Indiana University-Purdue University Indianapolis (IUPUI) / Background: Previous studies show that prazosin, an α1-adrenergic receptor antagonist, decreases alcohol drinking in animal models of alcohol use and dependence and in alcohol-dependent men. These studies extended previous findings by using a paradigm that allows for separate assessment of prazosin on motivation to seek versus consume ethanol or sucrose in selectively bred rats given acute or chronic prazosin treatment. Methods: Alcohol-preferring P rats were trained to complete an operant response that resulted in access to either 2% (Exp. 1) or 1% (Exp.2) sucrose or 10% ethanol. In Experiment 1, a 4-week consummatory testing phase consisted of rats bar-pressing to “pay” a specified amount up front to gain access to unlimited ethanol (or sucrose) for a 20-minute period. A 4-week appetitive testing phase examined how much the rats would bar-press for ethanol in an extinction session when no reinforcer could be obtained. In Experiment 2, during testing, the response requirement was dropped to a 1 and daily session cycles of drug (3 weeks/ 14 sessions from Tues to Fri) or vehicle (2 weeks/ 9 sessions from Tues to Fri) treatment were alternated per drug dose for a total of 3 drug doses (3 cycles) per rat. After each drug cycle, a single non-reinforced extinction session was conducted with no drug ‘on board’ and no reinforcer access. On test days, rats were given IP injections of either vehicle or one of three doses of prazosin (Exp 1: 0.5, 1.0, 1.5 mg/kg; Exp 2: 0.25, 0.5, 1.0 mg/kg; balanced design; -30 min). Results: In Experiment 1, prazosin significantly decreased ethanol-seeking at all doses tested. The highest dose decreased ethanol intake and increased the latency to first lever-press and first lick. Sucrose-seeking and intake were decreased by the same doses of prazosin. In Experiment 2, prazosin significantly decreased reinforcer-seeking at the lowest and highest doses while ethanol intake was not decreased by prazosin. Conversely, sucrose-seeking was decreased at the highest dose of prazosin tested while sucrose consumption was decreased by all doses. Latency to lever-press for sucrose was increased by the lowest dose of prazosin compared to vehicle. Conclusions: These findings extend previous research and indicate that prazosin decreases motivation to seek ethanol and sucrose. The specificity of prazosin on different behaviors and over different reinforcers suggests that these findings are not due to prazosin-induced motor-impairment or malaise. These data suggest that prazosin may work by decreasing the reinforcing properties of reinforcers in general.

Thesis (MPhil)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The community of the Western Cape carries the burden of the serious consequences of alcohol addiction. Alcohol abuse is very common and the consequences range from severe to devastating, not just for the individual but also for the family and the community as a whole. If answers are sought within the community, the problem deepens, and it becomes apparent why the problem of alcohol abuse is not being successfully addressed. The addict refuses treatment, the community respects the autonomy of the individual, and the problem drags on. The community also has many misperceptions concerning the causes and perpetuation of the pathological drinking behaviour of the addict, and are thus not equipped with the knowledge necessary to suggest the correct interventions for this physical and psychological illness. There is also concern that a person's autonomy and human rights are so highly regarded in the community that the appropriate treatment necessary for this serious disorder of addiction does not receive the attention it deserves. This paper investigates the causes of alcoholism and the factors which reinforce a person's drinking behaviour. The autonomy of the alcoholic is challenged and examined in depth. The importance currently assigned to autonomy and individual rights is questioned, and balanced against other important moral and ethical principles of our time. Alcohol is a drug which causes physical and psychological addiction. Addiction literally means "under the control" of something. Alcohol use is a socially acceptable habit. The psychotropic (calming) effect of alcohol serves as an effective support in or escape from stress in the life of the individual. There are also "vulnerable" individuals in the community in whom a genetic predisposition increases the chance of the development of alcohol dependence. In spite of the fact that alcohol dependence is an acquired physical condition, nobody intentionally becomes addicted to alcohol. With the knowledge of the power that addiction exercises over the life of the individual, attention is now given to the autonomy of the addict, and his/her capacity for rational decision making. The