Bakgrund: Sjuksköterskor i allmänt upplever det svårt att smärtlindra patienter eftersom smärta är en subjektiv företeelse. Sjuksköterskor belyser att det råder en brist på kunskap och riktlinjer vid hantering av smärtlindring. Sjuksköterskor som möter patienter med drogberoende som befinner sig i smärta anser att det är stressfullt och komplicerat. Detta på grund av att sjuksköterskorna upplevde det vara förenat med inre konflikter och moraliska dilemman. Syfte: Syftet var att beskriva patienters upplevelser av vårdpersonalens bemötande när patienterna upplever smärta som samtidigt är beroende av droger Metod: En litteraturöversikt baserad på tio vårdvetenskapliga artiklar gjordes. Artiklarna har analyserats enligt Fribergs (2012) analysmetod där författarna sökte efter likheter och skillnader av ett fenomen som sedan skapade resultatets teman. Resultat: Resultatet presenteras i två huvudteman. I det första temat: Hinder i vårdpersonalens bemötande uppkom det fem subteman. I dessa subteman beskrivs det om hur patienter upplever ett negativt bemötande ifrån vårdpersonalen. I det andra huvudtemat: Förutsättningar för bemötandet uppkom ett subtema. Det subtemat beskriver hur patienter med ett drogberoende upplever en god vårdrelation och hur den skapas. Diskussion: Författarna har diskuterat resultatets huvudfynd i förhållande till litteraturöversiktens bakgrund, författarnas synpunkter samt med Katie Erikssons caritativa teori som referensram. / Background: Nurses in general find it difficult to provide patients with pain relief because pain is a subjective phenomenon. Nurses emphasize that there is a lack of knowledge and guidelines for the handling of pain. Nurses who encounter drug dependent patients in pain find it to be stressful and complicated. The reason for this is that the nurses felt that it was fraught with their own inner conflicts and moral dilemmas. Aim: The aim of this study was to describe patient experiences of health care professionals treatment when the patient experiences pain and when they are at the same time addicted to drugs. Method: A literature review based on ten scientific articles was made. The articles was analysed with Fribergs (2012) method where the authors searched for similarities and differences out of a phenomenon that created the results themes. Results: The results of this litterature review are presented in two main themes. In the first main theme – Obstruct in the health care professionals treatment the authors could find five sub themes. These sub themes highlights how patients experience negative treatment from the health care professionals. In the second main theme: Preconditions in the treatment the authors could find one sub theme. This sub theme highlights how patients with drug addiction experience a caring relationship and how it can evolve. Discussion: The authors have discussed the results main findings in relation to the literature review background, the authors aspects and with Katie Erikssons “caritative” theory used as a theoretical framework

De nos jours la consommation de drogue est un phénomène sanitaire, mental et social. Cependant elle a existé de tout temps. L'usage des drogues licites et illicites chez les adolescents a connu une progression notable au cours des dernières décennies, au point que la drogue est devenue un problème sérieux sur la santé physique, psychologique et sociale. Ce qui reste le plus considérable réside dans l'augmentation du nombre des toxicomanes, et la décroissance de l’âge de la première consommation, ce qui est toujours inquiétant pour les familles et les responsableschargés de la prise en charge des adolescents. La famille est le premier environnement culturel pour les enfants. D'autres institutions sociales ont eu à jouer ce rôle, mais aucune n'a pu entreprendre parfaitement la tâche de façon efficace. Étant donné qu'une société saine dépend de l'équilibre et de la santé des familles, en vérité l'origine, ou la source, de la déviance et de la délinquance sociale se trouvent à l'intérieur de la cellule familiale. [etc.] / The consumption of drugs is the phenomenon of health, mental and social development of our days has obviously always existed. The use of licit and illicit drugs among youths has been a notable increase in recent decades that it is a serious problem on the physical, psychological and social healthy. The increase of the numbers of addicts and the declining age of them, which is always worrisome to families and responsible are very significant. The family is the first cultural environment for children. Despite the time it attributes much of his duties to the other social institutions, but any institutions could not undertake these functions perfectly. Whereas the health of society is dependent on family health, and indeed the originalsource of many of the social deviance and delinquency are within this social unit. [etc.]

This creative nonfiction dissertation is a memoir that probes the complex life and death of the author’s father, who became addicted in his late forties to crack cocaine. While the primary concerns are the reasons and ways in which the father changed from a family man into a drug addict, the memoir is also concerned with themes of family life, childhood, and grief. After his father’s death, the author moves to Las Vegas and experiences similar addiction issues, which he then explores to help shed light on his father’s problems. To enrich the investigation, the author draws from eclectic sources, including news articles, literature, mythology, sociology, religion, music, TV, interviews, and inherited objects from his father. In dissecting the life of his father, the author simultaneously examines broader issues surrounding modern fatherhood, such as cultural expectations, as well as the problems of emptiness, isolation, and spiritual deficiency.

