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Intentionen med denna studie har varit att genom en kvalitativ metod undersöka huruvida personer som arbetar inom hemtjänsten i Malmö stad upplever och uppfattar mötet med äldre där det uppkommer problem för personalen i deras arbete på grund av att den äldre har konsumerat alkohol. Detta genom att intervjua åtta hemtjänstpersonal angående deras förutsättningar att leva upp till lagen och den nationella och den lokala värdegrunden i Malmö stad. Vi vill även utröna om de anser att de har tillräckligt med kunskap inom området för att leva upp till dessa intentioner. Den insamlade empirin har bearbetats utifrån Aristoteles kunskapsteori med hjälp av de tre begrepp episteme, techne och fronesis samt utifrån teorin om handlingsutrymme. Det framkom i studien att intervjupersonerna inte främst uppger att det är deras kunskap som begränsar dem i att uppnå de intentioner som finns i lagar och värdegrunder, det som uppges vara de begränsande faktorerna är den äldres självbestämmande och organisationens resursbrist. Intervjupersonerna uppger att kunskapen de har och vilken de använder sig av i sitt arbete kommer främst från deras arbetslivserfarenhet vilket också styrks av tidigare forskning. När det i studien beskrivs hur det kan vara i mötet med de äldre som åsyftas i studien beskrivs detta att det kan se väldigt olika ut, där en del av intervjupersonerna beskriver att det i kan vara en tuff miljö att arbeta i. Då där det har förekommit rädsla för att utsättas för övergrepp. / The intention with this essay has been to study through a qualitative method whether or not people who is working in the homecare in Malmö city experience and perceive the meeting with elderly where there are problems for the staff in their work due to the fact that the elderly have consumed alcohol. By interviewing eight homecare staff regarding their prospects of living up to the law and the national and local value base in Malmö city. We also wanted to find out if they think they have enough knowledge in the area to live up to these intentions. The collected empiric has been processed from Aristotle's theory of knowledge using the three concepts episteme, techne and fronesis, and from the theory of “handlingsutrymme”. It was found in the essay that the interviewees do not primarily state that it is their knowledge that limits them in achieving the intentions contained in laws and the values, which is said to be the limiting factors, is the self-determination of the elderly and the organization's lack of resources. Interviewers state that the knowledge they have and which they use in their work comes mainly from their work experience, which is also supported by previous research. When it in the essay describes how it may be in the meeting with the elderly as referred to in the essay, this may look very different, some of the interviewees describe that in some cases it may be a tough environment to work in. Where they have occurred fear of being subjected to abuse.

Bakgrund: I Sverige växer cirka 385 000 barn upp i familjer där en eller bägge föräldrar har en riskabel konsumtion av alkohol, vilket innebär att 4- 5 barn i varje skolklass har minst en förälder med riskabel alkoholkonsumtion, och att minst 60 000 barn under 18 år har en förälder vilken har allvarliga alkoholproblem. Dessa barn har en ökad risk att utveckla ohälsa, där den psykiska ohälsan är en av de allvarligaste riskerna för folkhälsan på sikt. Syfte: Studiens syfte var att beskriva hur en förälders alkoholproblematik påverkar den psykiska hälsan hos barn (0 - 17 år). Metod: Metoden är en litteraturstudie där 10 vetenskapliga artiklar har analyserats och sammanställts för att besvara frågeställningen. Resultat: De granskade studierna visar tydligt på att barns psykiska hälsa påverkas av en förälders alkoholproblematik. Både internaliserade- och externaliserade symtom finns representerade, likväl som risken att utveckla egen missbruksproblematik. Slutsats: Forskning visar på ett samband mellan förälderns alkoholproblematik och påverkan på barns psykiska hälsa. Dock är inte förälderns alkoholproblematik i sig som enskild faktor endast avgörande om en ogynnsam utveckling sker hos barnen, utan flertalet andra förmedlande faktorer samspelar och utgör en påverkan. Flickor och pojkar anses bli påverkade på olika sätt, likväl föreligger varierande uppfattningar om hur allvarligt barnen påverkas. / Background: About 385 000 children in Sweden grow up in families where one or both parents show a risky alcohol consumption, which means that 4- 5 children in each class has at least one parent with risky alcohol consumption, and at least 60 000 children under 18 years of age have a parent which has serious alcohol problems. These children have an increased risk of developing illnesses, where mental illness is one of the most serious long-term public health risks. Aim: The aim of this study was to describe parental alcohol problems and the mental health outcome in children (0-17 years). Method: The method is a literature review, where 10 scientific articles have been analyzed and compiled, in order to follow the aim. Result: The reviewed studies clearly show that the mental health of children is affected by parental alcohol problems. Among the outcomes both internalizing- and externalizing symptoms are represented, as well as the risk of developing an own addiction problem. Conclusion: Research shows a connection between parental alcohol problems and the outcome in terms of children’s mental health. However, the parental alcohol problem in itself is not a sole risk factor for an unfavorable development of the children also other mediating factors interact and exert an influence.  Girls and boys are affected differently and also varying interpretations on how seriously children are affected, are found.

