Opioid morbidity and mortality and suicide are two current and central public health problems in the U.S. Both have continuously increased in the last two decades, and disproportionately affected some groups more than others, leading to the suggestion that these epidemics are connected. However, there is little evidence on the potential role that the opioid epidemic had on the rise of suicides. The overarching goal of this dissertation was to advance our understanding of the effects of the opioid epidemic on the rise in suicide rates in the U.S. First, a systematic review of the literature was conducted to critically evaluate the evidence on the effects of different opioid exposures on suicidal outcomes (e.g., suicidal ideation, attempts and suicides). There was ample evidence of individual-level associations between opioid use and related abuse/ dependence on suicidal outcomes. In contrast, the gap in the literature on group-level effects was clear, with only two studies examining these effects and showing that opioid availability was associated with suicide behavior in different populations. Several limitations were also identified in the reviewed studies that could partially explain the observed associations, indicating the need for further research. Second, the individual-level effects of prescription opioids nonmedical use and related abuse/ dependence on persistence and onset of suicidal ideation and attempts were examined. Longitudinal data from a national representative sample of the adult U.S. population was used to examine these associations. Results showed that heavy/ frequent use of prescription opioids and related abuse/ dependence had an effect on persistence and onset of suicidal ideation and persistence of attempts. However, none of these exposures were associated with onset of suicide attempt. Overall, these findings suggest that by increasing the number of those using prescription opioids and with opioid abuse/ dependence, and in turn the number of those with suicidal ideation/ behavior, the prescription opioid epidemic could have led to increases in suicide rates in the population. Finally, the group-level (i.e., state level) effects of three state level exposures, i.e., increasing trends in the per capita volume of prescription opioids, in the nonmedical use of these drugs, and in unintentional fatal opioid overdoses, on the increase in suicide rates were examined. For this, pooled cross sectional time series data from the 50 states (1999-2016) were used in linear regression models with state and year fixed effects. Although the volume of prescription opioids and the rate of fatal opioid overdoses increased over the study period, the prevalence of nonmedical use of prescription opioids decreased in most states. Results showed that the rate of unintentional fatal prescription opioid overdoses was associated with an increase in the rate of suicides. The range of effects sizes compatible with the data also suggested that the increase in the per capita volume of prescription opioids was linked to increases in suicide rates. Overall, this dissertation increased our understanding of the possible role that the opioid epidemic played on the increase in suicide rates in the U.S. As public efforts continue to fight the opioid epidemic, these findings can help inform future research that will guide the development of suicide prevention strategies and approaches to reduce the burden that the opioid epidemic poses on communities.

<p>This essay will focus on drug addicts and the world as they see it. The essay is based on intervjues with three men and one woman and participant observation of the three men´s social life in the surroundings of Stockholm. The informants’ opinions and experiences are central as well as the observations made of them during an intensive fieldwork. The study which was of an exploring character has revealed a complex relationship between the informants and society. The concepts of subculture and stigmatization seem equally central in the social life and perception of life of these drug addicts. The intricate relationship between the two needs further study before a model of the interrelationship can be presented. In a final discussion of the results of the study with the informants they confirm that they see themselves both as part of a subculture and stigmatized by society.</p><p>The study also includes some ethical reflections on the role of the investigator in relation to informants who are drug addicts.</p>

<p>Denna studie syftar till att undersöka hur man som förälder påverkas av att ha ett barn som missbrukar narkotika, vilket stöd föräldrarna har fått från olika instanser de har kommit i kontakt med i samband med barnets missbruk samt vad som skulle utgöra det optimala stödet enligt föräldrarna. Med studiens syfte som utgångspunkt valdes en kvalitativ forskningsansats och insamling av empiriskt material skedde genom semistrukturerade intervjuer. Tidigare forskning inom området är tydligt begränsad, dock visar forskning som finns att stöd till anhöriga är ett eftersatt område. Studiens resultat visar att föräldrarnas vardagsliv har påverkats dramatiskt då barnets missbruk har fört med sig negativa konsekvenser både praktiskt, ekonomiskt, känslomässigt och socialt. Resultatet visar på en brist av stöd från framförallt socialtjänsten. Enligt föräldrarna kan det optimala stödet utgöras av tidiga insatser, samverkan mellan de instanser de kommer i kontakt med i samband med barnets missbruk samt att få träffa andra föräldrar med liknande erfarenheter.</p> / <p>This study aims to examine how parents are effected by having a child addicted to drugs, what support have the parents received from instances they been in contact with regarding the child's addiction and what constitutes the best kind of support according to the parents. Based on the aim of the study a qualitative research approach was chosen and collection of the empirical data was made through semi-structured interviews. Previous research on the area has shown an obvious limitation. Existing research confirm however that support for dependants is a neglected area. The result of the study show that the everyday life for the parents has been dramatically affected as the drug addiction of the children has lead to negative consequences in terms of practical, economical, emotional and social areas. The result also shows a lack of support, mainly from the social services. According to the parents the best support can be obtained by early interventions, cooperation between the instances in current contact for the parents in connection with the child's drug abuse and the opportunity to meet parents with similar experiences as themselves.</p> / VG

This essay will focus on drug addicts and the world as they see it. The essay is based on intervjues with three men and one woman and participant observation of the three men´s social life in the surroundings of Stockholm. The informants’ opinions and experiences are central as well as the observations made of them during an intensive fieldwork. The study which was of an exploring character has revealed a complex relationship between the informants and society. The concepts of subculture and stigmatization seem equally central in the social life and perception of life of these drug addicts. The intricate relationship between the two needs further study before a model of the interrelationship can be presented. In a final discussion of the results of the study with the informants they confirm that they see themselves both as part of a subculture and stigmatized by society. The study also includes some ethical reflections on the role of the investigator in relation to informants who are drug addicts.

