Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Objectives: (1) To examine whether homelessness predicted earlier resumption of substance use after inpatient detoxification; and (2) to seek evidence concerning the impact of post-detoxification stabilization programs on homeless and housed persons in relation to recurrent substance use. Data Sources/Study Setting: Prospective six-month cohort of 470 addicted persons entering a publicly-funded urban detoxification program. Study Design: Survival analysis methods were used to determine the association between homelessness, stabilization program use, and time to recurrent substance use. Data Collection/Extraction Methods: The main analyses rely on baseline and six month interviews using standardized instruments. Additional analyses include interviews obtained after six months, and statewide administrative records of recurrent detoxification. Principal Findings: Among 254 persons available at six months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the greatest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88,1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40,0.94). A similar impact of stabilization programs was not seen among housed subjects. Analyses suggest that subjects available at six months were representative of the entire cohort. Conclusions: Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. / 2999-01-01

Yes / Flow experience has been widely investigated in experiential activities such as sports, the performing arts, gaming and Internet usage. Most studies focus on the positive aspects of flow experience and its effect on performance. In stark contrast, gambling research focusing on the negative side of addiction lacks an in-depth investigation of gamblers’ (positive) flow encounters. This separation of research lines seems out of place given that recent research indicates connections between flow and addiction. Joining both constructs in a causal effects model helps to gain a better understanding of their relationship and its contingencies. This paper empirically investigates whether and how it is possible to observe a “Janus face” of flow with its various sub-dimensions in online gambling. Empirical data was collected from 500 online gamblers by applying a structured questionnaire with established scales. The data was analyzed with a confirmatory factor analysis and a double-hurdle model to separate casual gamblers who are unsusceptible to any addiction issues from gamblers affected by initiatory addiction issues. The findings indicate that online gambling addiction is negatively influenced by two sub-dimensions of flow experience, namely a sense of control and concentration on the task at hand, while enhanced by a transformation of time and autotelic experience.

No / Recent research addressing the use of music to support the needs of people receiving treatment for drug addiction has led to the development and implementation of music-assisted therapeutic interventions. We hypothesized that two different music modalities combined with systematic desensitization can counter-condition drug-related cues and significantly reduce the associated craving responses. We further examined the effect of the two treatments on cognitive and psychopathological components of addiction. Twenty-four individuals experiencing drug addiction were randomly assigned to one of the three study groups, namely systematic desensitization (SD) combined with listening to New Age meditation music improvised live on Tibetan bowls (IMT), systematic desensitization combined with listening to relaxing New Age music recorded in individual MP3 devices (NIMT), or a control group that received no additional therapeutic intervention (CTR). Participants in the two treatment groups received six sessions in addition to their standard treatment during a period of three weeks. Evaluation took place at baseline, post-treatment and one month after the end of treatment. Results showed that IMT and NIMT combined with SD significantly reduced craving in response to external drug-conditioned cues, while IMT appeared to be slightly more effective than NIMT in altering permissive thoughts on drug and alcohol use, depression symptoms and everyday life craving reactivity. Further investigation as to the role of music-assisted systematic desensitization as a therapeutic intervention for drug addiction treatment is warranted. / Grant from Grundtvig Education and Culture Lifelong Learning Program (agreement contract number 2013-1-FR1-GRU11-50690).

Resting-state functional MRI(rs-fMRI) represents a powerful means to assess brain functional connectivity in healthy subjects and in neuropsychiatric patients. Aberrant functional connectivity has been observed in subjects affected by Alcohol Use Disorders (AUD) and other forms of substance dependence, a major health issue worldwide with limited treatment options. Despite intense investigation, the specific neuronal substrates involved and the functional implications of aberrant connectivity in these patients remain unknown. Moreover, it is unclear whether treatment can reverse these alterations, and normalize functional connectivity. Several methodological and conceptual questions in the analysis of functional connectivity are still open, and contribute to this uncertainty. Functional connectivity is defined in terms of correlated MR-signal fluctuations, and in-scanner patient motion and other nuisance signals can introduce spurious correlations, thus representing substantial confounding factors. At a more general level, understanding the effects of complex conditions, like AUD, on brain connectivity and their functional implications requires a deep comprehension of the brain organizational principles at multiple scales, a tremendous challenge that is at the heart of modern neuroscience. In this PhD dissertation I address some of the outstanding questions in the analysis and interpretation of aberrant functional connectivity in AUD. To this end, I have embraced the formalism of graph-theory, a powerful framework to assess the effects of alcohol abuse on the local and global topological organization of resting state connectivity. On the methodological side, I have investigated the effects of subject’s motion on the structure of resting state networks, and compared efficacy of different approaches to remove motion-related confounds. Moreover, I demonstrate the importance of network sparsification to remove spurious connections from the graph while maximizing the structural information that can be extracted from the system. Leveraging these methodological developments, I have evaluated functional alterations in different samples of AUD patients. In two independent studies, I demonstrated specific alterations in the topological organization of the insular cortex and subcortical basal structures in recently detoxified alcoholics. Interestingly, protracted abstinence appears to partially normalize functional connectivity, thus suggesting that alcohol-induced alterations in connectivity may be amenable to treatment. Based on these findings, I have studied the effects on brain functional networks of a putative novel treatment based on deep Transcranial Magnetic Stimulation (TMS). Specifically, I analyzed resting state connectivity in AUD patients subjected to repetitive TMS of the bilateral insula and of the anterior cingulate cortex (ACC), and demonstrated treatment-induced changes that may underlie the efficacy of this potential treatment in surrogate clinical read-outs.

