Recreational drug use peaks in the developmental stage of adolescence in humans. In this dissertation, we used a rodent model of adolescence and behavioral assessments of intravenous (i.v.) cocaine self-administration and reinstatement of cocaine-seeking to explore age differences in these cocaine-related behaviors, and then tested for the influence of environmental enrichment and for correlations between behavior and expression of plasticity genes. Although taking similar amount of cocaine, male rats trained to self-administer cocaine during adolescence (adolescent-onset) showed attenuated cue-induced reinstatement of cocaine seeking compared with adults. This attenuated cue-induced reinstatement did not generalize to a natural reward, sucrose pellets. Then we asked whether the attenuated reinstatement may be due to rapid developmental re-organization of reinforcement circuits (high plasticity) in adolescent-onset groups. To stimulate or inhibit neuroplasticity, subjects experienced environmental enrichment or impoverishment during abstinence. Environmental manipulations had no effect in adolescent-onset groups, whereas the enriched environment attenuated cue-induced reinstatement in adults compared with their impoverished counterparts. Thus, we turned to internal factors that may contribute to age-differences in reinstatement of cocaine seeking. Using in situ hybridization to quantify the mRNA for two neuroplasticity-related genes, activity-regulated cytoskeletal-associated gene (arc) and brain-derived neurotrophic factor (bdnf), we identified that overall, arc expression in the nucleus accumbens (NAc) and bdnf expression in the medial prefrontal cortex (mPFC) was higher in adolescent-onset than in adult groups. Together our data suggest that adolescence in rodents may be a period of relative biological resistance to some long-term drug effects.

What follows is a collection of poetry written during my time at GSU in the Doctoral program.

Sammanfattning Studiens syfte var att, med intervjuer, undersöka missbrukares upplevda motivationskällor (motiverande faktorer) för drogfrihet samt skillnader i motivationskällor för drogfrihet hos missbrukare som avslutat missbruket själva jämfört med dem som genomgått behandling. Resultatet visade att motivationskällan önskan av en förändring till ett bättre liv och tron på egna möjligheter att förändras var viktig för samtliga respondenter. Motivationskällan tron på den egna förmågan att kunna lyckas med ett avslut var särskilt viktig för dem som själva avslutade sitt missbruk och motivationskällan saknaden av och önskan att sluta såra människor i deras närhet för dem som slutade efter behandling. Studien visade också att missbrukarens tro på sin förmåga att lyckas avsluta ett missbruk samt nivån i personens upplevda motivation vid lyckade försök att avsluta ett drogberoende är viktiga faktorer för drogfriheten. / Abstract The aim was to investigate, with interviews, the motivational factors for drug soberness and differences in motivational factors between two groups of former addicts; those that ended their abuse by them self and those that ended after a treatment. The results indicated similar as well as different motivational factors for the two groups. It was also shown that the participants’ belief in their ability to successfully end their addiction and the level of motivation at the occasions of successful trials to end their addiction are important factors for soberness.

Der Konsum psychoaktiver Substanzen stellt einen der wichtigsten vermeidbaren Risikofaktoren für Krankheit und frühzeitige Sterblichkeit dar. Die Weltgesundheitsorganisation (WHO, 2009) berichtet im Rahmen ihrer Schätzungen zur weltweiten Morbiditäts-und Mortalitätsbelastung, dass die legalen Substanzen Tabak und Alkohol zwei der fünf wichtigsten gesundheitlichen Risikofaktoren darstellen. ...

