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Drug Consumption Rooms (DCRs), where injecting drug users (IDUs) can use pre-obtained drugs in a hygienic and professionally supervised low threshold setting, aim to engage high risk IDUs, reduce public drug use, injecting-related morbidity and mortality, and improve access to drug treatment. This thesis evaluates the service demand, accessibility, utilisation, and coverage of Australia???s first DCR, the Sydney Medically Supervised Injecting Centre (MSIC), located in an area with a history of illegal shooting gallery operation. MSIC impact on injecting practices and injecting related health, and referral to drug treatment were also examined. Methods included cross-sectional IDU surveys, key informant interviews, staff focus groups, analysis of client registration and surveillance data and routinely collected data on needles and syringes - including multiple indirect prevalence estimation, and prospective follow-up of MSIC referrals. Shooting gallery users expressed demand for and willingness to use the MSIC. Injecting episodes previously occurring in shooting galleries appear to have been transferred to the MSIC, although shooting galleries continued to operate at a reduced level. The MSIC service model was accessible, with few refusals of entry, high levels of client satisfaction and limited non-use for reasons relating to the model. MSIC engaged high risk IDUs - regular injectors, sex workers, and those injecting in public places and shooting galleries - who were also more likely to be frequent attendees. MSIC clients were more likely than other IDUs to inject in public places and shooting galleries, be HCV seropositive, have riskier injecting practices and more severe injecting related health problems. MSIC achieved good coverage of the local IDU population (70.7%, range 59.1%-86.7%) and modest coverage of their estimated total injecting episodes during its operating hours (8.8%, range 7.3%-10.8%). MSIC use was associated with improvements in injecting practices and health. Frequent MSIC use was also associated with higher rates of referral to drug treatment than less frequent use. Drug treatment referral uptake was positively associated with a recent history of daily injection and sex work and negatively associated with a lifetime history of psychiatric treatment and/or self harm. This research was confounded by substantial changes in heroin availability during the study period but provides new evidence on DCR coverage, impact on injecting practices and health, and referral to drug treatment. Implications for future research are discussed.

This thesis explored the effect of cocaine use on treatment outcomes for heroin dependent individuals in Sydney, Australia. A naturalistic, longitudinal design was employed in order to examine the effects of cocaine on outcomes over a two year period. Study 1 assessed the prevalence and correlates of cocaine use among heroin dependent individuals. Cocaine use was found to be common among entrants to all three of the major treatment modalities in NSW. Heroin users who also used cocaine (CU) displayed a poorer clinical profile at baseline than non-cocaine users (NCU), reporting higher levels of drug use and dependence, and a greater prevalence of needle risk-taking and criminal behaviour. Study 2 examined outcomes three months post-study entry. CU and NCU were found to have been equally well retained in treatment. Despite significantly reduced levels of cocaine use amongst the cohort, however, CU continued to display the higher levels of drug-related harm that characterized them at baseline. In order to determine whether cocaine use itself was responsible for the greater levels of harm observed amongst CU, or whether instead CU were an inherently more dysfunctional group for whom cocaine use merely served as a marker, comparisons were made within groups on the basis of cocaine use patterns over the study period. The results of these analyses demonstrated that commencing cocaine use resulted in a clear decline in functioning, whereas cessation resulted in corresponding improvements. In Study 3 outcomes were examined twelve months post-study. Baseline cocaine use was again found to predict poorer outcome, despite a large scale reduction in cocaine use amongst the cohort. Importantly, CU were significantly less likely than NCU to be abstinent from heroin at twelve months and more likely to have been incarcerated since study entry. In addition, the effect of persistence of cocaine use was examined. Results indicated that the harms associated with cocaine use increased with increasing persistence of use. Outcomes at two years post-study entry were explored in Study 4. At this time CU and NCU recorded similar outcomes in most domains. Thus, it appeared that the harms caused by cocaine use may take a substantial period of time to diminish. Patterns of cocaine use and motivations for cessation and commencement were also examined. Responses suggested that cocaine use amongst the cohort was largely opportunistic, with participants ceasing use for a variety of reasons, including the financial and psychological problems caused by cocaine use. Past year prevalence of cocaine dependence was measured in this study, with the majority of those who had used cocaine in the past year meeting criteria for dependence. In Study 5, generalized estimating equations were used to measure the effect of baseline cocaine use on major outcome variables over the entire two year study period. Even after controlling for treatment variables, heroin use and other baseline polydrug use, the results of this study confirmed previous findings within the thesis by demonstrating the negative effect of baseline cocaine use on most outcome variables. Evidently, cocaine use among dependent heroin users has serious, long lasting, consequences. To date, however, there has been a stark lack of research examining the effect of cocaine use on treatment outcomes for heroin dependence. To that end, the results of this thesis are encouraging, suggesting that treatment for heroin dependence may also aid in reducing cocaine use among this group.

