Syftet med vår undersökning är att belysa praktikers erfarenhet av olika aspekter som är av betydelse för att klienter inom missbruksvård ska kunna vidmakthålla stabil drogfrihet, samt att belysa olika insaster som kan främja drogfrihet. Den metodologiska utgångspunkten är kvalitativ forskningsansats med semistrukturerade intervjuer. För att få svar på frågeställningen har fem verksamma personer inom missbruksvården intervjuats. Resultaten undersöks med utgångspunkt från Prochaska och DiClemente teori om förändringsprocessen plus andra sekundära teorier som identitesutveckling, socialisationsprocessen och stämplingsteorin. Studiens resultat visar att stöd från familjen eller nätverket och hitta en väl fungerade vardagsstruktur kan bidra till att främja en bestående drogfrihet.  Att bygga nya relationer och lyckas skapa en ny accepterad social roll kan vara betydelsefullt för att lyckas förbli stabilt drogfri. Studien visar också att det finns glapp mellan behov och befintligt stöd för de personer som kämpar med att förbli drogfria och att det finns behov att implementera andra nya insatser.

Magister Psychologiae - MPsych / Substance use addiction is a debilitating and destructive human disorder that affects millions of people worldwide. Of all the provinces in South Africa, the Western Cape has the highest rate of MA use. This highly addictive stimulant, locally known as 'tik', has multiple physiological, psychological, and social effects on the user. The effects are associated with neurocognitive deficits that include deficiencies in working memory and high rates of delay discounting. Current neuropsychopharmacology literature seems to suggest that changes in neurotransmitter functioning and particular brain areas occur that contribute to some of the addictive behaviours associated with chronic MA use. New evidence is emerging that working memory training can help to improve rates of impulsivity in those addicted to MA by strengthening cognitive control. The aim of this project was to establish whether differences in impulse control existed in a sample of 33 male patients at a Western Cape drug rehabilitation centre who received either working memory training with standard drug rehabilitation and or standard drug rehabilitation only. Data was collected with a self-report impulsivity scale (BIS – 11) and analysed using inferential statistics. The results suggest that working memory training, when paired with a standard rehabilitation program, has superior effects in decreasing self-reported rates of impulsivity when compared to standard rehabilitation only. These findings suggest that working memory training may serve as a useful addition to improving impulsivity rates in MA rehabilitation treatment. Further research on a larger scale is required to investigate the findings of this project.