El projecte model alemany per al tractament assistit amb heroïna en addictes als opiacis va suposar un canvi en la política de drogues en aquest país. El tractament assistit amb heroïna i el tractament de manteniment amb metadona van ser comparats en un estudi multicèntric de 1015 pacients en 7 ciutats d'Alemanya. El grup tractat amb heroïna va mostrar una millor retenció en el tractament i una major resposta en la millora de salut física i mental, així com reducció de consum de drogues il·legals. En aquest treball es presenten cinc articles relacionats amb els factors clínics i psicosocials que influeixen en la recuperació d'aquests pacients i han de ser tinguts en compte per al seu adequat tractament. En concret s'analitzen el consum d'alcohol i benzodiazepines, els efectes de la comorbiditat psiquiàtrica, la influència de les experiències anteriors de tractament i les diferències de gènere. Es van detectar fortes reduccions en el consum d’alcohol en el grup d’heronïna, i aquests pacients van tenir millors resultats en quant a millora de salut i reducció del consum de drogues, tant per als pacients dependents d'alcohol com per als no dependents. Es van trobar resultats superiors del tractament assistit amb heroïna en pacients sense experiència en tractaments de manteniment pel que fa a la reducció del consum de drogues i la reducció de l'activitat il·legal, però no en la millora en salut. El tractament amb heroïna va tenir millors resultats estadísticament en pacients amb experiència prèvia en tractaments enfocats a l'abstinència, tant pel que fa a salut com al consum de drogues il · legals. Es va trobar un consum de drogues significativament major entre els pacients amb un diagnòstic comòrbid tant al principi com al final del tractament. L'heroïna va tenir un resultat superior a la metadona pel que fa a la reducció del consum de drogues en els pacients comòrbids i no comòrbids, però l'efecte va ser més feble en el grup comòrbid. L'heroïna va funcionar millor que la metadona en la millora de la salut per als pacients no comòrbids, però, aquesta diferència no es va mantenir en els pacients amb comorbiditat psiquiàtrica. L'ús de benzodiazepines durant el tractament va tenir una relació negativa amb els resultats de millora en salut en ambdós grups de tractament, però, en analitzar els resultats de l'ús de drogues, les diferències van ser estadísticament significatives només quan tots dos grups de tractament van ser combinats. La proporció de positius de benzodiazepines en orina durant el tractament va disminuir més en el grup tractat amb heroïna que en el grup tractat amb metadona. Els homes van tenir millors resultats per a la reducció del consum de drogues il · legals, però no pel que fa a la millora en salut o en retenció. En analitzar el grup de dones, es van trobar diferències estadísticament significatives entre els tractaments (heroïna o metadona) només en analitzar retenció. Després de realitzar una anàlisi multivariant incloent diverses característiques psicosocials, només l'exercici de la prostitució va predir pitjors resultats entre les dones. Finalment es presenten quatre models de predicció de resultats sobre la reducció del consum de drogues il·legals i la millora de l'estat de salut tant en la mostra total (utilitzant variables de la línia base) com en els pacients que van acabar l'estudi (utilitzant variables longitudinals). Segons els nostres resultats, podem donar suport a les següents conclusions: 1) Són necessàries intervencions específiques en pacients que consumeixen alcohol o benzodiazepines, o amb una infecció d'hepatitis C. 2) L'ús de tractaments previs de manteniment s'ha de reconsiderar com un requisit per a l'entrada en tractament assistit amb heroïna. Els pacients sense experiències prèvies de tractaments enfocats a l'abstinència tenen un quadre clínic més complicat. 4) Els pacients duals (és a dir, pacients diagnosticats amb trastorns psiquiàtrics comòrbids) han de tenir intervencions específiques. 5) El suport social sembla ser un factor clau per a la recuperació. 6) Les dones constitueixen un grup de risc especial. / El proyecto modelo alemán para el tratamiento asistido con heroína en adictos a opiáceos supuso un cambio en la política de drogas en este país. Se comparó el tratamiento asistido con heroína y el tratamiento de mantenimiento con metadona en un estudio multicéntrico de 1015 pacientes en 7 ciudades de Alemania. El grupo tratado con heroína mostró una mayor retención y respuesta en la mejoría de salud física y mental, así como reducción de consumo de drogas ilegales. En este trabajo se presentan cinco artículos relacionados con factores clínicos y psicosociales que influyen en la recuperación de estos pacientes y deben ser tomados en cuenta para su adecuado tratamiento. En concreto se analizan el consumo de alcohol y benzodiacepinas, los efectos de la comorbilidad psiquiátrica, la influencia de las experiencias anteriores de tratamiento y las diferencias de género. Se detectaron fuertes reducciones en el consumo de alcohol en el grupo de heroína, y estos pacientes tuvieron mejores resultados en cuanto a mejoría de salud y reducción del consumo de drogas, tanto para los pacientes dependientes de alcohol como para los no dependientes. Se encontraron resultados superiores del tratamiento asistido con heroína en pacientes sin experiencia en tratamientos de mantenimiento en cuanto a la reducción del consumo de drogas y la reducción de la actividad ilegal, pero no en la mejoría en salud. El tratamiento con heroína tuvo mejores resultados en pacientes con experiencia previa en tratamientos enfocados a la abstinencia, tanto en lo referente a salud como al consumo de drogas ilegales. Se encontró un consumo de drogas significativamente mayor entre los pacientes con un diagnóstico comórbido tanto al principio como al final del