La consommation excessive d’alcool présente des risques élevés pour l’individu et pour la société ; elle est fréquemment associée à une augmentation du risque d’accidents, d’actes de violence, et peut également conduire à court et/ou à long terme à de graves maladies et à des problèmes sociaux. Dès lors, l’utilisation de marqueurs fiables permettant de détecter une consommation excessive d’alcool, ponctuelle ou chronique, s’avère nécessaire pour prévenir des conséquences néfastes de l’abus d’alcool. L’éthylglucuronide (EtG) est un marqueur d’alcoolisation utilisé en toxicologie clinique (alcoologie) et médicolégale. Par rapport aux marqueurs indirects d’alcoolisation (CDT, &#947;-GT), ce métabolite mineur de l’éthanol est très spécifique et est quantifiable dans diverses matrices biologiques. La production d’EtG est catalysée par des enzymes de la famille des UDP-glucuronosyl-transférases (UGT). Cependant, les UGT impliquées dans la glucuronoconjugaison de l'éthanol, ainsi que les sources potentielles de variabilité interindividuelle de la production d'EtG, sont encore mal connues. Nos travaux ont ainsi consisté à (1) développer et valider une méthode de dosage de l’EtG dans différentes matrices biologiques par chromatographie en phase gazeuse couplée à la spectrométrie de masse en tandem, (2) identifier les UGT humaines impliquées dans la glucuronoconjugaison de l’éthanol et étudier la contribution relative de chaque isoforme active au niveau hépatique, (3) étudier l’impact de substances fréquemment utilisées par les consommateurs d’alcool sur la production d’EtG in vitro, (4) étudier l’impact de polymorphismes génétiques fonctionnels des UGT sur la production hépatique d’EtG, et enfin (5) évaluer l’impact de la consommation de cannabis et d’autres drogues sur la production d’EtG à l’aide de prélèvements post-mortem. Ces travaux ont notamment permis de montrer que (1) l'éthanol est glucuronoconjugué principalement par le foie, puis dans une moindre mesure par les reins et par l'intestin, (2) les UGT1A9 et 2B7 sont les deux enzymes majoritairement impliquées dans la glucuronoconjugaison de l’éthanol, quel que soit l’organe considéré, (3) la morphine, la codéine, la nicotine et la cotinine n’entraînent aucune modification des taux de production d’EtG in vitro ; le lorazépam et l'oxazépam augmentent légèrement cette production (p = 0,2 et 0,065, respectivement) ; le cannabidiol inhibe la glucuronoconjugaison de l’éthanol par un mécanisme non-compétitif (CI50 = 1,17 mg/L; Ki = 3,1 mg/L), alors que le cannabinol augmente cette glucuroconjugaison de manière concentration-dépendante (p <0,05), (4) les SNP c.-900G>A affectant l’UGT2B7 et IVS1+399T>C affectant l’UGT1A9 augmentent légèrement la production d’EtG in vitro. Enfin (5) le rapport des concentrations sanguines EtG/éthanol apparaît significativement plus élevé chez des co-consommateurs de cannabis et/ou d’autres drogues que chez des consommateurs d’alcool seul. L’ensemble de ces résultats démontre l’existence de plusieurs facteurs pouvant potentiellement influencer la production d’EtG et devraient donc être pris en considération lors de l’interprétation de sa concentration in vivo. / Alcohol abuse is frequently associated with an increased risk of road accidents and violence, and can also lead to serious social and health problems. Therefore, the use of reliable markers to detect excessive punctual and/or chronic consumption of alcohol is necessary to prevent the harmful consequences of alcohol abuse. Ethylglucuronide (EtG) has been proposed as a marker of alcohol consumption in a variety of clinical and forensic contexts. Compared with the indirect markers (e.g. CDT, &#947;-GT), this minor metabolite of ethanol is very sensitive and specific, and is quantifiable in various biological matrices. It is formed by conjugation of ethanol with uridine 5’-diphosphate glucuronic acid (UDP-GA) via the action of UDP-glucuronosyltransferase (UGT) enzymes. However, the knowledge of the UGTs involved in the glucuronidation of ethanol, and the potential sources of the interindividual variability of EtG production are still not clearly established. The aims of our work were (1) to develop and validate a method for the determination of EtG in different biological matrices by gas chromatography coupled with tandem mass spectrometry, (2) to identify the human UGT isoforms involved in the glucuronidation of ethanol, and then to evaluate qualitatively and quantitatively their specific contribution in the formation of EtG, (3) to study the impact of the co-administration of drugs frequently used by ethanol consumers on the in vitro production of EtG, (4) to study the impact of functional genetic polymorphisms of two UGTs on the hepatic production of EtG, and finally (5) to study the impact of the consumption of cannabis and other drugs on the production of EtG using post-mortem samples. The main results of our study showed that (1) ethanol is primarily glucuronidated by the liver and, to a lesser extent, by kidneys, (2) UGT1A9 and 2B7 were identified as the main human UGTs involved in ethanol glucuronidation, (3) morphine, codeine, nicotine, and cotinine did not modify EtG in vitro formation rate; lorazepam and oxazepam produced a minor, but not significant, increase of EtG formation. Only cannabinol and cannabidiol significantly affected ethanol glucuronidation; cannabinol significantly increased the glucuronidation of ethanol in a concentration-dependent manner, whereas cannabidiol inhibited the glucuronoconjugaison of ethanol by a non-competitive mechanism (CI50 = 1.17 mg / L; Ki = 3.1 mg / L), (4) the SNP c.-900G>A and IVS1+399T>C affecting UGT2B7 and UGT1A9, respectively, seem to increase the in vitro production of EtG, and (5) cannabis and/or drugs consumption (mainly opioids, benzodiazepines, and paracetamol) seem to be associated with ratios of blood concentrations of EtG/ethanol significantly higher than those observed among only alcohol consumers. Taken together, these results show the existence of several factors that could potentially influence the production of EtG, and that should be taken into account when interpreting its concentration in vivo.