The reinforcing properties of nicotine depend partly on cholinergic projections from the pedunculopontine tegmental (PPTg) and laterodorsal tegmental (LDTg) nuclei to midbrain dopamine neurons in the ventral tegmental area (VTA) and substantia nigra pars compacta (SNc). Neuronal activation was investigated using Fos expression in these areas following acute (0, 0.1, 0.4, 0.8mg/kg) or chronic systemic nicotine (0, 0.1, 0.4, 0.8, 1.0mg/kg given once per day for 5 days). We also examined co-localization of Fos expression in bNOS and TH positive neurons to determine what populations of neurons were activated by nicotine. Acute nicotine resulted in dose related Fos expression, with the biggest increase seen after 0.4mg/kg nicotine, but no co-localization occurred with bNOS in the PPTg/LDTg. Surprisingly, nicotine also failed to activate midbrain dopamine neurons. After animals were sensitized to nicotine there was a similar dose response curve in Fos expression, but the biggest increase was seen after 0.8mg/kg nicotine. Chronic nicotine, like acute, also preferentially activated non-cholinergic neurons in the LDTg and PPTg and non-dopamine neurons in the SNc and VTA. Further experiments looked at the mechanisms of Fos expression after nicotine administration. Fos expression in the LDTg/PPTg and SNc/VTA was suppressed after d-amphetamine, despite an increase in locomotor activity, suggesting that the increased Fos expression after chronic nicotine was not simply due to the locomotor activating effects of sensitized nicotine. Blocking autoreceptors in the dopaminergic midbrain by haloperidol pre-treatment did not increase Fos expression in dopamine neurons indicating that the inhibitory mechanism was not dependent on local autoreceptors. Novel methods of visualising and lesioning GABA neurons in the mesopontine tegmentum and midbrain were also examined. The data suggest that the mechanisms by which dopamine is involved in the pharmacological actions of passively administered nicotine are more complex than was first thought and that the role of non-dopamine neurons in the VTA (possibly GABA or glutamate containing) are also important.

This study aimed to identify the type, extent, and predictors of civic and political participation among addiction professionals. A sample of 633 addiction professionals participated in an online survey using the Citizen Participation Study’s survey instrument. Twenty-two political activities were measured as well as three predictors of political participation: resources, psychological engagement, and recruitment networks. Political participation and predictors of participation were analyzed for the full sample and compared among subgroups--social workers vs. those who were not social workers; those who reported they were recovering from alcohol and other drug (AOD) addiction vs. those who were not recovering; and those who held a professional addiction certification vs. those who were not certified and those who were certified plus held other professional credentials. The mean political participation index for participants who were not certified was significantly lower than for participants with a certification and those with a certification plus other professional credentials. No significant difference was noted in the mean political participation index for recovering participants and those not recovering from AOD addiction; and social workers and participants who were not social workers. Hierarchical multiple regression was used to assess the influence of resources, psychological engagement, and recruitment networks on political participation while controlling for recovery status, professional credentials, age, race, and gender. Resources, psychological engagement, and recruitment networks were all significant predictors of political participation. Recruitment networks was the strongest predictor for the full sample and for subgroups who were not social workers, certified, not certified, certified with other professional credentials, and not recovering from AOD addiction. Psychological engagement was the strongest predictor of political participation among individuals recovering from AOD addiction and social workers. However, the validation analysis did not replicate the findings for social workers, those not recovering from AOD addiction, and those who were certified. The significant role of recruitment networks in political participation has important implications for social workers and others interested in mobilizing addiction professionals for political participation. Recommendations for further research include the need to develop valid and reliable measures of political participation that capture civic activities and the use of technology. / text