tratamiento. La heroína tuvo un resultado superior a la metadona en lo referente a la reducción del consumo de drogas en los pacientes comórbidos y no comórbidos, pero el efecto fue más débil en el grupo comórbido. La heroína funcionó mejor que la metadona en la mejora de la salud para los pacientes no comórbidos, sin embargo, esta diferencia no se mantuvo en los pacientes con comorbilidad psiquiátrica. El uso de benzodiacepinas durante el tratamiento tuvo una relación negativa con los resultados de mejoría en salud en ambos grupos de tratamiento, pero, al analizar los resultados del uso de drogas, las diferencias fueron estadísticamente significativas sólo cuando ambos grupos de tratamiento fueron combinados. La proporción de positivos de benzodiacepinas en orina durante el tratamiento disminuyó más en el grupo tratado con heroína que en el grupo tratado con metadona. Los hombres tuvieron mejores resultados para la reducción del consumo de drogas ilegales, pero no en cuanto a la mejoría en salud o en retención. Al analizar el grupo de mujeres, se encontraron diferencias estadísticamente significativas entre los tratamientos (heroína o metadona) sólo al analizar retención. Después de realizar un análisis multivariante incluyendo varias características psicosociales, sólo el ejercicio de la prostitución predijo peores resultados entre las mujeres. Finalmente se presentan cuatro modelos de predicción de resultados sobre la reducción del consumo de drogas ilegales y la mejora del estado de salud tanto en la muestra total (utilizando variables de la línea base) como en los pacientes que terminaron el estudio (utilizando variables longitudinales). Según nuestros resultados, podemos apoyar las siguientes conclusiones: 1) Son necesarias intervenciones específicas en pacientes que consumen alcohol o benzodiacepinas, o con una infección de hepatitis C. 2) El uso de tratamientos previos de mantenimiento debe ser reconsiderado como un requisito para la entrada en tratamiento asistido con heroína. Los pacientes sin experiencias previas de tratamientos enfocados a la abstinencia tienen un cuadro clínico más complicado. 4) Los pacientes duales (es decir, pacientes diagnosticados con trastornos psiquiátricos comórbidos) deben tener intervenciones específicas. 5) El apoyo social parece ser un factor clave para la recuperación. 6) Las mujeres constituyen un grupo de riesgo especial. / The German model project for heroin assisted treatment of opiate addicts implied a change in the drug policy of this country. Heroin Assisted Treatment and Methadone Maintenance Treatment were compared in a multicentre study among 1015 patients in 7 cities in Germany. The heroin group showed better retention in treatment and greater response on physical and mental health improvement as well as illicit drug reduction. In this dissertation we present five papers relating to clinical and psychosocial factors that influence the recovery of these patients and should be taken into account for their proper treatment. Specifically, the consumption of alcohol and benzodiazepines, the effects of psychiatric comorbidity, the influence of prior treatment experiences and gender differences are analysed. Stronger reductions in alcohol consumption were detected in the heroin group, and these patients had better outcomes in health improvement and in reduction of illicit drug use both for alcohol dependent and non-dependent patients. The superiority of heroin in patients with no previous maintenance treatment experience was found on reduction of illicit drug use and the reduction of illegal activity, but not in the improvement of health. Heroin superiority in outcome was statistically significant for patients with previous abstinence treatment experience both for health and illegal drug consumption. Drug use was found to be significantly higher among patients with a comorbid diagnosis at the beginning and the end of treatment. Heroin had a better outcome than methadone for the reduction of illicit drug use in both comorbid and non-comorbid patients, but weaker effects were found in the comorbid group. Heroin worked better than methadone in improvement of health for non-comorbid patients; however, this difference was not present among patients with psychiatric comorbidities. Benzodiazepine use during treatment was found to have a negative association with health outcome in both treatment groups but, when analysing drug use outcome, differences were only statistically significant when both treatment groups were combined. The proportion of benzodiazepine positive urine tests during treatment decreased more in the heroin than in the methadone group. Men had significant better outcomes for the reduction of illegal drug use but not for health or retention. Among women, statistically significant differences between treatments (heroin or methadone) were only found for retention. After multivariate analyses including various possible psychosocial characteristics, only prostitution was found to predict worse outcomes among women. Finally we present four models predicting outcomes on reducing illegal drug use and improving health status in both the total sample (using baseline variables) and in patients who completed the study (using longitudinal variables). According to our results, we can support the following conclusions: 1) Specific interventions are needed in alcoholic, HCV and benzodiazepine consuming patients. 2) Previous maintenance treatment should be reconsidered as a requirement for Heroin Assisted Treatment entry. Patients without previous drug free experiences have a more complicated clinical picture. 4) Dual diagnosis patients (i.e. patients diagnosed with comorbid psychiatric disorders) need to have specific interventions. 5) Social support appears to be a key factor for recovery. 6) Women constitute a special risk group.