Bakgrund: Alkoholproblematik är ett stort problem som påverkar den enskilda personen, anhöriga och samhället. Lagar och riktlinjer slår fast att anhöriga ska erbjudas stödinsatser. Sjuksköterskans etiska kod omfattar både den enskilda individen, anhöriga och samhället. Tidigare studier har uppmärksammat livssituation och hälsa hos anhöriga till personer med psykisk ohälsa, men det saknas studier kring anhöriga till personer med alkoholproblem. Syfte: Syftet med denna studie var att beskriva livssituationen med särskilt fokus på hälsa hos vuxna anhöriga till personer med alkoholproblematik. Metod: Studien har en kvalitativ design med induktiv ansats. Sex vuxna anhöriga till personer med alkoholproblematik intervjuades individuellt med halvstrukturerad metod enligt Kvale och Brinkmann. Intervjumaterialet analyserades enligt Elo och Kyngäs metod för kvalitativ innehållsanalys. Resultat: Resultatet från intervjuerna utmynnade i fyra kategorier: En otrygg och ansvarstagande livssituation, Att leva för den andra och förlora sig själv, Variation av starka känslor samt Att komma vidare i livet och försonas med sig själv. Diskussion: Studiens metod diskuteras utifrån Graneheim och Lundmans kvalitetsbegrepp. Centrala fynd i resultatet diskuteras i relation till tidigare forskning samt Antonovskys teori om känsla av sammanhang (KASAM). / Background: Alcohol problems is a major problem that affects the individual, family and society. Laws and guidelines states that family members must be offered support. Nurse’s Code of Ethics includes both the individual, family and society. Previous studies have drawn attention to life situation and health of family members of persons with mental illness, but there is a lack of studies of family members of persons with alcohol problems. Aim: The aim of this study was to describe the life situation with a particular focus on health in adult family members of persons with alcohol problems. Method: The study has a qualitative design with an inductive approach. Six adult family members of persons with alcohol problems were interviewed individually with semi-structured method by Kvale and Brinkmann. The interview material was analysed using Elo and Kyngäs method of qualitative content analysis. Results: The results from the interviews resulted in four categories: An insecure and responsible life situation, To live for the other and lose yourself, Variety of strong emotions and To move on in life and to reconcile with yourself. Discussions: The study’s method is discussed based on Graneheim and Lundmans quality concepts. Central findings in the results are discussed in relation to previous research and Antonovsky’s theory of sense of coherence (SoC).

This study aims at exploring the intervention strategies directed to reduce alcohol drinking in Hogskolan in Gavle. Although many students consume alcohol in different settings such as parties and gathering, few of them can understand the whole picture of the school’s intervention strategies. As shown by the research, the social workers in health center attempt to form a collective relationship with students and use the open-ended questions when conducting the counseling. Meanwhile, the employees who are responsible for school bar not only try to create a safer environment based on Responsible Alcohol Drinking but also apply prevention strategies including a high alcohol price and a long waiting line. According to the overall situation in the community, a meeting has been organized among different sectors regarding health center, student union, and municipalities. The topics of the meetings are not only about the current situation in this region but also about the cooperative strategies of each sector. To take a closer look at the school’s alcohol methods, we interviewed two social workers at the health center as well as two employees in the students’ union who are mainly responsible for school bar.

