This thesis is a hermeneutic phenomenological investigation of the phenomenon of addiction, particularly alcohol addiction. My thesis draws heavily from the phenomenological school of hermeneutic phenomenology, in particular Max Van Manen’s (2006) text, Researching Lived Experience: Human Science for an Action Sensitive Pedagogy as a frame of reference for my inquiry into and analysis of the lived experience of addiction and recovery. The Van Manen text is used as a research handbook, guiding my approach, my analysis, and the project more generally. My thesis found that, using the existential of lived time, temporality, in recovery the present is essentially different than the past, and that recovering addicts necessarily rethink and reorient themselves to the past to heal.

This thesis is a hermeneutic phenomenological investigation of the phenomenon of addiction, particularly alcohol addiction. My thesis draws heavily from the phenomenological school of hermeneutic phenomenology, in particular Max Van Manen’s (2006) text, Researching Lived Experience: Human Science for an Action Sensitive Pedagogy as a frame of reference for my inquiry into and analysis of the lived experience of addiction and recovery. The Van Manen text is used as a research handbook, guiding my approach, my analysis, and the project more generally. My thesis found that, using the existential of lived time, temporality, in recovery the present is essentially different than the past, and that recovering addicts necessarily rethink and reorient themselves to the past to heal.

The topic of the thesis focuses on nutrition for people addicted to alcohol. The theoretical part of the thesis is to describe and adequate nutrition recommendations, which should people addicted to alcohol optimally receive. This section will describe the appropriate food components in the context of a variety of somatic and psychological changes in clients addicted to alcohol. There is also described the problems with the long-term consumption of high doses of alcohol occur in the context of micro and macronutrients. Pointed out the possible signs and risk inherent in inadequate nutrition in alcoholism carries. Also in this section above, which each term medical complications of alcohol bears. In the practical part of the thesis using of quantitative research focuses on finding the eating habits of clients psychiatric hospital in Opava and Prague. The aim of this section is to determine whether ingested during a stay in a psychiatric hospital corresponds to the nutritional needs of clients. To gather data, I used a questionnaire ADS (scale depending on the alcohol) (Skinner & Horn, 1984). I also used a food frequency questionnaire. (Institutet DANONE, 2000). The questionnaire focused on the evaluation of dependency on alcohol and nutrition. Synovate interviewed male. Man I chose, because between them...

The aim of this study has been to take part of six ex-alcohol addicts’ narratives about their lives with starting-point in which factors that has been significant and/or determining to be able to leave a life in abuse and what change this process has implied for their identity. To achieve the purpose with this study has three questions been formulated. These are what in the person’s life have been important in the process of a life free from alcohol, what were specific and decisive that effected the decision to stop using alcohol and what is the attitude to them self and their new role as an ex-alcohol addict.   Alcohol is a drug that is legal and accepted in the society and it´s hard to discover an addiction. Some people can handle to take their self out of the alcohol abuse on their own but for others different forms of professional help are necessary. This is a process that often takes long time and is influenced of both the individuals own efforts and different factors in the surroundings. To answer the aim and the questions the study is based on qualitative interviews. In our analysis to understand and interpret the material we have used earlier studies, social psychological theory whit an putting of symbolical interaction from roles and identity and how the individual define his or her situation. All the respondents in this study have received some kind of professional help and underwent treatment for their addiction. This has for everyone also been preceded by one or several of negative incidents that have been the trigger factor in the seeking relief. For five people treatment has been considerable and/or a crucial part to become free from the alcohol addiction. Also other insertion of support after the treatment has been important for all of them. Other factory that has been important in the process is positive refutation and support from other people in the surrounding.