Magister Scientiae (Occupational Therapy) - MSc(OT) / The growing phenomenon of drug abuse has alerted the attention of health professionals, addiction counsellors, school educators, the media and community members. Susceptible sub groups of the population such as adolescents have been seriously affected as addiction destroys their identities, health, daily performance, family structure and ultimately results in social disintegration. Consequently, rehabilitation facilities have been established and addicts are entering the treatment system via referrals from school principals, the judiciary court or desperate parents and family members. Despite this, after having spent a reasonable amount of time and money in rehabilitation centres, relapse rates are significantly high and addicts are returning to treatment. The question was then raised as to whether recurrent relapses were as a result of their occupational needs not being met in treatment. To understand whether the occupational needs of these recovering adolescents are met, a true client-centred approach was employed. A descriptive approach was used within a qualitative research paradigm. The participants that were selected from four drug rehabilitation facilities in the Cape Town Metropolis, included 8 recovering drug addicted adolescents, 2 rehabilitation workers employed at two different facilities, and a sum of 26 parents of recovering addicts. Purposeful sampling was used for the adolescents and rehabilitation workers while convenient sampling was used for the parents. To access the perspectives and perceptions of the participants the researcher used individual semi-structured interviews for the recovering adolescents and drug rehabilitation workers, and focus groups for the parents. The data was analysed thematically using Lincoln & Guba’s (1985) method of qualitative data analysis. All data was managed manually. The objectives of the study explored perceptions of drug addicted adolescents with regard to relapse, to describe the barriers with regard to drug rehabilitation and their occupational needs, to reveal facilitators with reference to the recovery process, and to present suitable strategies which may improve drug treatment practice. Three themes were constructed based on the findings of the study. The themes were: 1) easy to get in, difficult to get out, 2) breakdown on life caused by drug addiction, and 3) moving forward towards recovery. Since adolescence is known as a transitional period characterised by identity development, adolescents are naturally influenced by their social and physical environment, particularly their peer groups at school and in the community. Consequently, adolescents enter treatment with numerous physical, psychological, social, intrapersonal, and legal needs. The constant pursuit of drugs and its lifestyle leads to dysfunction and imbalance in the individual’s daily performances with relapse remaining a common element in the recovery process. The lack of knowledge from participants pertaining to the concept of relapse was perceived as a barrier to recovery. The physical and social environment such as the general availability and accessibility of drugs in adolescent’s community, the unfavourable influence that peers and family relationships play, organisational challenges such as staff handling principles regarding their developmental stage and ineffective communication within the rehabilitation centre, and personal barriers including manipulative and behavioural difficulties, emerged as contra-indicative to the recovery process. Many of the recovering drug addicted adolescents were unable to cope with the array of needs and triggers, and found themselves relapsing and returning to the rehabilitation facility. Among the many facilitators as perceived by the participants, the actual programme at the rehabilitation centre was significant in promoting progress. If it included education groups, where clients are taught about substance abuse, relapse and how to restructure their lifestyle of recovery, it was deemed as beneficial. Another facilitator highlighted by the participants was the involvement of family by incorporating parent support sessions, and an interesting factor suc Recommendations for the study included that adolescents who abuse substances need to be treated very differently to adults or children, and that maintaining communication or a connection with them via aftercare for example, will enable them to sustain their sobriety outside of the rehabilitation facility. Since addiction affects the individual’s identity, roles, and habits on an occupational performance level it is paramount that treatment should be addressed from an occupation-based perspective in collaboration with existing evidence-based addiction models. Occupational therapists are uniquely equipped to deal with these components. h as including spirituality as a resource was raised as valuable in their recovery process.