significance of the decision to request treatment for the individual, his/her family and the community is balanced against competency to take the decision. Argument is developed towards the conclusion that the alcoholic is indeed not autonomous, and does not have the competency to make decisions concerning treatment. If the autonomy of the addict is thus questioned, the way in which the person is then treated by the community becomes a difficult moral dilemma. The community's responsibility of care towards the individual and the wider community are jeopardized. The ethical principles of deontology (rules), utilitarianism (the best result for the greatest number), autonomy versus beneficence, solicitude, virtue, human rights and other principles are discussed in depth. A solution is sought that will eventually be "good" for the addict and the community. The conclusion is reached that it is "good" to intervene in the life of the addict at a certain stage of addiction. Involuntary treatment is suggested as one possible way of attacking the problem of serious alcohol abuse that is threatening to overwhelm the community. Practical suggestions are offered for the renewed application of existing treatment structures and legislation to the benefit of the addict and the community. / AFRIKAANSE OPSOMMING: Die gemeenskap in die Wes-Kaap gaan gebuk onder die ernstige gevolge wat alkoholverslaafdheid meebring. Alkoholmisbruik is baie algemeen en het ernstige tot vernietigende gevolge, nie net vir die induvidu nie, maar ook vir die gesin en die gemeenskap as geheel. As daar na antwoorde vir hierdie probleem in die gemeenskap gesoek word, verdiep die probleem en kom dit duidelik aan die lig waarom die probleem van alkoholmisbruik nie suksesvol aangespreek kan word nie. Die verslaafde persoon weier behandeling, die gemeenskap respekteer die indivdu sy · outonomiteit en die proble~m sleep voort. Die gemeenskap het ook baie wanopvattings omtrent die oorsake en instandhouding van die verslaafde se patologiese drinkgedrag en is dus nie met die nodige kennis toegerus om die korrekte ingrepe vir hierdie fisiese en psigiese siektetoestand voor te stel nie. Daar is ook kommer dat die gemeenskap 'n persoon se outonomiteit menseregte s6 hoog aanslaan dat 1 die toepaslike hantering van die ernstige verslawing nie tot sy reg kom nie. Hierdie werkstuk ondersoek die oorsake van alkoholisme en die faktore wat die persoon se drinkgedrag versterk. Die alkoholverslaafde se outonomiteit word uitgedaag en in diepte ondersoek. Die gewig wat 'n persoon se outonomiteit en 'regte' in die gemeenskap dra, word bevraagteken en met ander belangrike moreel etiese beginsels van die dag gebalanseer. Alkohol is 'n dwelm wat fisiese en psigiese verslaafdheid veroorsaak. Verslaafdheid beteken letterlik 'onder die beheer' van daardie substans. Alkohol gebruik is sosiaal 'n aanvaarbare gewoonte. Alkohol se psigotrope effek (kalmerend) dien as 'n effektiewe stut of ontvlugting vir stres in die lewe van die individu. Daar is ook 'kwesbare' individue in die gemeenskap waar 'n genetiese predisposisie die persoon meer 'vatbaar maak vir die ontwikkeling van alkohol afhanklikheid. Ten spyte van die feit dat alkohol-afhanklikheid 'n verworwe fisiese toestand is, raak niemand 'moedswillig' aan alkohol verslaaf nie. Met die kennis van die krag wat verslawing op die individua se lewe uitoefen as agtergrond word daar voorts gekyk na die outonomie en die verslaafde se vermoe tot rasionele besluitname. Die gewigtigheid van die besluit tot behandeling vir die individu, sy gesin en die gemeenskap word met kompetensie tot besluitname gebalanseer. Arguemente word gebou wat tot die gevolgtrekking lei dat die alkohol-afhanklike inderdaad nie outonoom is en nie die kapasiteit vir die neem van behandelingsbesluite besit nie. Indien die verslaafde se outonomiteit dan bevraagteken word, word die gemeenskap se verdere hantering van die persoon 'n groot morele dilemma. Die gemeenskap se verantwoordelikheid van sorg teenoor die individu en die groter gemeenskap kom in gedrang. Die etiese beginsels van deontologie (reels), konsekwensialisme (die beste vir die meeste), outonomiteit versus goedwilligheid, sorgsaamheid, deug, menseregte en ander beginsels word in diepte bespreek. Daar word voorgestel dat die gemeenskap se plig tot so~g, in die geval van endstadium alkoholisme, moreel sterker is as bloot die respek vir outonomie. Daar word tot die gevolgtrekking gekom dat dit 'goed' is om op 'n sekere stadium van verslawing in die lewe van 'n persoon in te gryp.· Nie-vrywillige behandeling word voorgestel as bloot een van die aanslae vanuit die gemeenskap om die ernstige probleem van alkoholmisbruik wat besig is om die gemeenskap te oorweldig aan te pak. Praktiese voorstelle word gemaak om huidige behandelingsstrukture en wetgewing opnuut tot voordeel van die verslaafde en die gemeenskap aan te wend.