<p>The purpose of this study was to increase the knowledge and understanding of what impact support-groups, such as represented by Qvinnoqulan, can have on women with drug-addiction. The questions at issue for the essay was: How does a selection of women who participate in Qvinnoqulan describe their thoughts, experiences and reflections of the group? What sense has Qvinnoqulan made for the women on a personal level and for contributing to live a life without drugs? To answer the questions a qualitative method was used and five interviews were made with women who participated in the activities of Qvinnoqulan. To analyze the data a social constructionist perspective and an empowerment perspective was used. The result of the study showed that the women were in the process of rebuilding a new life without drugs and reconstructing a new identity. Qvinnoqulan played an important role in that process and was functioning as a safe place in between the two different types of lifestyles; life with drugabuse and life without drugs. Elements such as female friendship, honesty, understanding and sharing familiar experiences with other women were important to maintain a life free from drugs.</p>

<p>This essay will focus on drug addicts and the world as they see it. The essay is based on intervjues with three men and one woman and participant observation of the three men´s social life in the surroundings of Stockholm. The informants’ opinions and experiences are central as well as the observations made of them during an intensive fieldwork. The study which was of an exploring character has revealed a complex relationship between the informants and society. The concepts of subculture and stigmatization seem equally central in the social life and perception of life of these drug addicts. The intricate relationship between the two needs further study before a model of the interrelationship can be presented. In a final discussion of the results of the study with the informants they confirm that they see themselves both as part of a subculture and stigmatized by society.</p><p>The study also includes some ethical reflections on the role of the investigator in relation to informants who are drug addicts.</p>

<p>Denna studie syftar till att undersöka hur man som förälder påverkas av att ha ett barn som missbrukar narkotika, vilket stöd föräldrarna har fått från olika instanser de har kommit i kontakt med i samband med barnets missbruk samt vad som skulle utgöra det optimala stödet enligt föräldrarna. Med studiens syfte som utgångspunkt valdes en kvalitativ forskningsansats och insamling av empiriskt material skedde genom semistrukturerade intervjuer. Tidigare forskning inom området är tydligt begränsad, dock visar forskning som finns att stöd till anhöriga är ett eftersatt område. Studiens resultat visar att föräldrarnas vardagsliv har påverkats dramatiskt då barnets missbruk har fört med sig negativa konsekvenser både praktiskt, ekonomiskt, känslomässigt och socialt. Resultatet visar på en brist av stöd från framförallt socialtjänsten. Enligt föräldrarna kan det optimala stödet utgöras av tidiga insatser, samverkan mellan de instanser de kommer i kontakt med i samband med barnets missbruk samt att få träffa andra föräldrar med liknande erfarenheter.</p> / <p>This study aims to examine how parents are effected by having a child addicted to drugs, what support have the parents received from instances they been in contact with regarding the child's addiction and what constitutes the best kind of support according to the parents. Based on the aim of the study a qualitative research approach was chosen and collection of the empirical data was made through semi-structured interviews. Previous research on the area has shown an obvious limitation. Existing research confirm however that support for dependants is a neglected area. The result of the study show that the everyday life for the parents has been dramatically affected as the drug addiction of the children has lead to negative consequences in terms of practical, economical, emotional and social areas. The result also shows a lack of support, mainly from the social services. According to the parents the best support can be obtained by early interventions, cooperation between the instances in current contact for the parents in connection with the child's drug abuse and the opportunity to meet parents with similar experiences as themselves.</p> / VG