This thesis investigated the contribution of the nucleus accumbens core (AcbC) and the hippocampus (H) to choice and learning involving reinforcement that was delayed or unlikely. Animals must frequently act to influence the world even when the reinforcing outcomes of their actions are delayed. Learning with action-outcome delays is a complex problem, and little is known of the neural mechanisms that bridge such delays. Impulsive choice, one aspect of impulsivity, is characterized by an abnormally high preference for small, immediate rewards over larger delayed rewards, and is a feature of attention-deficit/hyperactivity disorder (ADHD), addiction, mania, and certain personality disorders. Furthermore, when animals choose between alternative courses of action, seeking to maximize the benefit obtained, they must also evaluate the likelihood of the available outcomes. Little is known of the neural basis of this process, or what might predispose individuals to be overly conservative or to take risks excessively (avoiding or preferring uncertainty, respectively), but risk taking is another aspect of the personality trait of impulsivity and is a feature of a number of psychiatric disorders, including pathological gambling and some personality disorders. The AcbC, part of the ventral striatum, is required for normal preference for a large, delayed reward over a small, immediate reward (self-controlled choice) in rats, but the reason for this is unclear. Chapter 3 investigated the role of the AcbC in learning a free-operant instrumental response using delayed reinforcement, performance of a previously learned response for delayed reinforcement, and assessment of the relative magnitudes of two different rewards. Groups of rats with excitotoxic or sham lesions of the AcbC acquired an instrumental response with different delays (0, 10, or 20 s) between the lever-press response and reinforcer delivery. A second (inactive) lever was also present, but responding on it was never reinforced. The delays retarded learning in normal rats. AcbC lesions did not hinder learning in the absence of delays, but AcbC-lesioned rats were impaired in learning when there was a delay, relative to sham-operated controls. Rats were subsequently trained to discriminate reinforcers of different magnitudes. AcbC-lesioned rats were more sensitive to differences in reinforcer magnitude than sham-operated controls, suggesting that the deficit in self-controlled choice previously observed in such rats was a consequence of reduced preference for delayed rewards relative to immediate rewards, not of reduced preference for large rewards relative to small rewards. AcbC lesions also impaired the performance of a previously learned instrumental response in a delay-dependent fashion. These results demonstrate that the AcbC contributes to instrumental learning and performance by bridging delays between subjects' actions and the ensuing outcomes that reinforce behaviour. When outcomes are delayed, they may be attributed to the action that caused them, or mistakenly attributed to other stimuli, such as the environmental context. Consequently, animals that are poor at forming context-outcome associations might learn action-outcome associations better with delayed reinforcement than normal animals. The hippocampus contributes to the representation of environmental context, being required for aspects of contextual conditioning. It was therefore hypothesized that animals with H lesions would be better than normal animals at learning to act on the basis of delayed reinforcement. Chapter 4 tested the ability of H-lesioned rats to learn a free-operant instrumental response using delayed reinforcement, and their ability to exhibit self-controlled choice. Rats with sham or excitotoxic H lesions acquired an instrumental response with different delays (0, 10, or 20 s) between the response and reinforcer delivery. H-lesioned rats responded slightly less than sham-operated controls in the absence of delays, but they became better at learning (relative to shams) as the delays increased; delays impaired learning less in H-lesioned rats than in shams. In contrast, lesioned rats exhibited impulsive choice, preferring an immediate, small reward to a delayed, larger reward, even though they preferred the large reward when it was not delayed. These results support the view that the H hinders action-outcome learning with delayed outcomes, perhaps because it promotes the formation of context-outcome associations instead. However, although lesioned rats were better at learning with delayed reinforcement, they were worse at choosing it, suggesting that self-controlled choice and learning with delayed reinforcement tax different psychological processes. Chapter 5 examined the effects of excitotoxic lesions of the AcbC on probabilistic choice in rats. Rats chose between a single food pellet delivered with certainty (probability p = 1) and four food pellets delivered with varying degrees of uncertainty (p = 1, 0.5, 0.25, 0.125, and 0.0625) in a discrete-trial task, with the large-reinforcer probability decreasing or increasing across the session. Subjects were trained on this task and then received excitotoxic or sham lesions of the AcbC before being retested. After a transient period during which AcbC-lesioned rats exhibited relative indifference between the two alternatives compared to controls, AcbC-lesioned rats came to exhibit risk-averse choice, choosing the large reinforcer less often than controls when it was uncertain, to the extent that they obtained less food as a result. Rats behaved as if indifferent between a single certain pellet and four pellets at p = 0.32 (sham-operated) or at p = 0.70 (AcbC-lesioned) by the end of testing. When the probabilities did not vary across the session, AcbC-lesioned rats and controls strongly preferred the large reinforcer when it was certain, and strongly preferred the small reinforcer when the large reinforcer was very unlikely (p = 0.0625), with no differences between AcbC-lesioned and sham-operated groups. These results suggest that the AcbC contributes to action selection by promoting the choice of uncertain, as well as delayed, reward.