by Sylvia Chun Mei Chan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 105-114). / Abstract also in Chinese. / Chapter I. --- CHAPTER ONE: INTRODUCTION --- p.1 / Chapter i) --- Research Problems / Chapter ii) --- Rationale of the Research / Chapter iii) --- Objectives / Chapter II. --- CHAPTER TWO: LITERATURE REVIEW --- p.11 / Chapter i) --- Generalized Female Vulnerability Thesis / Chapter ii) --- Biological Factor / Chapter iii) --- Cultural Factor / Chapter iv) --- Motivational Factor / Chapter v) --- Situational Factor / Chapter III. --- CHAPTER THREE: CONCEPTUAL FRAMEWORK --- p.33 / Chapter i) --- The First Model / Chapter ii) --- The Second Model / Chapter iii) --- The Third Model / Chapter IV. --- CHAPTER FOUR: DATA AND METHOD --- p.51 / Chapter i) --- Sample and Data Collection / Chapter ii) --- Measurements of Variables / Chapter iii) --- Profile of Respondents / Chapter ix) --- Analytical Strategy / Chapter V. --- CHAPTER FIVE: ANALYSIS AND INTERPRETATION --- p.65 / Chapter i) --- The Whole Sample / Chapter ii) --- The Current Drinkers Sample / Chapter VI. --- CHAPTER SIX: DISCUSSION AND CONCLUSION --- p.81 / Chapter i) --- Implications of the Results / Chapter ii) --- Limitations of the Study / Chapter iii) --- Suggestions for Future Research / Chapter iv) --- Social Reflection / Chapter VII. --- BIBLIOGRAPHY --- p.105 / Chapter VIII. --- FIGURES --- p.i-vi / Chapter IX. --- TABLES --- p.vii-xxiv

Effective school-based alcohol prevention programs do exist. However, the overall efficacy of these programs has been compromised by implementation failure and a focus on abstinence based outcomes. The current thesis attempted to overcome such concerns by developing a computer-delivered school-based alcohol prevention program founded on a harm-minimisation approach. The aims of this thesis were to assess whether (1) this program would be both a feasible and acceptable means of overcoming the obstacles encountered in the implementation of school-based drug prevention programs, and (2) it was effective in decreasing alcohol misuse and related harm. CLIMATE Schools: Alcohol Module was developed in collaboration with teachers, students and relevant health and legal professionals. The final curriculum based program consists of six lessons, each with two components. The first component involves students completing an interactive computer-based program, with the second consisting of a variety of individual, small group and class-based activities. The feasibility and efficacy of CLIMATE Schools: Alcohol Module was assessed utilising a cluster randomised controlled trial involving 1434, Year 8 students (13 years old) from sixteen schools. CLIMATE Schools: Alcohol Module was found to be both feasible and acceptable in the school setting. The provision of alcohol prevention information in the background of a computerised teenage drama provided young people with an education program they enjoyed in a context to which they could relate. Teachers reported a willingness to implement CLIMATE Schools: Alcohol Module in routine practice. They believed it to be a high quality program which was superior to other drug education programs. CLIMATE Schools: Alcohol Module led to significant increases in knowledge of harm minimisation skills and subdued alcohol related expectancies. It was effective in reducing alcohol use, misuse and related harms for females, but not for males. The differential effects of gender are extensively discussed and implications for future research considered. CLIMATE Schools: Alcohol Module was clearly both feasible and acceptable and has the potential to offer an innovative new platform for the delivery of prevention programs in schools.

Effective school-based alcohol prevention programs do exist. However, the overall efficacy of these programs has been compromised by implementation failure and a focus on abstinence based outcomes. The current thesis attempted to overcome such concerns by developing a computer-delivered school-based alcohol prevention program founded on a harm-minimisation approach. The aims of this thesis were to assess whether (1) this program would be both a feasible and acceptable means of overcoming the obstacles encountered in the implementation of school-based drug prevention programs, and (2) it was effective in decreasing alcohol misuse and related harm. CLIMATE Schools: Alcohol Module was developed in collaboration with teachers, students and relevant health and legal professionals. The final curriculum based program consists of six lessons, each with two components. The first component involves students completing an interactive computer-based program, with the second consisting of a variety of individual, small group and class-based activities. The feasibility and efficacy of CLIMATE Schools: Alcohol Module was assessed utilising a cluster randomised controlled trial involving 1434, Year 8 students (13 years old) from sixteen schools. CLIMATE Schools: Alcohol Module was found to be both feasible and acceptable in the school setting. The provision of alcohol prevention information in the background of a computerised teenage drama provided young people with an education program they enjoyed in a context to which they could relate. Teachers reported a willingness to implement CLIMATE Schools: Alcohol Module in routine practice. They believed it to be a high quality program which was superior to other drug education programs. CLIMATE Schools: Alcohol Module led to significant increases in knowledge of harm minimisation skills and subdued alcohol related expectancies. It was effective in reducing alcohol use, misuse and related harms for females, but not for males. The differential effects of gender are extensively discussed and implications for future research considered. CLIMATE Schools: Alcohol Module was clearly both feasible and acceptable and has the potential to offer an innovative new platform for the delivery of prevention programs in schools.

