Community pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR=8.19; 95% CI=4.36–15.37), having high confidence in ability to discuss treatment facility options (aOR=4.16; 95% CI=2.65–6.52), having participated in prescription opioid abuse-specific continuing education (aOR=2.90; 95% CI=1.70–4.97), being male (aOR=2.23; 95% CI=1.38–3.59), and increased hours per week in the practice setting (aOR=1.02; 95% CI=1.004–1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.

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According to the regulations contained in the Social Services Act (SFS 2001:453), Swedish social services have a legal responsibility to provide support, care, and treatment for individuals with substance use problems.  This law mandate those who are responsible to provide treatment to motivate drug users to actively seek treatment on a voluntary basis, ensuring an end to their dependence on drugs. Studies have shown that although the treatment system largely focuses on promoting abstinence, about two-thirds of client’s relapse into substance use within one year after completing treatment. This dissertation focuses broadly on clients who repeatedly enter and use treatment for substance use disorders in the Swedish addiction treatment system. The aim of this thesis is to examine and identify the population groups who are repeated treatment users of the Swedish treatment system for substance use disorder, including both the voluntary treatment and compulsory care. This thesis was based on three national level databases. The results showed that clients with a higher degree of problems and problems in different areas of life also had an increased risk of having treatment for substance use disorder repeatedly. Clients who were older, men, reported more years of polydrug and alcohol use to intoxication, reported more compulsory care episodes for substance use, had ever been charged with crime, had ever been in inpatient mental health treatment, and had a higher ASI mental health symptom composite score, were significantly more likely to report more voluntary addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and drugs. Individuals who experienced prior compulsory care including mandatory treatment through LVU (law (1990:52)), been in prison, and had children mandated to out-of-home care, were more likely to have two or more entries in the compulsory care system for substance use disorder. In addition, this analysis showed that 59% of clients mandated to compulsory care dropped-out during their compulsory care episode, and that younger clients were significantly more likely to drop-out. Those who drop-out were significantly more likely to experience negative outcomes, i.e. additional sentence to compulsory care and higher risk of mortality.  A hierarchal logistic regression model also identified that individuals with riskier childhood conditions were more likely to have had repeated entries to compulsory care for substance use disorder. The indirect effects showed that a family history of substance use disorder and psychiatric problems are both associated with higher probability of institutional care as a child i.e. LVU, and that in turn, mandated childhood institutional care is related to repeated compulsory care intakes as an adult. Individuals who use treatment for substance use disorder repeatedly have a higher degree of problems i.e. an exposed and problematic group of individuals characterized by problem in several different areas of life. Growing up in a home environment with unfavorable conditions, mandated care before the age of 18 (LVU), compulsory care for substance use disorder as an adult, children taken into out-of-home care, and crime are the factors that are primarily associated with repeated treatment for substance use. A change in the view of treatment for clients in need of repeated use of treatment seems important, and access to adapted continuous care efforts are crucial to counteract the risk of relapse after a treatment episode of voluntary or compulsory care. Further, it seems important to motivate the client to complete the compulsory care without any deviation, since this seems to have positive effects on their substance use disorder.