<p>The aim of this study has been to take part of six ex-alcohol addicts’ narratives about their lives with starting-point in which factors that has been significant and/or determining to be able to leave a life in abuse and what change this process has implied for their identity. To achieve the purpose with this study has three questions been formulated. These are what in the person’s life have been important in the process of a life free from alcohol, what were specific and decisive that effected the decision to stop using alcohol and what is the attitude to them self and their new role as an ex-alcohol addict.</p><p> </p><p>Alcohol is a drug that is legal and accepted in the society and it´s hard to discover an addiction. Some people can handle to take their self out of the alcohol abuse on their own but for others different forms of professional help are necessary. This is a process that often takes long time and is influenced of both the individuals own efforts and different factors in the surroundings. To answer the aim and the questions the study is based on qualitative interviews. In our analysis to understand and interpret the material we have used earlier studies, social psychological theory whit an putting of symbolical interaction from roles and identity and how the individual define his or her situation. All the respondents in this study have received some kind of professional help and underwent treatment for their addiction. This has for everyone also been preceded by one or several of negative incidents that have been the trigger factor in the seeking relief. For five people treatment has been considerable and/or a crucial part to become free from the alcohol addiction. Also other insertion of support after the treatment has been important for all of them. Other factory that has been important in the process is positive refutation and support from other people in the surrounding.</p>

Resting-state functional MRI(rs-fMRI) represents a powerful means to assess brain functional connectivity in healthy subjects and in neuropsychiatric patients. Aberrant functional connectivity has been observed in subjects affected by Alcohol Use Disorders (AUD) and other forms of substance dependence, a major health issue worldwide with limited treatment options. Despite intense investigation, the specific neuronal substrates involved and the functional implications of aberrant connectivity in these patients remain unknown. Moreover, it is unclear whether treatment can reverse these alterations, and normalize functional connectivity. Several methodological and conceptual questions in the analysis of functional connectivity are still open, and contribute to this uncertainty. Functional connectivity is defined in terms of correlated MR-signal fluctuations, and in-scanner patient motion and other nuisance signals can introduce spurious correlations, thus representing substantial confounding factors. At a more general level, understanding the effects of complex conditions, like AUD, on brain connectivity and their functional implications requires a deep comprehension of the brain organizational principles at multiple scales, a tremendous challenge that is at the heart of modern neuroscience. In this PhD dissertation I address some of the outstanding questions in the analysis and interpretation of aberrant functional connectivity in AUD. To this end, I have embraced the formalism of graph-theory, a powerful framework to assess the effects of alcohol abuse on the local and global topological organization of resting state connectivity. On the methodological side, I have investigated the effects of subject’s motion on the structure of resting state networks, and compared efficacy of different approaches to remove motion-related confounds. Moreover, I demonstrate the importance of network sparsification to remove spurious connections from the graph while maximizing the structural information that can be extracted from the system. Leveraging these methodological developments, I have evaluated functional alterations in different samples of AUD patients. In two independent studies, I demonstrated specific alterations in the topological organization of the insular cortex and subcortical basal structures in recently detoxified alcoholics. Interestingly, protracted abstinence appears to partially normalize functional connectivity, thus suggesting that alcohol-induced alterations in connectivity may be amenable to treatment. Based on these findings, I have studied the effects on brain functional networks of a putative novel treatment based on deep Transcranial Magnetic Stimulation (TMS). Specifically, I analyzed resting state connectivity in AUD patients subjected to repetitive TMS of the bilateral insula and of the anterior cingulate cortex (ACC), and demonstrated treatment-induced changes that may underlie the efficacy of this potential treatment in surrogate clinical read-outs.

Voluntary wheel running is rewarding and believed to activate the same brain reward system as in alcohol and drug addiction. Brain-derived neurotrophic factor (BDNF), a well-known growth factor widely expressed in the brain, is modulated by both voluntary exercise and alcohol consumption. The aim of this study was to evaluate how voluntary exercise affects the expression levels of BDNF and its receptor TrkB in brain regions involved in positive and negative reinforcement. Additionally we wanted to evaluate the effect it may have on alcohol drinking behaviors in C57BL/6 mice, a mouse model which are naturally prone for engaging in voluntary exercise and voluntary alcohol consumption. We found a small upregulation in DG and CA1 after three weeks of exercise, confirming findings by others, and a significant 3-fold downregulation of BDNF in NAc after both three weeks of exercise and exercise followed by a five week period of either ethanol intake or not. Interestingly, we here show a significant 100-fold increase in BDNF after exercise and a 120-fold increase after both exercise and alcohol consumption in amygdala, a region involved in regulation of anxiety-related behavior and negative reinforcement. Additionally a slightly lower 10-fold increase in BDNF was seen after exercise and a 15-fold increase after exercise followed by ethanol in prefrontal cortex, a structure contributing to reward-related behavior. Behaviorally, we could not either directly following exercise or at five weeks post-exercise detect any significant effect of wheel-running on depression-related behavior. However, we did find that exercise significantly increased the alcohol intake.