Syftet med studien var att få fram personliga betraktelser av olika kategorier kopplat till intag av narkotika, alkohol och receptbelagda mediciner av personer med egenupplevda erfarenheter. Kategorierna missbruk och självmedicinering står i fokus men det lämnas även plats för andra kategoriseringar av intag. Detta för att undersöka hur kategoriseringar kan påverka behandlingsarbete. Sex personer intervjuas om deras upplevelser av narkotika- och alkoholintag samt hur de ser på olika kategoriseringar inom detta område. Det undersöks hur intervjupersonerna definierar sitt intag eller före detta intag av alkohol och narkotika samt hur denna kategorisering har kommit till. Studien är kvalitativ och har sex semistrukturerade intervjuer som underlag för resultatet. Studien börjar med en genomgång av olika begreppsdefinitioner gällande missbruk samt en genomgång av narkotikastrafflagen. Därefter redovisas forskning som tar upp attityder angående missbruk ur professionella behandlares perspektiv. I teoridelen tas tre teorier upp, Culture in action-teorin, självmedicinerings-hypotesen och stämplingsteorin. Resultatet visar respondenternas egna berättelser vilket är empirin som vår analys bygger på. Analysen görs ihop med de teorier som redovisats. Resultatet visar att många upplever självmedicinering som ett relevant begrepp och att den hårda kategoriseringen av missbrukare påverkar de stämplade starkt. Kategoriseringen av intag ser olika ut beroende på i vilket livsstadie personen befinner sig. Något som också spelar stor roll är i hur stor utsträckning intaget tagit över personens liv. Det framkom tankar om att den hårda kategoriseringen inom behandlingar upplevs som nedtryckande och stämplande. En mer individanpassad missbruksvård var önskad. Det framkom även vissa paralleller mellan respondenterna och självmedicinerings hypotes. / The purpose of this study was to reach personal views on categorization of the intake of natcotics, alcohol and prescription drugs by people with personal experiences on the subject. The categories drug abuse and self medication where the core categories but there where room for other categorization of intake. The purpose was to see how categorization can affect addiction treatment. Six persons where interviewed on their experiences of drugs and alcohol and their views on the categorization of these topics. The persons tell how they define their intake (or former intake) of drugs or alcohol and how this categorization came to be. This is a qualitative study the result is based on six semi structured interviews. It starts with a review on different definitions of addiction and the Swedish drug laws. Thereafter there is a presentation on research about the attitudes of professional addict treaters. The study contains three theories. The culture in action theory, the self-medication hypothesis and the labeling theory. The result shows the respondents own testimony witch is the foundation the analysis rests upon. The analysis is done together with the mentioned theories. The result shows that most respondents see self medication as a valid concept and that the harsh categorization in addict treatment has an impact on those facing it. The categorization of intake differs depending on the life situation of the person that does the categorization. Another important aspect is how much the intake is ruling the intakers life. The harsh categorization in addict treatment is seen as suppressive and labeling. A more individualized addict treatment where wanted. The study shows some parallels with the self-medication hypothesis.

Husitská teologická fakulta Univerzita Karlova v Praze Thesis Analysis of usage personal Computers and smart Phones by Adolescents Praha 2015 Mgr. Michaela Klimešová Annotation This thesis strives to grasp pitfalls of overuse of multimedia technologies by children of elementary and secondary schools in Czech Republic. The practical part is based on quantitative questionnaire and its statistical evaluation in program R. Key words Game addition, non-substance addiction, behavioral addiction, leisure time, school results Resumé The questionnaire in this thesis has around 30 questions regarding time of school children spent on digital devices - PC's, smart phones, etc. Further shortly DD. The data set has 156 children from last years of elementary schools and 157 children from first years of high schools (so called gymnázium in Czech Republic). The results consistently show that the more time a child spends on digital devices the worse has grades in mathematics and Czech language (the two main subjects). So the naive expectations of parents - the more PC, the more knowledge - is utterly misleading. The questionnaire cannot measure negative impact of time on DD up to two hours a day. There are some sex specific differences. Boys significantly prefer to play games. Girls prefer social networks. Boys has bigger...