Magister Artium (Child and Family Studies) - MA(CFS) / Alcohol abuse in youth is an ever growing problem in South Africa. The phenomenon leads to a variety of other problems, including the relationships that these youth have with their parents. The aim of the study was to explore the parent-child relationship in youth abusing alcohol. The first objective of the study was to explore and describe alcohol abuse in youth and the parent-child relationship from the youth’s perspective. The second objective was to explore and describe alcohol abuse in youth and the parent-child relationship from the parents’ perspective. A qualitative research approach has been used. Non probability purposive sampling has also been employed. The sample comprised of youth between the ages of 18-25 from a township area in the Western Cape, as well as a number of parents. The data collection process took place in the form of one-to-one interviews. The data analysis was done by means of coding and identification of themes. The findings revealed that factors such as family boundaries, relationships, economic factors, and problem and risk behaviour negatively influenced parent-child relationships in youth abusing alcohol. The recommendations had a strong emphasis on social work intervention that focus on strengthening family relationships. Youth were also advised to join programmes as a direct intervention for their alcohol abuse.

Magister Artium (Psychology) - MA(Psych) / Supportive relationships have been found to be very beneficial for health and well-being. However, amongst alcohol dependent individuals, family support is often low, as alcohol abuse can pose a barrier between the individual and his or her family. The aim of this study was to gain an understanding of how adult children experienced providing social support to a parent with alcohol abuse problems or recovering from alcohol addiction. To conceptualize the study, Bowen's Family Systems Theory was used, which highlights the impact that alcohol abuse has on a family as a whole, and that it does not solely affect the individual who is addicted to alcohol. Participants were selected using convenience sampling. Adopting a qualitative approach, the researcher conducted individual semi-structured interviews in which participants were students between the ages of 25 and 38 years. The qualitative interviews were transcribed verbatim and transcriptions were analyzed using Interpretative Phenomenological Analysis (IPA).Ethical clearance was obtained from the University of the Western Cape Higher Degrees Committee. Informed consent for conducting this research study was obtained from the University of the Western Cape (UWC) and Kensington Treatment Centre (KTC) as well as from participants. The consent forms indicate that only the researcher and the researcher's supervisor have access to the data obtained. The researcher pledged confidentiality and adherence to ethical rules and regulations. The researcher ensured that participant anonymity was not compromised upon analysis of the data. The study found that parental alcohol abuse has negative effects on the support provider's well-being and their involvement in the parent-child relationship. Effects included feelings of anger and shame; giving in to peer pressure; engaging in substance use and risky sexual behaviours; distancing themselves emotionally; and keeping secrets. Furthermore, participants also experienced social alienation; emotional and sexual abuse; and a fragmentation of the parent-child relationship.