Massively multiplayer online games (MMOGs) are a popular type of online video game. While these games and their players have been studied previously, there is gap in the literature that examines the relationship between one’s motivation to play MMOGs and loneliness, depression, and problematic use. For this study, 440 players of World of Warcraft (WoW), a popular MMOG, completed a demographics questionnaire and four measures, including Williams, Yee, & Caplan’s (2008) motivation measure, Peter’s & Malesky’s (2008) World of Warcraft-specific Problematic Usage-Engagement Questionnaire, UCLA’s Loneliness scale, and The Depression Anxiety Stress Scales. Results from quantitative analyses suggest that MMO players who are motivated to play for reasons of achievement and immersion are more likely to experience problematic use than those persons who play for social motivations. Loneliness and depression were only positively related with immersion motivated players, and there exists a significant negative relationship between social motivation and depression. These results suggest that gamers who play WoW for immersive reasons are the most at-risk in comparison to their peers. Implications for counseling, limitations, and directions for future research are discussed.

Gambling about money is a frequent phenomenon in our modern community’s. The gambling has for some people resulted in a compulsive gambling. These consequences affects not only the gambler but also have impact on his or hers relatives. The purpose of this study is to describe how a small selection off relatives to persons with a compulsive gambling experience the gambling consequences in there life. The empirical material consists of five interviews with five relatives to persons with a gambling dependence. Coping theory, theory of crises and a systemic perspective has been used to analyse the empirical material. The results that appear are that the relatives have all described early signs that they at the time could not interpret. They have felt that the gambler has been absent in mind. The discovery of the gambling describes as a chocking experience. They have created there own cooping strategies. The relatives show a great amount of strength and they have drawn positive experiences from a difficult reality like better relations and communication with the gambler, and can see that they have to take care of them selfs and not only care for the gambler. The study also indicates that family ties are hard to brake, especially between parents and there children.

Vårt syfte med denna uppsats har vart att undersöka om den sekundära bostadsmarknaden påverkar socialarbetarna i arbetet med hemlösa klienter som har eller haft missbruksproblematik. Då vi ansåg att det är socialarbetarnas upplevda verklighet som är av störst intresse valde vi att utföra kvalitativa intervjuer med fyra socialarbetare. Intervjuguiden formades med hjälp av Michael Lipskys bok Street-level Bureaucracy (2010) i vilken han beskriver sin teori om gräsrotsbyråkrats yrket, denna bok har även genomsyrat hela arbetet och sedan använts som ett verktyg i analysen av vår empiri. Bakgrunds avsnittet avser att ge en vid förståelse av hur komplex hemlöshetsproblematiken är, för att sedan i tidigare forskning smalna av till den forskning som behandlar vår syfte mer specifikt. Vi kommer i vår avslutande diskussion argumentera för att den sekundära bostadsmarknaden påverkar socialarbetarna på olika sätt då de måste acceptera hyresvärdarnas krav. Lägenheterna som utgör den sekundära bostadsmarknaden tillhandahålls i huvudsak av de allmännyttiga hyresvärdarna, då dessa nu skall drivas affärsmässigt har kraven på hyresgästerna höjts. Vi har valt att kalla denna uppsats Sekundära hyresgäster och vi som har skrivit uppsatsen är Marcus Vesterlund och Anders Wallin. / Our purpose with this paper was to examine if the secondary housing market affects the social workers in their work with homeless clients who have or have had substance abuse problems. Since we felt that the social worker's perceived reality is of most interest to us we chose to conduct qualitative interviews with four social workers. The interview guide was formed with the help of Michael Lipsky's book Street-Level Bureaucracy (2010) in which he describes his theory of the street-level profession, this book has also permeated the whole process and was used as a tool in the analysis of our empirical work. The background section is intended to provide a broad understanding of the complexity of homelessness, and then in the prior research section we taper to the research that deals with aspects of our purpose. We will in our concluding discussion argue that the secondary housing market affects the social workers in different ways when they have to accept the lessors requirements. The apartments that make up the secondary housing market is provided mainly by public lessors, as these are now to be operated commercially the demand on the tenants has increased. We have chosen to call this essay Secondary tenants and we who have written the essay are Marcus Vesterlund and Anders Wallin.

