Background World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017. Purpose The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan. Methods This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV television channel in Taiwan. The participants' stories were posted in Chinese, transcribed by the author, and translated from Chinese into English. Content analysis was used to identify the major themes. Results Of the 30 participants, 24 were male (80%) and six were female (20%). The major themes identified in their testimonies were: (a) Using illegal drugs related to peer recognition, lack of knowledge, and temptations; (b) drug addiction was an endless pain cycle; (c) turning points related to love, repentance, and hope; (d) drug withdrawal was related to avoiding temptation and overcoming the drug withdrawal syndrome through the Holy Spirit; and (e) outcomes were faith and new life. Conclusions/Implications for Practice In this study, people who received the gospel drug withdrawal programs expressed that their lives had changed, they had withdrawn from drugs successfully, they had become volunteers to help others, and interactions with their family had improved. These programs may be applied in the mental health nursing profession.

Objectives Many addicted pregnant patients receiving buprenorphine medication-assisted therapy (MAT) wish to discontinue this medication while pregnant. This study was undertaken to determine whether outpatient detoxification from buprenorphine during pregnancy is safe and effective when confirmed with postdetoxification urine drug screens (UDSs). Methods This case series reports the maternal and neonatal outcomes for 21 patients who ended MAT with buprenorphine while pregnant. A retrospective chart review of both maternal and newborn electronic medical records was performed to obtain results. Newborn neonatal abstinence syndrome (NAS) diagnosis, need for morphine, maternal safety and fetal/newborn complications were assessed. Maternal sobriety was documented with UDSs at the time of admission for delivery. Umbilical cord blood also was assessed for substances of abuse. An additional 182 pregnant women who lowered their buprenorphine doses but did not decide to end MAT were assessed via routine quality assurance methods. Results None of the women who stopped buprenorphine during their pregnancy as confirmed by UDSs and umbilical cord sampling delivered neonates who had NAS. Eleven patients ended MAT with medical assistance and 10 ended MAT without medical assistance. No overdoses were reported for the 182 additional pregnant patients who indicated an intention to taper buprenorphine dosage while pregnant but who did not decide to end MAT; the neonatal benefits were obtained without any identified maternal harm. Conclusions The neonates of pregnant women enrolled in an outpatient buprenorphine MAT tapering program who are able to completely stop taking buprenorphine (as documented by negative urinary drug screen) are very unlikely to have NAS. Further research will be important.

Thesis (M.S.)--Boston University / The purpose of this study is to learn to what extent the various treatments available for alcoholics and drug addicts, in addition to detoxication and drug withdrawal, were used by patients who were admitted to the Washingtonian Hospital; to ascertain to what extent social work services were used, and to ascertain, as far as possible, what services were offered by either the medical staff or the social service department but not accepted.

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

This dissertation advances our understanding of the variability and contingency of addiction treatment, a consequential social institution that simultaneously helps and regulates populations within criminal justice and healthcare systems. To do so, this dissertation draws on administrative and survey data, as well as archival and ethnographic research. I show that addiction treatment is structured by social, institutional, and historical contexts within which Americans are embedded. Together, the three chapters demonstrate the utility of venturing across time and place as a method of interrogating the distinction between care and control. Using macro-sociological theory and research, aspects of the project also help broaden our understanding of addiction treatment as vital to the enactment of contemporary state governance. I refer to this as therapeutic statecraft. Chapter 1 looks at how legal coercion is used to force people into rehab and how this practice is influenced by the interplay between state welfare and punishment systems. I find that coerced treatment is less common in states with broad and benevolent welfare systems that offer alternative pathways for residents to receive care and avoid minor encounters with the criminal justice system. Moreover, the extent to which poverty affects a state’s reliance on the criminal justice system as a referral source is contingent upon the degree of interpersonal surveillance facilitated by the broad administrative reach of state welfare systems. Furthermore, coerced treatment typically has a more disruptive, institutional character under punitive state contexts (i.e., strong-arm rehab). Chapter 2 reveals how racial disparities in state-mandated, community-based drug treatment referrals are exacerbated in places with racially punitive criminal justice systems and surveillance-oriented welfare systems. These systems work together to discreetly extend penal power in the name of recovery for a population segment. Chapter 3 examines changes in the care of sexual minorities at a specialized drug treatment facility over the past 30 years. The study finds that while staff members previously saw sexual stigma and discrimination as the source of addiction, current staff members use sexual stigma to regulate patients' "addictive tendencies," and may risk exacerbating stigma and inequality by losing sight of the broader underlying causes of addiction. Taken as a whole, the project’s findings contribute to our understanding of the significance of addiction treatment in contemporary times, particularly within the context of social policy and population management in the United States.