SammanfattningTitel: Kompetens för tvångsvård vid missbruk - ett behandlingsassistentperspektiv Syftet med denna studie var ett försök för oss att belysa Behandlingsassistenternas uppfattning om kompetens inom missbruksvård under tvång. Vad upplever de för utmaningar kompetensmässigt i deras arbete och vilka kompetenser anser de saknas för en kvalitativ och adekvat vård. Detta är en kvalitativ studie där vi har genomfört fem semistrukturerade intervjuer med behandlingsassistenter inom tvångsvård för missbruk. Kompetensbegreppsperspektivet som teoretisk bakgrund har använts för analys av studiens empiriska data, i kombination med tidigare forskning kopplad till kompetens inom tvångsvård. Resultaten visar vikten av blandade grupper med olika sorters kompetens, såväl inom missbruk som inom psykiatri och kriminologi. En allmän uppfattning bland de Behandlingsassistenterna vi intervjuade är att de efterlyser bredare kompetens genom hela organisationen, såväl formell - som reell kompetens. Formell kompetens i form av utbildning inom ämnet samt reell kompetens så som arbetslivserfarenhet och livserfarenhet. Ett tidigare eget missbruk hos personal kan exempelvis vara en form av reell kompetens inom missbruksvården. Behandlingsassistenterna beskriver en organisation som är komplex och med varierande utmaningar där personlig mognad och livserfarenhet i kombination med formell utbildning behövs.Kompetens i denna studie är främst kopplat till behandling inom tvångsvård. Vi ville ta reda på hur de såg på sin egen kompetens, arbetsgruppens kompetens. med fokus på reell och formell kompetens i behandlingssituationer / Titel: Competency for involuntary commitment/compulsory care in addiction - from the perspective of a treatment assistant. The purpose of this study is to shed light on the treatment assistents' perception of competency within compulsory/involuntary addiction treatment. What challenges do they experience in their work and what competence do they view as missing for qualitative and adequate care. This is a qualitative study where we performed five semi-structured interviews with treatment assistants in involuntary treatment/compulsory care for addiction.The term competency perspective as a theory background has been used for analysis of the studies' empirical data in combination with earlier research regarding competency within involuntary treatment/compulsory care. The results show the importance of mixed groups with different kinds of competency both in substance abuse care as well as within psychiatry and criminology. A general perception among the treatment assistants we interviewed is the need for a broader competency throughout the whole organisation, both formal and real competence. Formal competence in the form of education and real competence in the form of work experience as well as life experience. A personal history of addiction could be an example of real competence within addiction care. The treatment assistants describe an organisation that is complex, with varied challenges where personal maturity and life experience combined with formal education is needed.Competency in this study is primarily connected to involuntary/compulsory addiction treatment. We wanted to find out how the treatment assistants viewed their own competency, that of the work group, with a focus on real and formal competency in treatment situations.

BACKGROUND. Substance use is a widespread phenomenon in prisons, with a numberous associated problems, for instance high incidence of infectious diseases, recidivism, poor physical and mental health and high costs of repressive measures, which still do not eradicate drug use in prison facilities. In 2016, the first addictologist was admitted to the prison system in Czechia. Two years later, 14 more table places were established. The thesis brings an overview at this period (2018 - 2021). AIMS. The aim of the thesis is to provide an information about starting and forming of specialized addiction services in prison seeting from the perspective of addictologists. The theoretical part of the thesis also presents the results of foreign research on the effectiveness of selected interventions and strategies and recommendations for good practice. RESEARCH QUESTIONS. The research questions address the experience of addictologists and are focused on four main areas: workplace formation, clientele, quality assurance and the impact of Covid-19 on the workplace. METHODS. To meet the aims, the method of semi-structured interviews with selected informants who entered prisons in 2018 was used along with document analysis. RESULTS. The experience of addictologists point out some problematic areas, for instance lack...

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Background: The effectiveness of exposure therapy in the treatment of addiction is a topic of discussion. The question remains whether movie exposure can be a meaningful intervention in regimen. A research project with a similar focus has not yet taken place in the Czech Republic, although the use of movies in addictology treatment is not new. Also, only a small number of similar studies can be found worldwide. Aims: The primary goal was to verify the possibilities of movie intervention as a supplement to the standard regimen treatment of addictions in the inpatient department of men of the Department of Addictology. Methodology: The diploma thesis is based on a qualitative research methodology supplemented by a questionnaire survey. Patients were selected by deliberate targeted selection. In addition to the general criteria for entering treatment, a cut-off of min. third week of treatment. The research group consisted of 22 patients with an average age of 39 years. The obtained data were analyzed mainly by means of content analysis of focus groups, based on the method of grounded theory. The research used 3 types of questionnaires focused on the current feelings of patients, appetite for addictive substances and evaluation of predefined problems that commonly occur in treatment. Results: The focus...