L’addiction à Internet a fait l’objet de nombreuses études à travers le monde durant les vingt dernières années. Pourtant aucun consensus au sujet de sa définition ou de ses critères diagnostiques n’a encore été admis, soulevant ainsi de nombreux débats. Ce travail a pour objectif d’étudier la conceptualisation de l’addiction à Internet principalement au travers de ses outils d’évaluation, et de combler un manque de données empiriques au sein d’échantillons français.Étude 1 – Objectif : Déterminer le nombre d’outils de mesure de l’addiction à Internet et mettre en avant leurs qualités psychométriques. Résultats : Quarante-cinq outils mesurant l’addiction à Internet ont été identifiés dont seulement dix-sept ayant été évalués plus d’une fois en termes de propriétés psychométriques. La plupart des échelles existantes nécessitent de plus amples travaux de validation. Bien que critiqué, l’Internet Addiction Test (IAT) est l’échelle présentant le plus de supports empiriques. Cependant, de nombreuses échelles prometteuses requièrent un examen plus approfondi. Étude 2 – Objectif : Évaluer les qualités psychométriques de l’Online Cognition Scale (OCS). Résultats : Les analyses factorielles de l’OCS suggéraient un meilleur ajustement du modèle avec une solution à 5 facteurs (27 items), comparé au modèle original (36 items). Nos résultats mettent en avant une excellente consistance interne et des corrélations inter items et test-retest satisfaisantes. Les scores de l’OCS étaient significativement corrélés avec ceux de l’IAT, du temps passé en ligne et des symptômes dépressifs au cours des deux passations. Étude 3 – Objectifs : Évaluer les qualités psychométriques de la Generalized Problematic Internet Use Scale-2 et la pertinence du modèle d’Utilisation Problématique Généralisée d’Internet (UPGI) au sein d’étudiants français. Résultats : Les résultats de la modélisation en équations structurelles soutiennent ce modèle conceptuel de l’addiction à Internet, et un bon ajustement du modèle aux données. Les qualités psychométriques de la version française de la GPIUS-2 étaient satisfaisantes, notamment la fiabilité, et les validités convergente et concurrente, confirmant l’utilité de cet outil multidimensionnel. Étude 4 – Objectif : Explorer la relation entre l’UPGI et les Utilisations Problématiques Spécifiques d’Internet (UPSI). Résultats : Nos analyses mettent avant des relations significatives entre l’UPGI, les symptômes psychopathologiques et la plupart des UPSI, avec de nombreuses différences en fonction du genre et de l’âge. Alors que les scores d’UPSIcommunication prédisaient ceux d’UPGI chez l’ensemble des participants, ceux d’UPSIrecherche d’informations et jeux en ligne, ainsi que les symptômes dépressifs n’étaient significatifs que chez les femmes, les hommes et les jeunes adultes, et l’UPSIconsommation de vidéo/musique et le temps passé en ligne uniquement chez les femmes et les jeunes adultes. / Internet addiction has been the subject of numerous studies worldwide, during the last twenty years. Yet, no consensus on its definition or diagnosis criteria has been admitted, which therefore is triggering numerous debates. The present research aims to study the conceptualization of Internet addiction mainly through its assessment tools, and to fill in the lack of empirical data among French samples.Study 1 - Aim: To assess the measurement tools for Internet addiction and their psychometric properties. Results: Forty-five tools assessing Internet addiction were identified, of which only seventeen had been evaluated more than once in terms of their psychometric properties. Most of the existing scales for Internet addiction require further validation work. Despite criticism, the Internet Addiction Test (IAT) appears to be the scale with the most empirical support. However, numerous promising scales warrant further examination.Study 2 - Aim: To evaluate the psychometric properties of the Online Cognition Scale (OCS). Results: Confirmatory factorial analyses showed that the 4-factor solution did not demonstrate satisfactory fit but the 5-factor model was found to better fit the data. Our results revealed that the scale scores demonstrated excellent internal consistency and satisfying inter-item correlation and test-retest reliability. The OCS was significantly correlated with the IAT, time spent online and depressive symptoms at both time points.Study 3 - Aim: To evaluate the psychometric properties of the Generalized Problematic Internet Use Scale-2 and the relevance of the Generalized Problematic Internet Use (GPIU) model among French users. Results: Path analysis provided support for this conceptual model of problematic Internet use, and a good fit to the data. The psychometric properties of the French version of the GPIUS-2 were satisfying, including reliability, concurrent and convergent validities, suggesting the usefulness of this multidimensional tool.Study 4 - Aim: To explore the relationship between GPIU and Specific Problematic Internet Uses (SPIU) Results: Our analysis revealed significant relationships between GPIU, psychopathological symptoms and most of SPIU, with many differences according to gender and age. SPIUcommunication scores significantly predict GPIU scores among the whole sample, whereas SPIUinformation seeking and gaming, and depressive symptoms were only significant among women, men and young adults, and SPIUconsumption of video/music and time spent online, among women and young adults.

Résumé confidentiel / Confidential abstract