Background: It is now well established that there are core cognitive impairments associated with a diagnosis of schizophrenia. In parallel with our increased understanding of these core deficits, our awareness that mentally ill offenders (MIOs) are at additional risk of cognitive impairment due to an increased rate of traumatic brain injury and substance abuse has also grown. Absent from the literature is evidence of whether these cognitive impairments change over longer periods of time in MIO’s and whether these changes, or baseline abilities, impact an individual’s risk of violence. Furthermore, the negative impact head injury has on an individuals’ cognitive, behavioural and psychological functioning is well documented. These changes can lead to an increased likelihood of violence and crime, yet there is currently a scarcity of knowledge regarding the prevalence of head injury within mentally ill offenders in Scotland and its association with risk-related outcomes. Aims: The aims of the present thesis were to; (a) Examine the course of cognition in N=49 mentally ill offenders who underwent neuropsychological assessment while in the State Hospital, Scotland in 2004-5, and assess whether baseline or change in cognition predicts violent incidents or risk at follow-up, and; (b) Examine the cross-sectional association between head injury, substance abuse and risk-related outcomes of all individuals within the forensic network in Scotland for whom data could be extracted (N=428). Hypotheses: (a) We hypothesized that processing speed, verbal comprehension, working memory, delayed verbal memory, delayed non-verbal memory, impulsivity, inattention and problem-solving would decline over a 10-year period, and that deficits in impulsivity, emotion recognition, working memory and delayed memory would predict patients’ risk-related outcomes in a sample of mentally ill offenders. (b) It was also hypothesized that the presence of head injury and/or substance abuse within patients would predict worse risk-related outcomes, namely: quantity of violent offences, risk of harm to self, risk of harm to others and severity of violent offences. Analysis: We conducted a series of repeated measures MANOVAs, MANCOVAs and hierarchical linear regressions in SPSS Statistics to test our hypotheses. Individuals with a primary or secondary diagnosis of a learning disability were excluded. Results: (a) Our results propose that cognitive abilities significantly change over time (F(1.51, 30.1) = 5.98, p = .011), but direction of change is ability dependent. We found that impulsivity (Effect Size (ES) = .253), inattention (ES = .233), working memory (ES = .288) and auditory delayed memory (ES= .268) worsen over time. Measures of impulsivity and working memory significantly predicted some, but not all, risk-related outcomes, however these effects became diluted once additional variables with shared variance were added into the predictive models. We did not find that traumatic brain injury, substance misuse or alcohol misuse significantly mediated change in cognition over time. (b) In the national cohort study, results suggested that head injury had a significant effect on HCR total scores, F(1,259) = 6.679, p = .010 (partial eta square = .025), violence during admission (χ2 = 5.545, p = .022) and violent offences at a .1 p-value only, F(1,259) = 3.495, p = .063 (partial eta square = .013). Drug misuse only had a significant impact on total violent offences, F(1,259) = 8.933, p = .003 (partial eta square = .033) and nothing else. Furthermore, the interaction between alcohol misuse and schizophrenia also only had impact on total violent offences, F(1, 259) = 7.516, p = .007 (partial eta square = .028). Head injury was not significantly associated with either historical or current self-harm, however alcohol misuse, drug misuse and schizophrenia were. Conclusions: Our results highlight the unstable nature of cognition in mentally ill offenders and the impact that head injury has on violence-related outcomes, over and above substance misuse and a diagnosis of schizophrenia. This has potentially renovating implications for clinical practice regarding risk management, assessment, and treatment planning.

Forgiveness is argued, by scholars and lay persons alike, to play an important role in substance abuse recovery. However, little empirical research has been conducted to verify such assumptions. Cross-sectional naturalistic data from a sample of 126 Southern Appalachian college students identified as likely to be hazardous or harmful drinkers were analyzed through multiple-mediation statistical procedures. The general hypothesis of this study was that, while controlling for demographic characteristics, including lifetime religiousness, higher levels of forgiveness would be associated with both better mental health and higher levels of social support, which in turn would be associated with salutary alcohol-related outcomes. In the context of forgiveness of self, for four of the five alcohol-related outcomes, the relationships operated mainly through mental health and primarily in an indirect rather than mediating fashion. Feeling forgiven by God was directly associated with three outcomes. Forgiveness of others was not associated with any of the outcomes measured. While forgiveness appears to be important and beneficial in association with alcohol-related outcomes, it may be that forgiveness of self is most important. Limitations discussed include sample- and measurement-related issues.

