Thesis (M.S.), Wellness Management--University of Central Oklahoma, 2008. / Includes bibliographical references (leaves 56-58).

Thesis (M.S.), Wellness Management--University of Central Oklahoma, 2008. / Includes bibliographical references (leaves 56-58).

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 103-121).

The aim of this diploma work is to explore tactics which would help serve as a preventive measure from inpatients inflicting self-harm. This work was conducted in selected psychiatric departments throughout the Czech Republic by using an anonymous questionnaire investigation. Only fifty percent of the departments have internal guidelines for detection of at risk patients. Eighty-eight percent of departments have an internal system for reporting extraordinary events. Many of these departments have advanced technical equipment, but there are still some departments with technical equipment at lower levels, probably due to the high costs associated. Only two departments are using scales for evaluation of admitting patients. Fifty percent of the departments evaluate risks of self-harm for admitting patients. Self-harm was present in all departments in this study; seventeen percent of departments did not report any number of suicide attempts and forty two percent of the departments did not report any number of the self-harm attempts. The results are showing a positive trend in the role of prevention, as well as increasing the safety level within individual departments. The data are also showing that not all of departments are taking sufficient measures to ensure prevention. Clear evidence of self-harm and suicide...

Self-harm and suicide is more prevalent within the prison environment than in community samples, with those in the first weeks of imprisonment at greatest risk. Descriptions and evaluations of static risk factors (e.g. mental health diagnosis) dominate the empirical literature with few dynamic (e.g. defeat) and protective factors (e.g. resilience) evaluated. Additionally, current research is largely atheoretical and the integration of existing knowledge into a unifying model may improve the predictability of assessment. In the current research Williams and Pollock’s cry of pain model provided the template for assessing predictors of self-harm or suicide. For three months, all new arrivals at a local prison were invited to complete baseline questionnaires to assess factors derived from the cry of pain model. It was hypothesised that the factors derived from the model (perceived stress, defeat, entrapment and absence of rescue factors) would be predictive of self-harm and suicide risk and would distinguish prior self-harmers from non self-harmers. Two hundred and seventy prisoners participated in the study. Prisoners with active psychosis and non-English speakers were excluded. All participants were followed up for four months for instances of self-harm. Eighteen participants engaged in self-harm during this period. The hypotheses derived from the model were supported in the prediction of future engagement in self-harm in prison and had some support in identifying those who engaged in previous self-harm and those at risk of suicide. Additional research is needed to confirm the factor structure of defeat and entrapment and the presence of ‘scripts’ as relevant factors in the cry of pain model. The 3 implications for practice are discussed including the identification of patterns of risk linked with self-harm and suicide. The measures utilised in the study were shown to be largely valid within this population. Methodological limitations are discussed together with their implications for future research.

There has been a well-documented and causal relationship between cigarette smoking and disease for over forty years, and at least an implicit concern over tobacco and health for decades, if not centuries prior; however, government policy on how to address tobacco as a public health issue has been erratic. At the turn of the twentieth century, when cigarettes first became a national phenomenon, the federal government imposed few if any regulations, and even encouraged the use of cigarettes. By the 1960s, government, public health entities and the tobacco industry were cooperating to try to fix the problem. Although there was great success in this early, if uneasy alliance, by the 1980s this coalition was fragmented and the search for a pragmatic solution to the tobacco problem came to an abrupt end. This dissertation is an investigation into how policy-makers, tobacco industry executives and public health officials each ignored opportunities to come to a practical solution to the problem which confronted them. The 1960s saw these groups work together to formulate a harm reduction policy approach which would lessen, if not eliminate, the concerns from each constituent group. Despite some significant early successes, this effort was derailed due to partisan positioning, misguided self-interest, and certain individual personalities. This analysis of the safer-cigarette campaign sheds light on a little explored avenue in the tobacco debate, as well as highlights the challenges of policy making in Washington.