Alcohol abuse in families remain a serious problem in South Africa. Early exposure to dysfunctional family patterns may contribute to juvenile offending. Such an exposure will be detrimental to children’s development and may create emotional problems for them. It would appear that certain factors contribute towards juvenile delinquency such as divorce among parents, single parent families, unemployment of parents, family violence, substance abuse and poverty. The researcher was motivated to undertake this study as she observed in the field of Social Work that nearly all juvenile offenders were exposed to alcoholism in their families of origin. The question arised whether there is a relation between alcohol abuse in the family system and juvenile delinquency. The goal of this study was to explore the extent to which alcohol abuse in the family system may contribute towards juvenile delinquency and imprisonment. The researcher conducted a qualitative study through which the goal of the study has been achieved. Further research in this field is recommended to prevent the effect alcohol abuse may have on the family system. / Dissertation (MA (Social Work))--University of Pretoria, 2005. / Social Work / unrestricted

No description available.

Introduction: Severe mental illness (SMI), Human immunodeficiency virus (HIV) infection and hazardous alcohol use are global epidemics. Each condition is independently associated with significant adverse health outcomes. The presence of two or more of these conditions in one individual may result in worse health outcomes. A key mediator of poor health outcomes are factors such as medication adherence. In resource-limited countries like South Africa, the impact of psycho-social factors may contribute further to worse health outcomes. These factors include poverty and unemployment; as well as gender. In South Africa, proportionately more women are infected with HIV than men; and they are also vulnerable to the problems of trauma and interpersonal violence. The main aim of this study was to investigate the prevalence of a triple co-morbidity of SMI, HIV infection and hazardous alcohol use in a female population at a community psychiatric clinic in Cape Town South Africa; and the impact of this triple comorbidity on medication adherence. Furthermore, we set out to identify demographic and clinical variables that are predictors of poor adherence to both psychotropic medication and ART where applicable. Methods: We conducted a cross-sectional study of female patients presenting to Gugulethu psychiatric clinic over a ten-month period. Demographics and clinical variables were explored using the Alcohol Use Disorders Identification Test (AUDIT); the adapted Morisky Scale to Assess Adherence to Psychotropic Medications; and an adherence to HIV antiretroviral treatment self-assessment instrument. A descriptive analysis of the demographic and predictor variables was undertaken to explore the prevalence of concurrent HIV infection and hazardous alcohol use in out-patients with SMI; as well as to investigate whether co-morbidity is associated with poor levels of adherence to psychotropic medication, as well as antiretroviral treatment (ART) in HIV positive patients. Results: We interviewed 127 patients, of whom 55 were HIV positive (43.3%). The overall prevalence of a triple comorbidity in this population was 7.9%. Only 20% within this triple comorbidity group were adherent to their psychotropic medication. Out of the 10 participants with a triple comorbidity, only five were on ART. Of these 5 participants, only two were adherent. Individuals with hazardous alcohol use were less adherent to psychotropic medication compared to those without. The seven respondents in the dual diagnosis group (SMI and hazardous alcohol use) had the lowest overall psychotropic adherence levels compared to the other subgroups (0%). Furthermore, concurrent hazardous alcohol use predicted poorer levels of compliance to ART for those with HIV infection. Conclusion: The presence of a triple diagnosis was not found to be a predictor of poorer medication adherence, compared to having one or two diagnoses. Nevertheless, there was evidence that concurrent hazardous drinking in SMI patients predicted poor compliance to both psychotropic and ART treatment regimens (for those living with HIV). These patients should be supported in future interventions to improve medication adherence and reduce hazardous drinking.