Little is known about the prevalence of substance use and abuse among individuals with intellectual disabilities. However, studies show that individuals with intellectual disabilities are at greater risk of developing substance abuse problems. Furthermore, traditional drug abuse treatment programs may be insufficient in order to tackle the individual needs of the users with intellectual disabilities. This study focuses on addiction counsellors, and aims to give insight into how they experience their work with individuals who are suffering from intellectual disabilities and substance abuse. In this study, qualitative interviews were conducted with five counsellors from two different municipal organizations. Subsequently, the analysis of the results has been categorized thematically, supported by Lipsky’s theory of street-level bureaucrats and Polanyi’s notion of tacit knowledge. The results suggest that the professionals are experiencing several challenges in their work with the target group. The lack of knowledge and insufficient national guidelines regarding the work with the target group, in combination with treatment methods that are not adapted to the needs and the abilities of people with intellectual disabilities, leave the professionals in a situation where their experiences and tacit knowledge is used to design and conduct the target group’s treatment.

The topic Needs of people addicted to drugs and alcohol to maintain succesful abstinence in aftercare was chosen. Aftercare is an important part of addiction treatment, but often overlooked and unused. The aim is to clarify the needs of abstinent persons addicted to alcohol and other non-alcohol drugs and their subsequent comparison. The thesis is divided into two parts, theoretical and practical. The theoretical part deals with the development of addiction, its diagnosis, description of drugs and treatments options. Chapters dealing with treatment are thoroughly discussed because of the individual usage during the treatment of addiction. Aftecare of addicted people and problems with relapse take place in this part of work. The second part deals with research focused on identifying the needs of addicted people to drugs and alcohol to maintain successful abstinence and their subsequent comparison. Clarifying of these needs can serve as a recommendation to other abstaining people or as a support to services in the system of aftercare to successful abstinence nowadays. KEYWORDS Addiction, addictive substances, drug addiction treatment, abstinence, relapse, aftercare for drug and alcohol rehab

Utifrån de teoretiska begreppen handlingsutrymme och paternalism undersöker studien handläggares hantering av gravida kvinnor med missbruksproblematik med fokus på samverkan och hänsyn till graviditet. Urvalet består av sex handläggare med erfarenhet av gravida klienter med missbruk. Hälften av intervjupersonerna arbetar i stadsdelsförvaltningar och kommuner i Stockholm medan den andra hälften arbetar i andra kommuner. Det empiriska materialet insamlades genom semi-strukturerade intervjuer med utgångspunkt i en vinjett. Därefter analyserades materialet utifrån en tematisk analys. Resultatet visar att handläggarnas hantering av klientgruppen varierar i stor utsträckning. Vissa handläggare anpassar insatserna på grund av klientens graviditet medan andra inte låter sig påverkas av det. Dessutom skiljer sig handläggarnas uppfattning kring vad som krävs för att tillämpa LVM när det gäller en gravid klient. Tidigare forskning visar att det är framgångsrikt att samla insatser för att tillgodose klientgruppens behov. Samtidigt visar studiens resultat att detta inte går att uppnå om det inte finns en god samverkan mellan kommun och region. Handläggarnas fokus på samverkan varierar vilket också påverkar klientgruppens möjlighet att få heltäckande behandling. / Based on the theoretical concepts of room for action and paternalism, the study examines caseworkers' handling of pregnant women with substance abuse problems with a focus on collaboration and consideration of pregnancy. The selection consists of six caseworkers with experience of pregnant clients with addiction. Half of the interviewees work in district administrations and municipalities in Stockholm, while the other half work in other municipalities. The empirical material was collected through semi-structured interviews based on a vignette. The material was then analyzed based on a thematic analysis. The results show that the case managers' handling of the client group varies to a large extent. Some caseworkers adapt the interventions due to the client's pregnancy, while others are not affected by it. In addition, case managers differ in their views on what is required to apply compulsory care when it comes to a pregnant client. Previous research shows that it is successful to gather efforts to meet the needs of the client group, the results of the study show that this cannot be achieved if there is no good cooperation between municipality and county council. The case managers' focus on collaboration varies, which also affects the client group's ability to receive comprehensive treatment.