Cognitive impairments and changes in the structure and function of related brain regions, namely the prefrontal cortex and striatum, have long been implicated in drug addiction. However, it is unknown whether these abnormalities predate substance abuse, potentially serving as risk factors for dependence, or if they are the consequence of protracted use. To address this question, endophenotype research using stimulant-dependent individuals’ biological siblings has been used to investigate traits implicated in the pathology of addiction. Impairments present in both groups suggest an underlying risk-state for dependence, while additional abnormalities present only in stimulant-dependent individuals reflect potential effects of the drugs themselves. Contrastingly, there are also individuals who use stimulant drugs in a controlled manner without developing dependence. These ‘recreational users’ may lack the underlying traits that comprise a greater risk for dependence, or they might maintain additional protective factors against the development of addiction. Experiments in the first half of this dissertation used functional magnetic resonance imaging to investigate neurocognitive similarities and differences between dependent stimulant users, their non-dependent siblings, recreational users of cocaine, and unrelated healthy control volunteers. In Chapter 2, performance on a colour-word Stroop task was impaired in both stimulant-dependent individuals and their siblings, suggesting an endophenotype of cognitive inefficiency. However, neural activity significantly differed between the groups, indicating additional changes specific to the use of stimulant drugs. In Chapter 3, dependent users showed significant attentional bias to salient stimuli on a cocaine-word Stroop task, with a concurrent increase in prefrontal activation. Conversely, recreational users showed resilience in the face of cocaine cues and a decrease in arousal. Finally, Chapter 4 explored differences in reward sensitivity to both generic and drug-specific reinforcers, comparing the effects of personal and family history of stimulant exposure on a monetary incentive delay task. It is also under debate whether the neurocognitive differences seen in stimulant-dependent individuals are unique to substance abuse, or if parallel changes in behaviour and neurobiology are present in similar addiction-spectrum disorders, such as binge eating leading to obesity. In Chapter 5, stimulant-dependent and obese individuals with binge-eating behaviours showed differences in their substance-specific and general reward responsivity on a novel reward-valuation task. However, in Chapter 6 a similar decline in orbitofrontal cortex grey matter volume in relation to both years of stimulant use and body mass index was identified, implicating an overlap in this area between both conditions. These findings are integrated in Chapter 7, discussing the neurocognitive risk and protective factors that underlie an individual’s vulnerability for addiction, not only to stimulant drugs, but also potentially for other addictive behaviours.

Background: The UK has a high prevalence of opioid use; although this population is ageing. The use of opioids is associated with excess mortality and offending and so remains a priority for public health and criminal justice policy. Aims: There are two broad aims for this thesis: firstly, to quantify excess mortality and offending associated with opioid use, and secondly, to assess the effectiveness of drug treatment at reducing these harms. Methods: Cohorts were extracted from the Drug Data Warehouse (DDW); a collection of case-linked drug treatment and criminal justice datasets, linked to mortality and offending records. Excess mortality was quantified by comparing deaths observed in a cohort of opioid users to that expected from the general population, matched on age and gender. The association between opioid use and offending was quantified using a cohort of drug-tested offenders, comparing those who tested positive for opiates and/or cocaine with those who tested negative. The effectiveness of treatment was calculated using two separate measures: the effect of being in treatment, using a time-dependent treatment exposure, and the effect of initiation to treatment. In the latter analysis, the approach was to use observational data to emulate randomised controlled trials, in an attempt to better establish the causal effect of treatment initiation. Confounding bias, when treatment exposure is time-dependent, was discussed, using path diagrams and simulations. Results: The opioid-user cohort extracted from the DDW is the largest assembled to-date (N = 198,247). Controlling for age and gender, opioid use was associated with considerably higher mortality and offending than non-users. Older age was a risk factor for drug related poisoning (DRP) death. The association with offending was considerably higher for females. Compared to periods out of treatment, the risk of a fatal DRP was lower during pharmacological treatment but not during periods where the user received psychological support only. Simulations illustrated that when treatment exposure is time-dependent, analyses may be biased in the presence of confounding by a time-dependent variable. Among opioid-using offenders, there was little support for the hypothesis that initiation to drug treatment was effective at reducing the risk of future acquisitive offending. Conclusion: In England and Wales, there remain considerable excess mortality and offending associated with opioid use. Age and gender have an important influence on these relationships. Treatment (as delivered in England and Wales) appears effective at reducing the risk of a drug-related death, provided there is a pharmacological component, but not at reducing the risk of future offending.