Today, more Americans die each year because of drug overdoses than are killed in motor vehicle accidents. In fact, in 2015, more than 33,000 individuals died due to an overdose of heroin or prescription opioids. Sadly, 40-60 % of patients on current opioid addiction treatment medications relapse. Studies have shown that the addiction/abuse liability of opioids are abolished in mu opioid receptor (MOR) knock-out mice; this indicates that the addiction and abuse liability of opioids are mainly mediated through MOR. Utilizing the “message-address concept”, the our laboratory reported a novel non-peptide, reversible MOR selective ligand 17-cyclopropylmethyl-3,14β-dihydroxy-4,5α-epoxy-6α (isoquinoline-3-carboxamido)morphinan (NAQ). Molecular modeling and mutagenesis studies revealed that the selectivity of NAQ for MOR is because of the π-π stacking of the isoquinoline ring of NAQ with W318. Therefore, other heterocyclic ring systems were explored to obtain a diverse library of compounds with similar or different molecular interactions and pharmacologic characteristics as NAQ. The newly designed compounds were indole analogs of 6α/β-naltrexamine. The compounds were synthesized and the affinity and selectivity for MOR determined using the radioligand binding assay while the functional activity at MOR was determined using the [35S]GTPγS binding assay. The indole analog of 6α-naltrexamine substituted at position 7 (compound 6) was found to be very potent and had the lowest efficacy in the [35S]GTPγS functional assay while the indole analog of 6β-naltrexamine substituted at position 2 (compound 10) was identified as a MOR agonist and had the greatest efficacy. In vivo studies were conducted using the warm-water immersion assay to find whether the synthesized compounds had antinociceptive effects and/or blocked the antinociceptive effects of morphine. Not surprisingly, compound 10 was identified as an opioid agonist while compound 6 almost completely blocked morphine’s antinociceptive effects. The opioid antagonist effect of compound 6 was found to be dose dependent with an AD50 of 2.39 mg/kg (0.46-12.47). An opioid withdrawal assay was conducted on compound 6 using morphine-pelleted mice. Compound 6 produced significantly less withdrawal symptoms at 50 mg/kg than naltrexone at 1 mg/kg. Therefore, compound 6 has the potential to be used in opioid addiction and withdrawal treatment.

In this review I examine the clinical uses of psychedelics as an adjunct to psychotherapy to treat three major mental health disorders; Major Depressive Disorder (MDD), Post Traumatic Stress Disorder (PTSD) and Addiction (Substance Use Disorder). I assess the hallucinogen treatment model's efficacy in treating chronic mental health disorders that have been unresponsive to legal and traditional psychiatric treatment. I review the earlier studies conducted with psychedelics and discuss the more recent ones. This review may be helpful to therapists and clinicians who would like to further their understanding of psychedelic therapy.

This study examined the attitude, academic preparation, and practice competence of social workers in relation to substance use disorder in the state of Georgia. Three hundred and one (301) survey participants responded to the study for which they were selected, utilizing non probability convenience sampling. The survey participants were composed of bachelor-, master-, and doctoral-level students and professionals who currently live in the state of Georgia. The survey questionnaire titled A Study of Social Workers in Relation to Substance Use Disorders consisted of 35 closed-ended questions. The findings of the study indicated that although there was a statistically significant difference in the attitude of BSW, MSW, and DSW/PhD social workers overall, there was no statistically significant difference found with regard to academic preparation or practice competence.

Socialarbetare använder sig av flera typer av kunskap för att hantera komplexiteten av deras arbete, en del får man via utbildning men en del behöver förkroppsligas utifrån ett eget utforskande. Syftet med denna studie var att undersöka hur fronesis kommer till uttryck bland socialarbetare som jobbar med ungdomar med missbruksproblematik. Med inspiration från hermeneutik har i denna studie utforskat hur socialarbetare översätter deras tidigare erfarenheter till praxis. Empirin består av sex intervjuer med praktiserande socialarbetare som har flera års erfarenhet i behandlande arbete med ungdomar. Datat analyserades utifrån fronesis teori vilket är uppbyggd ur tre subkategorier: praktisk handling, moralen och personlig utveckling. Fronesis i denna studie är förmågan att anpassa sig till sammanhanget hos en situation och förmågan att handla i enlighet med en målsättning. Resultatet visar att subkategorierna gick att identifiera hos informanternas utsagor samt hade påverkan på varandra. Analysen visar att behandlarens målsättning kunde påverka både arbete samt möjligheter till vidare utveckling. / Social workers use several types of knowledge to get about in their complex work, some of which is given through education but some you have to embody on your own. The aim of this study is to use phronesis as a theory and see if this theory can explain some of the nature behind social workers experience-based knowledge. Using an approach inspired by hermeneutics this study aimed to explore how social workers translate their experience into praxis. The data consists of six interviews with practicing social workers with several years of experience in caring work with adolescents. The material was analyzed with phronesis theory which is built up by three subcategories¨: practical action, morals and personal development. Phronesis in this study is the ability to adapt to the context of the situation and the ability work towards a goal. The results show that the subcategories were identifiable in the data and had an influence on one another. Analysis shows that one’s goals could have effect on work and possibilities for further growth.