Submitted in partial fulfillment of the requirements for the Degree of Master of Human Resources, Durban University of Technology, Durban, South Africa, 2017. / The aim of this study was to assess the employee assistance programme related to substance abuse within a selected private hospital in KwaZulu Natal. A paucity of information within the South African context on how employees with substance abuse problems were being managed within the workplace provided the motivation for this study. The objective of this study was to evaluate existing employee assistance programmes, the line manager model and existing human resource policies and procedures within the selected private hospital. The research design adopted a mixed method approach using a questionnaire, followed by an interview based on findings of the questionnaires. The intended sample size was 185 out of 460 staff and the final return of questionnaires was 219. Of significance is the response rate of over a 40% which implies a margin error of 5%. The data was analysed using the computerised Statistical Program for Social Sciences (SPSS version 22.0 for Windows). This study concluded with the findings that emerged from the research. The findings suggest that employees with substance abuse problems are not being effectively managed and that there are no awareness models apart from the employee wellness provider. The limit of the employee wellness provider is that it markets “employee wellness” rather than an emphasis on substance abuse. A suggestion is that the human resource department and the wellness provider partner in inspiring a substance abuse prevention and assistance campaign. Another recommendation highlights the training of all line managers in identification of recognising employees with substance abuse problems prior to work performance being affected. The study concluded with suggestions for future research in this field. / M

Indiana University-Purdue University Indianapolis (IUPUI) / Our laboratory has previously identified the clock gene D-box Binding Protein (DBP) as a candidate gene for bipolar disorder and alcoholism using a Convergent Functional Genomics (CFG) approach. In subsequent work, we established mice with a homozygous deletion of DBP as a stress-reactive genetic animal model of bipolar disorder and co-morbid alcoholism. In the present study, we found that the omega-3 fatty acid, DHA, may have mood stabilizing capabilities in stressed DBP knockout mice, and reduces alcohol consumption in these mice as well as in the alcohol preferring (P) rats. Given their potential health benefits and their relative lack of negative side-effects, omega-3 fatty acids may become an important supplement for bipolar patients and co-morbid alcoholics, a potential that warrants continued research.

Text in Afrikaans / The research question in this study involves the subjective experiences of quality of worklife (QWL) by alcoholics and non-alcoholics, in order to form an idea about the differences in such experiences, between the two groups. Personality is related throughout to QWL and alcoholism. A sample consisting of 60 alcoholics and 58 non alcoholics was used. Personality measurements were done by using Cattell's Sixteen Personality Factor Questionnaire (16-PF) whilst experienced QWL was measured with the self developed QWL-questionnaire. In order to test the hypotheses for this study, the data has been processed by using Pearson's Product-moment coefficient of correlation and t-tests. The results from the study indicate a significant relationship between personality and certain exclusive QWLdimensions for alcoholics. There is however, no significant difference in the subjective experiences of global QWL between alcoholics and non-alcoholics. Several personality factors have been identified as being related to alcoholism. / Die navorsingsvraagstuk in hierdie studie betrek die subj ektiewe ervaring van gehalte van werklewe (GWL) deur alkoholiste en niealkoholiste, ten einde 'n begrip te vorm van die verskil in sodanige ervaring, tussen die twee groepe. Persoonlikheid word deurgaans in verband gebring met GWL en alkoholisme. 'n Steekproef bestaande uit 60 alkoholiste en 58 nie-alkoholiste is gebruik. Persoonlikheidsmetings is met die 16-Persoonlikheidsfaktorvraelys van Cattell gedoen terwyl ervaarde GWL met die selfontwerpte GWL-vraelys gemeet is. Ten einde hierdie studie se hipoteses te toets, is die data verwerk deur van Pearson se produkmomentkorrelasiekoeffisient en t-toetse gebruik te maak. Die studie se resultate dui op 'n beduidende verband tussen persoonlikheid en sekere eksklusiewe GWL-dimensies by alkoholiste. Daar bestaan egter geen beduidende verskil in die subjektiewe ervaring van globale GWL tussen alkoholiste en nie-alkoholiste nie. Daar is etlike persoonlikheidsfaktore geidentifiseer wat met alkoholisme verband hou. / Industrial and Organizational Psychology / M.Com. (Industrial Psychology)