The purpose of this study was to increase the knowledge and understanding of what impact support-groups, such as represented by Qvinnoqulan, can have on women with drug-addiction. The questions at issue for the essay was: How does a selection of women who participate in Qvinnoqulan describe their thoughts, experiences and reflections of the group? What sense has Qvinnoqulan made for the women on a personal level and for contributing to live a life without drugs? To answer the questions a qualitative method was used and five interviews were made with women who participated in the activities of Qvinnoqulan. To analyze the data a social constructionist perspective and an empowerment perspective was used. The result of the study showed that the women were in the process of rebuilding a new life without drugs and reconstructing a new identity. Qvinnoqulan played an important role in that process and was functioning as a safe place in between the two different types of lifestyles; life with drugabuse and life without drugs. Elements such as female friendship, honesty, understanding and sharing familiar experiences with other women were important to maintain a life free from drugs.

This essay will focus on drug addicts and the world as they see it. The essay is based on intervjues with three men and one woman and participant observation of the three men´s social life in the surroundings of Stockholm. The informants’ opinions and experiences are central as well as the observations made of them during an intensive fieldwork. The study which was of an exploring character has revealed a complex relationship between the informants and society. The concepts of subculture and stigmatization seem equally central in the social life and perception of life of these drug addicts. The intricate relationship between the two needs further study before a model of the interrelationship can be presented. In a final discussion of the results of the study with the informants they confirm that they see themselves both as part of a subculture and stigmatized by society. The study also includes some ethical reflections on the role of the investigator in relation to informants who are drug addicts.

Denna studie syftar till att undersöka hur man som förälder påverkas av att ha ett barn som missbrukar narkotika, vilket stöd föräldrarna har fått från olika instanser de har kommit i kontakt med i samband med barnets missbruk samt vad som skulle utgöra det optimala stödet enligt föräldrarna. Med studiens syfte som utgångspunkt valdes en kvalitativ forskningsansats och insamling av empiriskt material skedde genom semistrukturerade intervjuer. Tidigare forskning inom området är tydligt begränsad, dock visar forskning som finns att stöd till anhöriga är ett eftersatt område. Studiens resultat visar att föräldrarnas vardagsliv har påverkats dramatiskt då barnets missbruk har fört med sig negativa konsekvenser både praktiskt, ekonomiskt, känslomässigt och socialt. Resultatet visar på en brist av stöd från framförallt socialtjänsten. Enligt föräldrarna kan det optimala stödet utgöras av tidiga insatser, samverkan mellan de instanser de kommer i kontakt med i samband med barnets missbruk samt att få träffa andra föräldrar med liknande erfarenheter. / This study aims to examine how parents are effected by having a child addicted to drugs, what support have the parents received from instances they been in contact with regarding the child's addiction and what constitutes the best kind of support according to the parents. Based on the aim of the study a qualitative research approach was chosen and collection of the empirical data was made through semi-structured interviews. Previous research on the area has shown an obvious limitation. Existing research confirm however that support for dependants is a neglected area. The result of the study show that the everyday life for the parents has been dramatically affected as the drug addiction of the children has lead to negative consequences in terms of practical, economical, emotional and social areas. The result also shows a lack of support, mainly from the social services. According to the parents the best support can be obtained by early interventions, cooperation between the instances in current contact for the parents in connection with the child's drug abuse and the opportunity to meet parents with similar experiences as themselves. / VG

Aquest treball pretén presentar un primer model en relació a la conducta autolesiva que es dona al medi penitenciari tenint en compte les relacions que poden haver entre la conducta autolesiva en el medi comunitari i el medi penitenciari així com poder confirmar els tipus de conductes autolesives d’altres treballs. En aquest treball es fa primer una revisió de les diferents definicions de conductes autolesives i la seva classificació així com els diferents models explicatius. Tot seguit fem una revisió bibliogràfica dels diferents treballs que relacionen les autolesions i diferents trastorns psicopatològics, així com de la seva incidència a les presons. A continuació s’elabora una proposta de model amb el capítol de metodologia, amb especial èmfasi amb els participants, instruments i procediment emprat. Els resultats s’analitzen i es presenten en el capítol 7 i la discussió i les conclusions en el capítol 8.