Denna studie syftar till att undersöka hur man som förälder påverkas av att ha ett barn som missbrukar narkotika, vilket stöd föräldrarna har fått från olika instanser de har kommit i kontakt med i samband med barnets missbruk samt vad som skulle utgöra det optimala stödet enligt föräldrarna. Med studiens syfte som utgångspunkt valdes en kvalitativ forskningsansats och insamling av empiriskt material skedde genom semistrukturerade intervjuer. Tidigare forskning inom området är tydligt begränsad, dock visar forskning som finns att stöd till anhöriga är ett eftersatt område. Studiens resultat visar att föräldrarnas vardagsliv har påverkats dramatiskt då barnets missbruk har fört med sig negativa konsekvenser både praktiskt, ekonomiskt, känslomässigt och socialt. Resultatet visar på en brist av stöd från framförallt socialtjänsten. Enligt föräldrarna kan det optimala stödet utgöras av tidiga insatser, samverkan mellan de instanser de kommer i kontakt med i samband med barnets missbruk samt att få träffa andra föräldrar med liknande erfarenheter. / This study aims to examine how parents are effected by having a child addicted to drugs, what support have the parents received from instances they been in contact with regarding the child's addiction and what constitutes the best kind of support according to the parents. Based on the aim of the study a qualitative research approach was chosen and collection of the empirical data was made through semi-structured interviews. Previous research on the area has shown an obvious limitation. Existing research confirm however that support for dependants is a neglected area. The result of the study show that the everyday life for the parents has been dramatically affected as the drug addiction of the children has lead to negative consequences in terms of practical, economical, emotional and social areas. The result also shows a lack of support, mainly from the social services. According to the parents the best support can be obtained by early interventions, cooperation between the instances in current contact for the parents in connection with the child's drug abuse and the opportunity to meet parents with similar experiences as themselves. / VG

Aquest treball pretén presentar un primer model en relació a la conducta autolesiva que es dona al medi penitenciari tenint en compte les relacions que poden haver entre la conducta autolesiva en el medi comunitari i el medi penitenciari així com poder confirmar els tipus de conductes autolesives d’altres treballs. En aquest treball es fa primer una revisió de les diferents definicions de conductes autolesives i la seva classificació així com els diferents models explicatius. Tot seguit fem una revisió bibliogràfica dels diferents treballs que relacionen les autolesions i diferents trastorns psicopatològics, així com de la seva incidència a les presons. A continuació s’elabora una proposta de model amb el capítol de metodologia, amb especial èmfasi amb els participants, instruments i procediment emprat. Els resultats s’analitzen i es presenten en el capítol 7 i la discussió i les conclusions en el capítol 8.

Thesis (Ph.D.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references ([399]-463). Also available via the World Wide Web.

Thesis (D. Min.)--Gordon-Conwell Theological Seminary, Charlotte, NC, 2003. / Abstract and vita. Includes bibliographical references (leaves 131-135).

published_or_final_version / Social Work and Social Administration / Master / Master of Social Sciences

This is an ethnographic account of peer learning among a group of heroin 'addicts' in Delhi, India. This study responds to the limited attention given to 'naturalistic' or 'informal' peer learning patterns in the educational literature, and the lack of explicit exploration of the phenomenon among drug user populations. The study involved seven and a half months of fieldwork with the predominant use of participant observation and semi-structured interviews to generate data. Analysis was inductive and interpretive with the use of situated learning theory to 'tease out' patterns in the data. The participants were using and non-using addicts affiliated to SHARAN, a non-governmental organization (NGO) in the religious marketplace of Yamuna Bazaar. The group included approximately 300-500 members, 20 of whom were main informants. Analysis of the group organization revealed community-based and masculinity-based characteristics that enabled the group to manage stigma, promote 'positive' ideals, and co-construct nonhegemonic masculinities. Peer-based outreach was identified as a form of 'institutional' peer learning in which peer educators performed the roles of 'doctor', 'role model', and 'counsellor' during interactions with 'clients' that had the effect of disempowering clients in many cases. The practice of poetry in which peers created couplets in alternating exchanges was identified as one form of naturalistic peer learning that entailed processes of legitimate peripheral participation, meaning negotiation, and reflective learning. Street 'doctory' in which peers provided medical care in the form of procedures, illness discussions, and health consultancy was identified as another naturalistic peer learning pattern involving processes of legitimate peripheral participation, meaning negotiation, and learning through teaching. These findings suggest that naturalistic peer learning involved co-participatory processes that manifested in a diversity of everyday practices. It is recommended that engaging these processes and practices would be useful for interventions, while further research should explore such patterns in other contexts.