Alcohol abuse is a worldwide public health concern. Nurses, representing the largest body of health care providers, are a potential resource to provide screening and brief intervention for patients with alcohol problems. This study evaluates the effect of an educational intervention on the attitudes, beliefs, and confidence levels of nurses regarding screening and brief intervention for alcohol problems. One hundred eighty-one students at Vanderbilt University School of Nursing participated in a four-hour educational intervention to train providers in brief negotiated intervention (BNI) for screening, early detection and brief treatment of alcohol problems. Participants completed questionnaires before and after this training. Analysis of the data using paired t-test and one-way analysis of variance showed statistically significant positive change in the nurses' attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment after the educational intervention. For example, the percentage of nurses who reported always having confidence in assessing patients' readiness to change their behavior increased from 8.3% to 23.5% after training. In conclusion, the BNI educational intervention can be effective in promoting positive changes among nurses in attitudes, beliefs, and confidence levels regarding alcohol abuse and its treatment.

No description available.

Calamity of the White Picket is a collection of essays that portray how perfection-whether a perfect image, perfect relationship, perfect friendship, or perfect family-becomes withered down, destroyed, and turned into something else. They explore how the idealized image of a family surrounded by a cute white picket fence is dismantled and rearranged through theft, addiction, and a disintegrated family. The essays explore drug addictions, childhood nostalgia, the relationship between heritage and property, innocence, and a stolen best friend. The collection is a train ride of family problems, broken friendships, lying and stealing, and hidden secrets about love and sex. Through these essays, I let go of my versions of the white picket fence, and embrace the new and complicated life that replaces it, ultimately still trying to maintain happiness.

Alcohol abuse and illicit drug use in the United States are major concerns of American households, as well as of the White House. This dissertation research evaluates alcohol abuse and controlled drug use by American workers in the context of various individual, organizational, and occupational settings. It tests the importation and organizational stress perspectives, the occupation subculture perspective, and the lifecycle wage compensation theory. The analyses are developed utilizing (1) logistic regression, (2) generalized linear modeling, including Poisson regression and negative binomial regression, (3) weighted modeling estimation, taking the clustering effects of complex survey design into account, and (4) the hierarchical growth curve modeling of intra- and inter-individual differences. Using data from the National Longitudinal Survey of Youth 1979—1993, the 1997 National Household Survey on Drug Abuse, and the 1998 National Occupational Information Network (O*NET 98), I find that employees' drinking and controlled drug use behavior are predicted by a number of individual background characteristics, as well as workplace-environment variables. I also find that occupational characteristics influence alcohol and drug using behaviors of workers, although in more complex ways than suggested by much of the organizational stress and occupational subculture literature. It appears that occupations with higher levels of steady employment prospects exert the most significant negative effect on employees' alcohol use, marijuana use, and any illicit drug use, regardless of an employee's age, gender, race, education, and income. It also appears that the etiology of cocaine use is different from that of either alcohol use or other drugs, such as marijuana. Finally, I find that when education and years employed are held constant, employees' current marijuana use is negatively associated with their earnings. No evidence has been found that current alcohol use, current marijuana use, or lifetime cocaine use predicts future growth rates on earnings. Having examined the factors of occupational, organizational, and individual social/demographic characteristics as they influence patterns of alcohol abuse and controlled drug use in multiple large representative samples of the labor force, discussions on the research findings, the implications, the limitations, and the future study directions are presented. / Ph. D.