Massively multiplayer online games (MMOG’s) are a specific form of online computer games that allow for millions of people to simultaneously play online at any time. This form of online gaming has become a huge phenomenon worldwide both as a popular past time and a business endeavour for many individuals. There are more than 16 million people worldwide who subscribe to fantasy role-playing online games. Although such games can provide entertainment for many people, they can also lead to problematic Internet use (PIU). PIU has also been referred to as Internet addiction, and can cause significant problems in an individual’s functioning. The study aimed to enhance a greater understanding of the phenomenon of male adults’ experiences PIU with MMOG’s. More specifically the study aims to identify if PIU with MMOG’s can be considered a form of Internet addiction within South Africa. Furthermore, assisting in the further development of online addiction diagnosis and treatment strategies. The study utilised an interpretive phenomenological approach (IPA) and participants were purposively sampled. The data was collected using semi-structured individual interviews. Furthermore, Braun and Clarks thematic analysis was used during data analysis while incorporating the four major processes in phenomenological research, namely 1) epoche, 2) phenomenological reduction, 3) imaginative variation and, 4) synthesis. Themes that emerged from the analysis of the participants’ experiences included, initial description of use, motives for continued use of MMOG’s, consequences of PIU with MMOG’s, perceptions of PIU with MMOG’s, and treatment considerations. This study provided a thick description of South African and international literature and combines the literature with the themes that emerged from the participants experiences in order to produce discussions based on the findings of this qualitative study. Conclusions, recommendations, and limitations of this study informed future research on cyber citizenship by providing a detailed understanding of the context of South African male adults’ experiences of PIU with MMOG’s.

This thesis engages in discribing Czech gambling law and it's recent development in preparing a very new gambling act. The goal of this diploma thesis is to point out at the biggest problems of so far existing gambling act and at what way they should be dealt in the new one. I use two main economic theories to explain reasons of issuing new act. The first one is The Theory of Interest Groups and the other one is Theory of Public Interest which are applied at the case of Czech Republic. Next goal of this thesis is an analysis of popularity of all gambles according to sum of money gambled and money paid back. I also describe a historic development of gambles and it's regulation and show that the ability to innovate new ways to evade the law had very often no limits and the regularors have never been able to make up a clear set of rules that would be unavoidable.

Tron på den egna förmågan att förbli återhållsam (”abstinence self-efficacy”) har visat sig vara en bidragande faktor till att personer med substansberoende lyckas förbli återhållsamma. Syftet med studien var att undersöka om det fanns gemensamma teman inom tron på den egna förmågan hos människor med substansberoende, med särskilt fokus på faktorer som bidrar till förmågan att förbli återhållsam. Detta har undersökts genom åtta intervjuer med människor som inte längre är aktiva i sitt substansberoende. Deltagarna var 19-65 år gamla, varav en var kvinna. Alla deltagare har haft någon form av substansberoende, varav sex deltagare hade alkohol som sin huvudsubstans. De teman som hittades inom förstärkande faktorer var yttre - relationer och aktiviteter, samt inre - inneboende motivation och tankar. Det tema som hittades inom faktorer som försvagar var motgångar. Studien kan användas för att bättre förstå vilka faktorer som är bidragande när det kommer till substansberoendes tro på den egna förmågan att förbli återhållsam.

The aim of this thesis is to find a method how to test the tools for an intervention with procrastination on social networks. The thesis tests and according to a built scale evaluates if there are people who are addicted to social networks. Further, the thesis introduces tools suitable for the intervention of this addiction and states distinct suggestions on how to perform a wider research to explore the most suitable tools. The thesis compares both the software tools centered on measuring, blocking, hiding and aiming, and psychological tools centered on how to work with oneself through calming down and mindfulness or creating a personal vision. The research is aimed at the PC and smart phones Android platforms. The outcome is a suggestion to investigate both tools individually described and their variable combinations during the intervention of the addiction to social networks to closely understand the effect of their using and practical implementation.