric Association, 1995). The aim of this double blind placebo controlled quantitative study was to determine the effectiveness of a homoeopathic complex (Caladium seguinum 30 CH, Nux vomica 30 CH and Staphysagria delphinium 30 CH); a tautopathic preparation and the combined effect thereof, in the treatment of nicotine withdrawal syndrome as determined by the Tolerance Dependence Questionnaire, Smoking History and Perceptions of Treatment Questionnaire. Methodology Forty participants recruited by means of convenience sampling were randomly and equally divided into one of four treatment groups, namely tautopathic group, homoeopathic group, combined tautopathic and homoeopathic group and placebo group. The duration of the study was 2 weeks and two consultations with each participant were conducted. The respective interventions were administered in oral spray format; participants were asked to spray their respective preparations directly into their mouth three times daily and to repeat the dose whenever they had a craving for a cigarette. iv Measurements in the form of the Tolerance Dependence Questionnaire (Appendix D), Perceptions of Treatment Questionnaire (Appendix H), and Smoking History (Appendix G) were used to quantify response to treatment. Non-parametric statistical analysis was conducted to analyse the data. Results All four research groups experienced a statistically significant reduction in the amount of cigarettes smoked, favourable perceptions of their response to treatment and improved tolerance. Statistically however when the groups were compared with each other they were similar with respect to their tolerance to nicotine, perception of response to treatment and reduction in amount smoked. Although interventions were statistically similar in terms of effectiveness, the data does suggest that Tautopathy as an intervention warrants exploration. The Tautopathic group achieved the highest reduction in the number of cigarettes smoked when comparing medians (11 less smoked per day), achieved the highest percentage of participants who experienced reduced cravings, and the highest percentage of participants who would continue using the intervention (90% respectively) as well as improvements in 6/9 variables of the Tolerance Dependence Questionnaire. Conclusions The study concludes that each of the four subject groups (including placebo) proved to be successful in aiding the participant to cease smoking. The results showed a significantly positive perception of the participants to the interventions used. The influence of the placebo effect however was very evident in this study; in addition other factors such as the unique method of administration of the medication (oral spray format on demand) the Hawthorn effect and the participants’ desire/commitment to quit smoking may have contributed to the positive results obtained. Notwithstanding the above and although not statistically significant; positive trends within the data do suggest that the Tautopathic approach used in this study should be further investigated in future.

Socialtjänsten och tidigare forskning beskriver att anhörigas integrering i missbruksvården är bristfällig. Trots detta understryker allt mer forskning att denna integrering är en viktig och betydelsefull del i missbruksvården. Utifrån detta ämnade vi undersöka hur anhöriga integreras och vilken betydelse integreringen hade för de anhöriga, för missbrukaren samt för missbruksvården och behandlingen. Studien genomfördes genom fyra kvalitativa intervjuer med socialsekreterare och missbruksbehandlare som var verksamma inom Socialtjänstens vuxenenhet. Resultaten utifrån hermeneutisk tolkning, empowerment- och systemteori visade att anhörigas integrering i ett professionsperspektiv är en självklar del i arbetet med missbrukaren och att integreringen har stor betydelse för såväl missbrukarens tillfrisknande som för anhörigas livskvalité. Integreringen skapade kunskap och förståelse bland de anhöriga så att de frångick sin roll som möjliggörare för missbruksbeteendet och lärde sig sätta gränser gentemot missbrukaren. För att missbrukarens tillfrisknande skulle vara hållbart var således förutsättningen att missbruket sattes i förhållande till ett större sammanhang, missbrukarens sociala nätverk. / The social services and previous research has argued that the integration of relatives and close family to addictive health care is lacking. Despite this, an increasing number of researchers underline its importance and meaningfulness in addictive health care. Building on this, our aim was to investigate how relatives and close family are integrated in addictive health care and what implications it has for the relatives, the addict, as well as the addictive healt care and the treatment. The study is based on four qualitiative interviews with social workers and treaters of addictive behaviors. The results based on heremenutic interpretation, empowerment- and systems theory showed that the integration of relatives from a professional perspective is an obvious part of the work with the addict and that the intregation have a great impact on the addict’s recovery as well as on the quality of life for the relatives. The integration built on knowledge and understanding among the relatives, enabled them to divert from their role as enablers of addictive behavior, and instead being able to set boundaries against the addict. In order to make the addicts recovery durable, a prominent condition was thus that the addiction was put into a bigger frame, i.e. the addict’s social network.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Education / Master / Master of Science in Information Technology in Education