Thesis (PhD (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: There is a paucity of research documenting women’s undisclosed drinking. This study explored the discursive accounts of women’s alcohol dependence, treatment history and barriers in accessing alcohol dependence treatment. The goals of this dissertation were to explore women’s alcohol dependence history; explore women’s treatment history (or lack thereof); identify barriers and nature of barriers that limit women’s access to alcohol dependence treatment; identify the reasons for women not accessing treatment, and to interpret women’s experiences of treatment per se. A Human Scientific Approach was adopted to examine and interpret how women’s drinking is socially constructed. A social constructionist approach was utilised to access and construct meaning from the discourses emanating from the women’s narratives of their experience with alcohol and their attempts at rehabilitation. Ten women were interviewed using the life story (narrative) interview method. The findings illustrate two major discourses namely, secret drinking and inaccessibility of appropriate treatment facilities for women alcohol dependents. This means that participants feel forced to conceal their drinking and to drink secretively because of the stigma associated with women drinking heavily. The stigma they experience translates into barriers (mostly internal barriers) to seeking institutionalised treatment. This makes it easier for them to seek alternative treatment such as an anonymous fellowship, like Alcoholics Anonymous. Other discourses signify the importance of problem identification and treatment readiness. This means that if the alcohol dependent woman realises what the real problem is causing her to use alcohol as an escape or as a coping strategy, she will be more willing to address the underlying problem. Recommendations are made focusing on micro and macro-level intervention strategies such as access to treatment, public health campaigns and policies to improve the quality of life of women recovering from alcohol dependence. / AFRIKAANSE OPSOMMING: Daar is min inligting beskikbaar oor die dokumentering van vroue wat in-die-geheim alkohol gebruik. Hierdie studie het die diskursiewe weergawe van vroue se alkoholgebruik, behandelingsgeskiedenis en hindernisse tot die behandeling van alkohol-misbruik verken. Die doelstellings van hierdie verhandeling is om die volgende te verken: Vroue se afhanklikheidsgeskiedenis; vroue se rehabiliteringsgeskiedenis (of die gebrek daaraan); die identifisering van hindernisse en die aard van die probleme wat vroue se toegang tot die behandeling van alkohol-misbruik beperk; die identifisering van redes waarom vroue rehabilitering weier; en die interpretasie van vroue se belewings van behandeling per se. ‘n Humanisties-wetenskaplike benadering is gebruik om die sosiale konstruksie van vroue se drinkgewoontes te ondersoek en te interpreteer. Die verstaan van en die skep van betekenis van die diskoerse van die vroue, en die temas wat na vore gekom het vanuit hul vertellings/narratiewe van hul alkohol-ervarings en hul pogings tot rehabilitering, is binne die raamwerk van die sosiaal-konstruksionistiese uitgangspunt aangepak. Onderhoude is met tien vroue gevoer en die narratiewe metode is gebruik. Die bevindings toon twee hoofdiskoerse naamlik, drinkery in-die-geheim en die ontoeganklikheid van gepaste behandelingsfasiliteite vir vroue met afhanklikheidsprobleme. Dit beteken dat vroue ondervind dat hulle gedwing word om in-die-geheim te drink, as gevolg van die stigmatisering van vroue en oormatige alkohol-gebruik. Hierdie stigmatisering kan herlei word tot hindernisse (meestal interne hindernisse) te make met ge-institutionaliseerde behandeling. Om die rede is dit makliker vir vroue om alternatiewe behandeling soos anonieme gemeenskappe, byvoorbeeld Alkoholiste Anoniem te oorweeg. Ander diskoerse beklemtoon die identifisering van probleme en die instemming tot rehabilitering. Dit beteken dat wanneer die alkoholis die werklike probleem vir alkohol-gebruik verstaan as ‘n ontsnapping of as ‘n hanteringsstrategie, sy meer gewillig sal wees om die onderliggende probleem aan te spreek. Aanbevelings is gemaak met die fokus op mikro- en makrointervensiestrategieë, soos die toegang tot rehabilitering, openbare gesondheidsveldtogte en beleide ten einde die leef-kwaliteit van vroue in die herstelproses van alkoholafhanklikheid te verbeter.