Bakgrund: Alkohol- och drogmissbruk är idag ett utbrett problem som drabbar minst 15,3 miljoner människor världen över. Det råder en allmän stigmatisering i dagens samhälle mot missbrukare, bland gemene man samt inom hälso- och sjukvården. Denna stigmatisering har skapats dels på grund av den bild media skapar av den stereotypa missbrukaren och dels på grund av okunskap. Sjuksköterskor hyser ofta fördomar mot denna patientgrupp vilket kan leda till bristfällig vård. Syfte: Syftet är att beskriva sjuksköterskans erfarenhet och upplevelse av att vårda patienter som missbrukar alkohol och droger. Metod: En allmän litteraturstudie baserad på fem kvalitativa studier, tre kvantitativa studier och en mixad studie. Resultat: Fyra teman kunde urskiljas; attityder, kunskapsbehov, starka känslor och vårdande relationer. Slutsats: Sjuksköterskor hyser fördomar och har negativa attityder mot patienter som lider av missbruk. Kunskapsbehovet är stort och bristen på kunskap påverkar vården negativt. Vård av denna patientgrupp ger upphov till starka (ofta negativa) känslor hos sjuksköterskor. Den vårdande relationens karaktär är beroende av sjuksköterskans inställning. Klinisk betydelse: Studien kan ge sjuksköterskor och annan vårdpersonal en inblick i ämnet och inspirera till en mer fördomsfri vård. / Background: Drug- and alcohol addiction is a widespread problem in the world today and at least 15, 3 million people suffer from drug- and alcohol addiction. Stigma against addicts, caused by a lack of knowledge and an image of the stereotypical addict perpetuated by media, is widely spread in today’s society amongst the general public as well as healthcare professionals. Nurses are often prejudiced against this group of patients which can cause inadequate care. Aim: To describe nurse's knowledge and experience of caring for patients who suffer from drug- and alcohol addiction. Method: A literature review consisting of five qualitative studies, three quantitative studies and one mixed method study. Result: Four themes were identified; attitudes, knowledge, strong emotions and caring relationships. Conclusion: Nurses are found to have negative attitudes and be prejudiced against patients who suffer from addiction. Lack of knowledge affects the care negatively and the need for knowledge is great. Caring for this group of patients generates strong feelings, which are often negative, in nurses. The characteristics of the caring relationship are dependent on the nurses’ attitude. Clinical significance: This study may give nurses and other health professionals an insight into the matter and inspire a more open-minded care.

This thesis takes Discursive Psychology as its main theoretical influence. Drawing on the resources of Discursive Psychology and utilising analytic tools provided by Conversation Analysis, these principles are applied to the study of addiction, and specifically alcohol problems. The data explored are telephone calls to an alcohol helpline. Four analytic chapters are presented. The first focuses on the concept of loss of control over drinking, identifying features of how this concept is constructed in talk and suggests possible functions of control talk for both callers and Advice Workers. The second analytic chapter examines how Advice Workers respond to callers' professed impaired control over their drinking and I demonstrate that embedded in discursive sequences of problem formulation and advice giving are issues of agency, accountability and responsibility. The thesis moves on to explore the role of knowledge in calls to an alcohol helpline and the analysis reveals that both the expert status of the Advice Worker and the speciality of the topic are co-constructed between the speakers on the helpline. The final analytic chapter features just one telephone call and demonstrates the application of such an analysis for alcohol service providers. The thesis ends with a discussion of the main overall findings and the implications of the research for clinical practice. I close by arguing that initial agency contact is a very important site of study and recommend that this should be explored utilising naturally-occurring talk.