No / This article adopts a 'dialogical' relational perspective to explore the recently introduced initiative of coercive treatment for drug misuse in the UK. Conversational interviews were undertaken with 11 people who had been sentenced to the Drug Treatment and Testing Order. Receiving treatment for drug misuse is often storied within a motivational account that is expectant of a 'readiness to change'; such assumptions seem theoretically problematic when change is legally imposed. Therefore, moral and ethical concerns surround the introduction of this initiative, however the interview data illustrates the potential that participation might offer for the creation of 'counterstories' where a more moral self can be enacted. Our analysis suggests that this counterstory is co-constructed thus being an outcome of both self and other. Furthermore such stories appear fragile; constantly under assault from detrimental authoritative discourses that are not only part of wider social understandings around drug misuse but also permeate the policy and practice of coercive treatment.

No / This scholarly examination of the worldwide web of narcotics today provides students, social workers, health providers, law enforcement officers and policy makers with an up-to-date, overall exploration of the world of drugs. Vast resources are pumped into the 'war on drugs'. But in practice, prohibition has failed. Narcotics use continues to rise, while technology and globalisation have made a whole new range of drugs available to a vast consumer market. Where wealth and demand exist, supply continues to follow. Prohibition has failed to stem consumption and production, criminalised social groups, impeded research into alternative medicine and disease, promoted violence and gang warfare, and impacted negatively on the environment. The alternative is a humane policy framework that recognizes the incentives to produce, traffic and consume narcotics.

The striatum represents the main input nucleus of the basal ganglia, a system of subcortical nuclei critically involved into motor control and motivational processes and altered in several conditions such as Parkinson’s diseases or drug addiction. The projection neurons of the striatum are GABAergic (γ-aminobutyric acid) medium-sized spiny neurons (MSNs), and account for the large majority of striatal neurons, while interneurons represent about 10% of striatal cells. The MSNs are subdivided into two subpopulations that form two main efferent pathways: the striatonigral and striatopallidal neurons. The striatonigral MSNs project to the entopeduncular nucleus (EP) and substancia nigra pars reticulata (SNr) (direct pathway) and co-express dopamine D1 receptors (D1R) and substance P neuropeptide (SP). On the other hand, striatopallidal MSNs project to the lateral globus pallidus (LGP) (indirect pathway) and co-express dopamine D2 receptor (D2R), adenosine A2A receptor (A2AR) and enkephalin (Enk). The D1R striatonigral and D2R striatopallidal MSNs are equal in number and shape and are mosaically distributed through all the striatum. The dorsal striatum is mainly involved in motor control and learning while the ventral striatum is crucial for motivational processes. In view of the still debating respective functions of projection D2R-striatopallidal and D1R-striatonigral neurons and striatal interneurons, both in motor control and learning of skills and habits but also in more cognitive processes such as motivation, we were interested in the development of models allowing the removal of selective striatum neuronal populations in adult animal brain. Because of the mosaical organisation of the striatum, a targeting of specific neuronal type, with techniques such as chemical lesions or surgery, is still impossible. Taking advantage of new transgenic approaches, the goal of the present work was to generate and/or to initiate the characterization of genetic models in which a selective subtype of striatal neuron can be ablated in an inducible way. We used a transgenic approach in which mice express a monkey diphtheria toxin (DT) receptor (DTR) in D2R-striatopallidal or D1R-striatonigral neurons. Local stereotactic injections of DT can then induce selective neuronal ablation in functionally different striatal areas.<p>We first investigated functions of D2R-striatopallidal neurons in motor control and drug reinforcement by their selective ablation in the entire striatum or restricted to the ventral striatum. This DTR strategy produced selective D2R striatopallidal MSN ablation with integrity of the other striatal neurons as well as the striatal dopaminergic function. D2R MSN ablation in the entire striatum induced permanent hyperlocomotion while ventral striatum-restricted ablation increased amphetamine place preference.<p>We next compared respective roles of D2R-striatopallidal and D1R-striatonigral neurons in motor control and skill learning in functionally different striatum subregions.<p>Finally, to target nitrergic interneurons of the striatum, we developed a bacterial artificial chromosome genetic strain in which the cre-recombinase expression is under the control of the neuronal nitric oxide gene promoter.<p><p>Altogether, those results show that DTR expression and DT local injections is an efficient and flexible strategy to ablate selective striatum neuronal types with spatial resolution. We provide the first direct experimental evidences that D2R striatopallidal neurons inhibit both locomotor and drug-reinforcement processes and that D2R and D1R MSNs in different striatum subregions have distinct functions in motor control and motor skill learning. Those results strongly support a cell-type and topographic functional organization of the striatum and underscore the need for characterization of the specific cellular and molecular modifications that are induced in D2R and D1R MSNs during drug-reinforcement or procedural learning.<p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Thesis (MTh)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Drugs are a very real problem in South-Africa. It affects health and is endemic to societal problems. Methamphetamine, popularly called “Tik,” is relatively cheap and easy to come by. Many young people use it and become addicted - with very bad repercussions for their families and society at large. In the Bellville South area most families suffer because of this scourge and are desperately looking for help. Faith communities have no option but to address the problem. The research focuses on the Bellville-South community where numerous families struggle with the scourge, desparately looking for help. As such faith communites are challenged to get involved and address tik-addiction and the related sociao-economic problems. The leadership of the Rhenish Church in Bellville took on the challenge to live up to the needs of families and society and to provide guidance for families. It is realistic to accept that there is no easy quick-fix solution to the problem. A holistic approach is needed. Thus the congregation has to do some real soul-searching and address its being functions, identity and calling in a time like this. How can the church be a safe haven for its members and the suffering community‟s parents and children? The research took an analytical look at the congregation, describing it from different angles. It also made a study of the drug problem, focussing on Tik. From a normative angle it looked at the essence of a missional church and asked how a missional church should address these challenges. It develops a strategy to guide leadership and congregation to support the families affected by the scourge. Eventually a missional ministry should be in place that will reach out in love and care to serve the community. / AFRIKAANSE OPSOMMING: Dwelmmisbruik is ‟n geweldige probleem in Suid-Afrika. Hierdie probleem hou nie net gesondheidrisiko‟s in nie, maar veroorsaak ook ernstige en dikwels verwoestende sosiale probleme. Methamphetamine, populêr bekend as Tik, is redelik goedkoop en vrylik beskikbaar. Dit word deur talle jongmense gebruik met die gepaardgaande veelvuldige gevolge en verslawing. Dit affekteer individue, gesinne, en totale gemeenskappe. Hierdie studie fokus op die gemeenskap van Bellville-Suid waar talle gesinne worstel met die euwel en desperaat soek om hulp. Hierdie situasie van tikverslawing en gepaardgaande sosiale uitdagings daag veral die verskillende geloofsgemeenskappe uit om betrokke te raak by die aanspreek van die probleem. Ook die Rynse Kerk Bellville staan midde in die sosiaal-maatskaplik en sosio-ekonomies uitdagings en behoeftes. Die leierskap van die gemeente is soekend om hulself te bekwaam om op „n sinvolle wyse lidmate te begelei in hoe om veral die uitdagings rondom tikverslawing aan te spreek. Aangesien gesinne in besonder deur hierdie verskynsel geraak word, fokus hierdie studie op die behoeftes van gesinne. Die gemeente besef dat daar nie ‟n resep vir so iets is nie en dat die probleem holisties aangepak moet word. Die gemeente word dus verplig om baie ernstig selfondersoek te doen en na sy wese, sy identiteit en roeping te kyk. Hoe kan die gemeente ‟n veilige hawe vir sy lidmate en gemeenskap se ouers en kinders word? Die ondersoek beskryf die Rynse Kerk Bellville asook die probleem van tikverslawing in die families van die gemeente. Hoe sou daar in die lig van „n missionale teologie op die uitdagings gereageer word? ‟n Bedieningsplan word voorgestel om die leierskap en lidmate te bemagtig om ondersteunend betrokke te raak by geaffekteerde families. Die doel hiervan is om ‟n missionale bediening te vestig wat met barmhartigheid en liefde die gemeenskap dien.