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Two recent local studies of relapse among individuals who had attended inpatient alcohol rehabilitation programmes in the Western Cape found relapse rates of up to 60%. A high incidence of comorbid anxiety, low self-efficacy and avoidant coping style were principal reasons cited for relapse. The following literary review was undertaken in an effort at better understanding current findings on the comorbid relationship between alcohol abuse/dependency and anxiety, and on dysfunctional coping styles and relapse. It also reviews current literature and theory concerning the treatment of alcoholics using the Relapse Prevention (RP) model of therapy. Based on these findings, recommendations are made for the application of RP to the clinical psychology groups run for alcohol abusing/dependent inpatients at Neuro Clinic D, Stikland Hospital, Western Cape. Relapse Prevention Therapy was selected because of its integrated approach to addressing both substance abuse and the inadequate coping styles that often render people vulnerable to anxiety, depression and relapse. It was also chosen because of the more constructive, less punitive approach it takes to substance dependence/abuse and the issue of lapses and relapse. The recommendations made in this review should not, in any way, be seen as criticism of the existing programme at Neuro Clinic D. They are, essentially, the individual reflections of the author based on the four months he spent conducting clinical psychology groups in the unit and the findings of two local studies that looked at some of the reasons for relapse following treatment in this and other local facilities. The specific focus on the groups run by clinical psychologists should also not be seen as ignoring the important and valuable work done by other professionals in the unit; notably those in psychiatry, nursing, social work, occupational therapy and pastoral care. On the contrary, information gathered by these professionals is vital to the team effort of rehabilitation, and the identification of psychosocial stressors and cognitive patterns that place people at risk of relapse. / AFRIKAANSE OPSOMMING: Twee onlangse plaaslike studies van terugvalonder pasiënte wat binnepasiëntalkoholrehabilitasieprogramme in die Weskaap bygewoon het, het terugvalkoerse van tot 60% gerapporteer. 'n Hoë voorkoms van komorbiede angs, lae sin van self-vermoë en 'n vermydende streshanteringstyl was die hoofredes aangevoer vir die terugval. Die volgende literatuur-oorsig is onderneem in 'n poging tot 'n beter begrip van huidige bevindinge oor die komorbiede verhouding tussen alkoholmisbruik/afhanklikheid en angs, en oor wanfunksionele streshanteringstyle en terugval. Die oorsig beskou ook huidige literatuur en teorie aangaande die behandeling van alkoholiste deur middel van die Relapse Prevention (RP) model (Terugvalvoorkomingsmodel) van terapie. Op grond van hierdie bevindinge word aanbevelings gemaak VIr die toepassing van RP op die kliniese-sielkundegroepe aangebied VIr alkoholmisbruikende/afhanklike binnepasiënte by Neurokliniek D, Stiklandhospitaal, Weskaap. RP is gekies op grond van sy geïntegreerde benadering tot beide substansmisbruik en die onvoldoende streshanteringstyle wat dikwels mense kwesbaar maak vir angs, depressie en terugval. Die model is ook gekies as gevolg van die meer konstruktiewe, minder strafgerigte benadering tot substansafhanklikheid/misbruik en tot val en terugval. Die aanbevelings in hierdie oorsig moet in geen opsig beskou word as kritiek op die bestaande programme in Neurokliniek D nie. Hulle is, in wese, die individuele gevolgtrekkings van die skrywer gebaseer op sy vier maande ondervinding met sielkundegroepe in die eenheid en op die bevindinge van twee plaaslike studies wat ondersoek ingestel het na sommige van die redes vir terugval na behandeling in hierdie en ander plaaslike fasiliteite. Die spesifieke fokus op die groepe wat deur kliniese sielkundiges bestuur word moet ook nie gesien word as 'n geringskatting van die belangrike werk van ander professionele mense in die eenheid nie, in die besonder dié in psigiatrie, verpleging, maatskaplike werk, arbeidsterapie and pastorale sorg. In teendeel, inligting ingesamel deur hierdie mense is lewensbelangrik vir die spanpoging van rehabilitasie, en vir die identifisering van psigo-sosiale stressors en kognitiewe patrone wat pasiënte vatbaar maak vir terugval.