Studien syftar till att utifrån ett brukarperspektiv belysa hur stort inflytande brukare inom den kommunala missbruksvården har på sin egen vård. Brukare avses i detta fall personer som har och har haft en kontakt med missbruks- och beroendevården över tid. För att besvara studiens syfte har fem brukare intervjuats. Studiens data har sedan analyserats med hjälp av maktteori. Studien visar att upplevelsen av inflytande påverkar vården och att den kan variera hos brukarna beroende på vilka egenskaper de själva besitter, de professionella besitter och hur relationen dem emellan utvecklas. Samtliga brukare i studien upplevde att de befann sig i ett underläge i maktförhållandet gentemot de professionella. För att känslan av inflytande skulle vara stark hos brukarna krävdes det att de professionella hade en förmåga att förhålla sig till och i viss mån reducera obalansen i maktförhållandet. Att brukarna kände att de hade makten att påverka vården samt att de blev lyssnade på var centralt för att en känsla av inflytande skulle infinna sig. Om detta inte var närvarande i relationen med de professionella infann sig istället en känsla av maktlöshet och begränsat inflytande. / This study aims to explore what client’s connected to their local council’s alcohol and substance abuse treatment thinks matter for their own care. The aim of exploration concretized to involve clients influence over their own care.  Clients in this case are referred to people who have and have had a contact with the alcohol and substance abuse treatment over time. To respond to the study's purpose five clients has been interviewed. The data were then analyzed by using a theory of power. The study shows that the client´s experience of influence matters and may vary depending on the characteristics the clients themselves possess, the professional possess and how the relationship between them evolves. All clients in the study felt that they were in a lower position of power compared to the professionals. To create a strong feeling of influence within the clients the professional had to have an ability to relate to and, to a certain extent reduce the imbalances in power relations. To create a feeling of influence within the clients they had to feel that they had the power to affect the care and that they were listened to. If this was not present in the relationship with the professionals, a sense of powerlessness and limited influence appeared instead.

<p>Opioid drug abuse represents a serious public health concern with few effective therapeutic strategies. A primary goal for researchers modeling substance abuse disorders has been the delineation of the biological and environmental factors that shape an individual’s susceptibility or resistance to the reinforcing properties of abused substances. Early-life environmental conditions are frequently implicated as critical mediators for later-life health outcomes, although the cellular and molecular mechanisms that underlie these effects have historically been challenging to identify. Previous work has shown that a neonatal handling procedure in rats (which promotes enriched maternal care) attenuates morphine conditioning, reduces morphine-induced glial activation in the nucleus accumbens (NAc), and increases microglial expression of the anti-inflammatory cytokine interleukin-10 (IL-10). The experiments described in this dissertation were thus designed to address if inflammatory signaling in the NAc may underlie the effects of early-life experience on later-life opioid drug-taking. The results demonstrate that neonatal handling attenuates intravenous self-administration of the opioid remifentanil in a drug concentration-dependent manner. Transcriptional profiling of the NAc reveals a suppression of pro-inflammatory cytokine and chemokine signaling molecules and an increase in anti-inflammatory IL-10 in handled rats following repeated exposure to remifentanil. To directly test the hypothesis that anti-inflammatory signaling can alter drug-taking behavior, bilateral intracranial injections of plasmid DNA encoding IL-10 (pDNA-IL-10) or control pDNA were delivered into the NAc of naïve rats. pDNA-IL-10 treatment reduces remifentanil self-administration in a drug concentration-dependent manner, similar to the previous observations in handled rats. Additional experiments confirmed that neither handling nor pDNA-IL-10 treatment alters operant responding for food or sucrose rewards. These results help define the conditions under which ventral striatal neuroimmune signaling may influence motivated behaviors for highly reinforcing opioid drugs.</p> / Dissertation