<p>Several Swedish studies have suggested that within the group of clients contacting social welfare offices for social assistance, approximately one third are having problems with heavy drinking. The overall aim of the dissertation was to study how social workers approach these problems in single, male clients. That is; are the drinking problems of these clients approached and if they are, when and why does this happen? The subject has been investigated in four studies. In study I (n=66) and II (n=103) social workers were to respond, in a written questionnaire, on how they would act on a hypothetical client described in vignettes. The results from these studies suggest that there is no consensus among social workers of how to act towards the clients drinking problem and that social workers personal values seem to influence their choice of action taken. In study III, data was collected from case files on male single clients in nine municipalities. Case files in which alcohol related notes were present (n=297) were investigated. The results indicate that social workers are more active as regards demands on clients to moderate or stop their alcohol consumption if the clients are able to work, than if they are not. Study IV was based on focus-group interviews in eight municipalities. In each municipality, a work group of social workers dealing with social assistance were interviewed on one occasion. The social workers approach to the client’s problems was described as a mobile point within a two-dimensional system. The legislative dimension concerned the clients’ right to be equally treated versus the right to have their application judged individually with every circumstance considered. The other dimension was related to traditional social work with the client’s integrity versus the need for support and control. The results were contextualised mainly from three aspects, the influence from raised demands on a “knowledge-based” practice, the prerequisites consistent of the specific frames for social work and changes in the public discourse constituting the frame of socially acceptable drinking habits.</p>

<p>Antisocial behaviour and alcohol problems are areas of great concern to society, not only associated with personal and emotional costs for the affected individuals and their victims, but also with major societal financial costs. What makes some individuals more likely than others to develop these kinds of problems? The general aim of this thesis was to explore the role of individual characteristics in the development of antisocial behaviour and alcohol problems. More specifically, the research focused on aspects of hyperactive behaviour, personality traits and biological vulnerability indicators in relation to self-reported norm breaking and violent behaviour, registered general criminality and violent offending in particular, and further, on risky alcohol use and drinking offences. The studies were based on both a prospective longitudinal project in which a group of adolescent male lawbreakers and controls were followed from the 1960s into the 1990s, and on more recently collected data on a representative group of Swedish male and female adolescents.</p><p>The results of the thesis supported that neuropsychological deficits, manifested in attention difficulties, and personality traits reflecting disinhibition and negative emotionality, influence the development of antisocial behaviour and risky alcohol use, which in turn increases the risk of subsequent alcohol problems. The findings indicated, furthermore, that these neuropsychological deficits may be associated with an underlying biological vulnerability to various forms of disinhibitory psychopathology. Although the thesis focuses on individual characteristics, the results also support the view that environmental risk factors such as the influence of family and peers and possible stress experiences, play an important role. It was emphasized that individual characteristics continuously interact with environmental conditions in shaping each individual’s developmental course. Results also revealed that adolescent females displaying violent behaviour and engaging in potentially harmful use of alcohol deviated more in personality traits than did the corresponding group of males. Further knowledge of the development of these problems in females is crucial, since most theories in this area have been developed primarily on male samples.</p>

Antisocial behaviour and alcohol problems are areas of great concern to society, not only associated with personal and emotional costs for the affected individuals and their victims, but also with major societal financial costs. What makes some individuals more likely than others to develop these kinds of problems? The general aim of this thesis was to explore the role of individual characteristics in the development of antisocial behaviour and alcohol problems. More specifically, the research focused on aspects of hyperactive behaviour, personality traits and biological vulnerability indicators in relation to self-reported norm breaking and violent behaviour, registered general criminality and violent offending in particular, and further, on risky alcohol use and drinking offences. The studies were based on both a prospective longitudinal project in which a group of adolescent male lawbreakers and controls were followed from the 1960s into the 1990s, and on more recently collected data on a representative group of Swedish male and female adolescents. The results of the thesis supported that neuropsychological deficits, manifested in attention difficulties, and personality traits reflecting disinhibition and negative emotionality, influence the development of antisocial behaviour and risky alcohol use, which in turn increases the risk of subsequent alcohol problems. The findings indicated, furthermore, that these neuropsychological deficits may be associated with an underlying biological vulnerability to various forms of disinhibitory psychopathology. Although the thesis focuses on individual characteristics, the results also support the view that environmental risk factors such as the influence of family and peers and possible stress experiences, play an important role. It was emphasized that individual characteristics continuously interact with environmental conditions in shaping each individual’s developmental course. Results also revealed that adolescent females displaying violent behaviour and engaging in potentially harmful use of alcohol deviated more in personality traits than did the corresponding group of males. Further knowledge of the development of these problems in females is crucial, since most theories in this area have been developed primarily on male samples.