Bakgrund: Alkoholberoende är en psykisk sjukdom med både hög förekomst och stor utbredning. Socioekonomisk status (SES) är ett begrepp som innefattar utbildningsnivå, yrkesstatus och inkomst (Statistikcentralen, i.d). Många olika faktorer såsom arv och miljö kan öka risken för att en person drabbas av ett alkoholberoende. Tidigare forskning är oense gällande sambandet mellan alkohol och SES. Syfte: Att kartlägga hur människor med olika socioekonomiska förutsättningar upplever sitt alkoholberoende och mötet med sjukvården. Metod: En explorativ design med kvalitativ forskningsansats som bygger på personers egna upplevelser och erfarenheter av fenomenet alkoholberoende. Resultat: Känsloliv och tillgänglighet var avgörande orsaker till att ett alkoholberoende utvecklades. Yrkeslivet kunde både bidra till ökad och minskad alkoholkonsumtion. Alkohol kunde användas för att uppnå behag, dämpa ångest och känna samhörighet. Nyktra alkoholister upplevde överlag inte alkohol som något negativt. Personer med högre SES konsumerade mer alkohol i veckorna och fick lättare och snabbare tillgång till vård. Oavsett SES kunde alkoholberoende leda till psykiska besvär och försämrad ekonomi, vilket påverkade de personer med lägst SES hårdast. Rattfylleri var det mest frekvent rapporterade riskbeteendet under alkoholpåverkan, detta hade ingen koppling till SES. Upplevelser av passivitet från omgivningen var vanligt, när omgivningen agerade kunde det väcka förnekelse. Sjuksköterskans bemötande upplevdes som oklanderligt men sjukvården betraktades generellt som icke-fungerande. Terapeutisk effekt uppnåddes lättare om hjälparen också hade ett alkoholberoende, en av orsakerna till att Anonyma Alkoholisters verksamhet upplevdes som positiv. Produktivitet, intressen och motivation var nyckelfaktorer för att motverka återfall. Slutsats: I de socioekonomiska grupperna varierade upplevelserna av alkoholberoendet främst gällande dryckesmönster, tillgång till vård samt bakomliggande orsaker till alkoholdrickandet. Ett alkoholberoende drabbade de personer med lägst SES hårdast. Bemötandet av personer med alkoholberoende inom svensk hälso- och sjukvård upplevdes som oklanderligt, dock var många delar av vården utformade på ett icke-fungerande sätt. / Background: Alcohol addiction is a widespread mental illness with high prevalence. Socioeconomic status (SES) is a term that includes education, occupational status and income (Statistikcentralen, i.d). Many different factors such as heredity and the environment may increase the risk of a person becoming addicted to alcohol. Previous research presents different results about the relationship between alcohol and socioeconomic status. Aim: To chart how people with different socioeconomic conditions experienced their alcohol addicition and the health care. Methods: An explorative design with qualitative research approach based on people’s own experiences of the phenomenon alcohol addiction. Results: Emotions and availability were main reasons of the development of an alcohol addiction. People´s employment could contribute to both increased and reduced alcohol consumption. Alchol could be used to reach amenity and solidarity and to decrease anxiety. Sober alcoholics did not experience alcohol as something negative. People with a high SES consumed a greater quantity of alcohol during the weekdays and had easier and quicker access to health care than people with lower SES. Alcohol addition could contribute to psychological issues and a worsened economy, especially for the people with lowest SES. Drunk driving was the most highly reported risk behaviour under the influence of alcohol but without connection to the SES. The respondents experienced that the surrounding people mostly remained passive but when they did react it could issue in denial. The nurse’s treatment were experienced as impeccable but the health care was generally considered as not effective. Therapeutic effect was achieved more easily if the helpers had their own addictions, one of the reasons to that Anonymous Alcoholics was regarded as a positive activity. Productivity, hobbies and motivation were key factors to prevent relapse. Conclusion: The experience of the alcohol addiction varied between the socioeconomic groups, mainly concerning drinking patterns, access to health care and the underlying causes to alcohol drinking. An alcohol addiction affected those people with the lowest SES mostly. The treatment of people with alcohol addiction in the swedish health care were experienced as faultless, yet there were many aspects of the healthcare that were generally considered to be dysfunctional.