Chaque année, de nombreux programmes de prévention des dépendances sont implantés dans les écoles québécoises. L'efficacité de ces programmes peut être minée par différents facteurs, dont le manque d’adaptation du programme aux caractéristiques de la population ciblée (Grover, 2010; Grover, Cram et Bowman, 2007; McKennitt, 2007) et les problèmes d'implantation (Janosz, 2010; Joly, Tourigny et Thibaudeau, 2005). Ainsi, un programme probant pourrait s'avérer peu efficace s’il est mal adapté ou mal implanté (Botvin, Baker, Dusenbury, Tortu et Botvin, 1990; Chen, 2015; Dumas, Lynch, Laughlin, Smith et Prinz, 2001; Dusenbury, Brannigan, Falco et Hansen, 2003; Janosz, 2010; Rohrbach, Graham et Hansen, 1993; Rossi, Lipsey et Freeman, 2004) ou encore créer des effets iatrogènes chez la population ciblée (Botvin et Griffin, 2007; Craplet, 2006; Sohn, 2000; Werch et Owen, 2002). Au Québec, si l’étude de l'adaptation et de l’implantation des programmes de prévention en milieu scolaire apparait limitée pour la population générale (Janosz, 2010; Roberge, Choinière et Laverdure, 2009), elle semble absente chez la population autochtone. Or, dans certaines communautés autochtones québécoises, des taux élevés de consommation de psychotropes sont rapportés, sans compter que l'initiation à l’alcool et aux drogues survient à un âge précoce (Cotton et Laventure, 2013; Pronovost, Plourde, Alain, Eveno et Laperrière, 2009). Les particularités culturelles et la dispersion géographique de certaines communautés d'une même Nation peuvent complexifier l'implantation des programmes (Dell et al., 2012; Grover, 2010; Grover et al., 2007; McKennitt, 2007; Whitbeck, Walls et Welch, 2012). Pour offrir des programmes de prévention qui répondent aux besoins des jeunes autochtones, leur adaptation et l’évaluation de leur implantation apparaissent alors essentielles (Kumpfer, Pinyuchon, de Melo et Henry, 2008; McKleroy et al., 2006; Ringwalt et Bliss, 2006; Wingood et DiClemente, 2008). Cette thèse par articles a pour but d’expérimenter l'adaptation culturelle d'un programme de prévention. À cette fin, le premier article vise à identifier les facteurs facilitant ou entravant l’implantation initiale d’un programme de prévention des dépendances (Système d) chez les élèves innus du Québec d'âge scolaire primaire. Le second article vise à illustrer le processus d’adaptation de ce même programme, puis à vérifier la fidélité de son implantation en ce qui a trait à l'adhérence au contenu. Cette thèse comporte un devis de recherche mixte incorporé. Dans le volet qualitatif, différents répondants ont été rencontrés afin de documenter leur satisfaction et d’identifier les facteurs ayant facilité et entravé l'implantation: les animateurs du programme (n=6), les intervenants scolaires (n=2), les enseignants (n=2), la direction de l'école (n=1) et les parents des élèves ayant participé à la version initiale du programme (n=9). Dans le volet quantitatif, des journaux de bord ont permis de compléter l'identification des facteurs, en plus de mesurer l'adhérence au contenu de la version initiale du programme puis de sa version adaptée. Les résultats obtenus ont permis d’identifier différents facteurs entravant l'implantation du programme (manque de disponibilité des membres du personnel scolaire, complexité de certains concepts). D’autres facteurs ont toutefois facilité l’implantation du programme (adaptation en cours d’animation, capacité de résolution de problèmes des animateurs et des enseignants). Si certains de ces facteurs (formation au programme, aptitudes des personnes qui implantent) sont également observés en milieu scolaire non autochtone, d'autres facteurs (implication de membres du Conseil de bande, barrières de la langue et de la culture) apparaissent plus spécifiques au contexte communautaire autochtone. L’identification de ces facteurs, bien qu'elle ne concerne qu'une communauté autochtone, pourrait être transposée à d’autres communautés afin optimiser l’implantation et l'adaptation des programmes de prévention dans leurs écoles. Les principales adaptations apportées au programme Système d concernent la restructuration du protocole d'intervention (réduction de la durée des ateliers, ajout d'un cinquième atelier ainsi que d'un volet communautaire), la diversification des méthodes pédagogiques utilisées et l’intégration de références culturelles autochtones dans le contenu du programme. Il semble toutefois que l'adaptation du programme, bien que nécessaire pour correspondre à la réalité des élèves innus, se soit avérée insuffisante pour augmenter l'adhérence à son contenu. L'ensemble des résultats obtenus dans cette thèse permet de sensibiliser les différents praticiens des milieux scolaires autochtones, dont les psychoéducateurs, sur l'importance de sélectionner, implanter et adapter avec soin des programmes afin de prévenir adéquatement les dépendances auprès des jeunes autochtones.