The aim of this study has been to take part of six ex-alcohol addicts’ narratives about their lives with starting-point in which factors that has been significant and/or determining to be able to leave a life in abuse and what change this process has implied for their identity. To achieve the purpose with this study has three questions been formulated. These are what in the person’s life have been important in the process of a life free from alcohol, what were specific and decisive that effected the decision to stop using alcohol and what is the attitude to them self and their new role as an ex-alcohol addict.   Alcohol is a drug that is legal and accepted in the society and it´s hard to discover an addiction. Some people can handle to take their self out of the alcohol abuse on their own but for others different forms of professional help are necessary. This is a process that often takes long time and is influenced of both the individuals own efforts and different factors in the surroundings. To answer the aim and the questions the study is based on qualitative interviews. In our analysis to understand and interpret the material we have used earlier studies, social psychological theory whit an putting of symbolical interaction from roles and identity and how the individual define his or her situation. All the respondents in this study have received some kind of professional help and underwent treatment for their addiction. This has for everyone also been preceded by one or several of negative incidents that have been the trigger factor in the seeking relief. For five people treatment has been considerable and/or a crucial part to become free from the alcohol addiction. Also other insertion of support after the treatment has been important for all of them. Other factory that has been important in the process is positive refutation and support from other people in the surrounding.

Cocaine (CA) exposure during pregnancy causes long-lasting negative effects on fetal brain development and eventually results in motor dysfunction or changes in learning and memory performance. £^-amino-butyric acid (GABA) is the primary inhibitory neurotransmitter in the adult brain and undergo a switch from excitatory to inhibitory during early postnatal period. The excitatory/inhibitory switch is resulted in the relative temporal expression of K+-Cl- cotransporter 2 (KCC2). GABA is the neurotransmitter in the rat was born from excitement to inhibition and until the growth of thirty days have completely inhibitory. Here we test the effect of CA prenatal exposure on the expression of KCC2 in prefrontal cortex (recognition), hippocampus (memory), VTA (reward) and nucleus accumbens (reward). Protein expression profile of control or prenatal CA treated groups were evaluated by western blot in 2 days interval from postnatal day (PND) 8 to 30. The expression of KCC2 was time-dependently enhanced from PND 8 and reaches its maximal expression around PND 18 in prenatal CA exposure groups. The time-dependent profile of KCC2 expression in prefrontal cortex and NAc was significantly delayed in prenatal CA exposure group. We then correlate the KCC2 expression and the cocaine sensitivity by locomotor activity assay. We found group A shows a higher sensitivity to cocaine than group B in control rats. Surprisingly, group A of prenatal cocaine reduce the sensitive to cocaine to a similar extend like group B in control rats, suggesting prenatal exposure of cocaine might enhance the KCC2 expression. Furthermore, age range of A group (PND 22~27) and B group (PND 29~34) to repeated cocaine exposure resulted in up-regulation of KCC2 expression in B group earlier than A group. We found that the KCC2 expressions of repeated cocaine exposure in B group were higher than A group. In other words, in the B group, the inhibitory effect of GABA was significant and the locomotor activity was relatively slow. Therefore, the A group was more easy be cocaine addiction than B group. We next explore the signaling mechanism underlying cocaine exposure-induced KCC2 expression inhibition. Brain slices were incubated with cocaine with or without dopamine receptor antagonists and KCC2 expression was evaluated by western blot. Either SCH23390 (dopamine D1-receptor inhibitor) or eticlopride (dopamine D2-receptor inhibitor) significantly hamper the inhibition of KCC2 expression by cocaine in normal slices. However, only D2 antagonist eticlopride but not SCH23390 is effective reverse cocaine-induced KCC2 expression inhibition. Overall, results from our current studies provide a further insight into the molecular mechanism of cocaine-induced synaptic modification.