Opium, the dried resin obtained from the unripe seedpods of the poppy flower, has been used for medicinal and euphoric purposes since ancient times. Morphine, the main active ingredient of opium, and other clinically useful opioid analgesics all mediate their effects through activating the mu opioid receptor. Studies involving the mu opioid receptor knockout mice showed that the interaction with the mu opioid receptor is also responsible for many notorious side effects associated with these drugs including dependence and addiction. Therefore, selective antagonists for the mu opioid receptor are needed to study its function in drug abuse and addiction. Previously, based on molecular modeling studies and the “message-address” concept, a series of 14-O-substituted naltrexone derivatives were designed and synthesized. These compounds carried an ester-linked heteroaromatic substitution at the 14-position of naltrexone which was designed to interact with the putative “address” site, that was identified in the mu opioid receptor through molecular modeling studies. The lead compound of this series was determined to have a high affinity and selectivity for the mu opioid receptor. Because the 14-O-substituted naltrexone derivatives were not very stable, the ester linkage in these compounds was replaced by an amide one and a series of 14-N-substituted naltrexone derivatives were synthesized. The affinity and selectivity of these novel naltrexone derivatives were determined in a competitive radioligand binding assay. Interestingly, the 14-N-substituted naltrexone derivatives did not maintain the high selectivity of the 14-O-substituted series. It was hypothesized that the conformational constraint introduced by the amide linker was detrimental to the mu opioid receptor selectivity. Therefore, three 14-N-substituted naltrexone derivatives which carried more flexible linkages were synthesized and evaluated. The mu opioid receptor selectivity was not recovered by introducing rotational freedom into the linker. Some of these 14-N-substitued naltrexone derivatives were determined to be mu-kappa opioid receptor dual selective antagonists. Since the mu opioid receptor antagonists are effective at treating drug addiction, while growing evidence suggests that the kappa opioid receptor antagonists may be beneficial in lowering drug cravings, these novel mu-kappa opioid receptor dual selective antagonists may find unique clinical utility in the treatment of opioid dependence.