Background A growing body of research suggests the therapeutic use of cannabis may affect the use of other substances, including reducing the use of alcohol, tobacco and prescription drugs such as opioid analgesics. However, most of the evidence stems from small, cross-sectional surveys or population-level studies, both of which have significant limitations, including the inability to conclusively determine causality for behavioural changes. Furthermore, very little detail has been gathered on the factors that potentially impact substitution, including patient characteristics and patterns of cannabis use (e.g., X, Y, Z). Additionally, despite consistent calls by physicians, academics, patients and policy-makers around the globe citing the need for high quality studies to identify the risks and benefits of cannabis in both medical and non-medical applications, there are many pre-existing and ongoing challenges to conducting such research. These include shifting regulatory policies that may be impacting access to cannabis for both medical and non-medical use, and that could ultimately be affecting patient retention in prospective medical cannabis studies. In the interest of learning more about how the use of cannabis effects the use of alcohol, tobacco and other substances, and to better understand factors that may be impacting retention in prospective cannabis research, I designed and conducted two studies: 1. The Canadian Cannabis Patient Survey 2019 (CCPS 2019) was a national cross-sectional survey of 2102 Canadian medical cannabis patients that examined demographics, patient patterns of cannabis use, and self-reported changes in the use of alcohol, tobacco, prescription drugs and illicit substances following medical cannabis initiation. 2. The Tilray Observational Patient Survey (TOPS) was a prospective, multi-site, observational study examining the impact of medical cannabis products on quality of life and the use of prescription drugs of 1145 patients over a 6 month period, which provided an opportunity to conduct a survival analysis and other analyses to assess variables potentially impacting retention in longitudinal cannabis studies. Methods This dissertation includes three analyses of the data resulting from these studies in the form of one published and two submitted manuscripts. The first paper provides an overview of research to date examining the impact of cannabis and cannabinoids on alcohol use, followed by an analysis of the 973 CCPS 2019 participants who either previously or currently use alcohol. The questionnaire gathered a detailed inventory of alcohol use prior and post medical cannabis initiation using two separate but related measures: drinking days per month, and standard drinks per week. The analyses used descriptive statistics as well as univariate and multivariate regression analyses to explore patient characteristics and other variables potentially associated with changes in alcohol use post medical cannabis, including assessing the impact of “intent” to use medical cannabis to reduce alcohol use, as well as participation in other substance use treatment modalities. Findings suggest that medical cannabis initiation is associated with significant reductions in alcohol use, and that younger age (<55 years of age), specific intent to use medical cannabis to reduce alcohol use, and greater patterns of alcohol use prior to medical cannabis initiation were associated with greater odds of reducing alcohol. The second paper follows a similar methodology and format as the first paper, but with a focus on tobacco/nicotine (T/N) use. In this case, 650 survey participants reported past or current T/N use, and the analysis focused on assessing patient characteristics and other variables associated with changes in T/N uses per day, with the primary outcome of interest being no use in the 30 days prior to the survey, which was considered to be complete cessation of T/N use. The findings suggest that odds of T/N cessation were greater amongst those who were age 55 or older or that reported >25 T/N uses per day prior to initiating medical cannabis use, and that specific intent to use medical cannabis in T/N reduction/cessation efforts resulted in significantly greater odds of reducing T/N use, while involvement with traditional T/N cessation treatments (pharmacological or psychobehavioral) was negatively associated with T/N cessation. The third paper addresses the challenge of retaining patients in prospective observational medical cannabis studies at a time when there are major policy changes disrupting the legal supply while also increasing access options for adults who use cannabis. The Tilray Observational Patient Study (TOPS) was one of the largest national prospective medical cannabis studies ever conducted, taking place at 21 medical clinics in five provinces. The study was designed to assess the impact of medical cannabis on quality of life and prescription drug use over a six month period. However, initial data analysis on 1145 patients enrolled at/before Oct 15, 2018 that had completed at least one post baseline visit highlighted a significant rate of patients that were lost to follow up (LTFU). This high drop out rate, coupled with a compensation scheme that provided credits to help cover the cost of medical cannabis led to concerns of potential retention bias limited the conclusions that could be drawn from this data. However, the study and resulting data provided a unique opportunity to examine baseline patient characteristics that may have been protective of LTFU, so a survival analysis was conducted on this cohort. Additionally, since the study took place during the official launch of the legalization of adult non-medical use of cannabis in Canada on Oct. 17th, 2018, the potential impact of this significant increase in legal access options on the odds of study retention was the subject of additional analyses. The survival analysis found that baseline use of antidepressants or antiseizure medications, citing no preference for either THC or CBD, and inhalation as a primary method of use were associated with increased probability of survival/retention in the study at six months. Additionally, while the legalization of non-medical adult cannabis use in October 2018 resulted in more than three times the odds of participants being LTFU at six months, being under 55 years old, having a preference for THC, or citing inhalation as a primary method of use was partially protective of LTFU following legalization. Discussion The studies in this dissertation presented an opportunity to gather subjective and objective data on naturalistic patterns of medical cannabis use from large, heterogeneous cohorts of patients, and to explore associated impacts on the use of alcohol, tobacco and other substances. The results of these studies provide a more comprehensive understanding of the public health risks and benefits associated with the medical use of cannabis, and could subsequently inform policy decisions affecting access to cannabis vis-à-vis other drugs, private and public payer considerations related to cost-coverage for medical cannabis, and potentially lead to the development of novel alcohol and tobacco cessation strategies. Additionally, the survival analysis conducted on TOPS participants highlights some of the challenges of conducting medical cannabis research at a time when patients have a multitude of cannabis access options, including legal adult dispensaries and a still robust illicit market. Future longitudinal medical cannabis studies should consider the potential impact of policy changes effecting cannabis access on study retention/survival, and may want to focus on patient populations with characteristics associated with lower odds of LTFU. / Graduate / 2022-03-09

Background: Suicide is the second leading cause of death among 15 to 29 year olds and 79% of global suicides occur in low- to-middle income countries. South Africa has the eight highest rate of suicide in the world, evidence that suicide is a serious public health concern. Identifying socio-demographic and clinical factors associated with high risk of serious self-harm or suicide, may be useful for improving patient care and strengthening appropriate referral pathways. Aim: To determine the sociodemographic and clinical factors associated with elevated levels of suicidal intent among self-harm patients who presented for treatment in the emergency room of an urban hospital in Cape Town, South Africa. Setting: A retrospective folder review of all patients who presented for treatment of deliberate self-harm to Groote Schuur Hospital. Methods: During the time period, 238 consecutive presentations for deliberate self-harm were identified and recorded on a data capture form.which obtained information about demographics, clinical characteristics and suicidal intent. The data was analysed using bivariate and multivariate analyses. Results: In our sample of 238 patients, 128 (54%) self-reported an elevated level of suicidal intent. Being of male gender, higher levels of education and having multiple reasons for selfharm were significant predictors of an elevated level of suicidal intent. Conclusion: Suicide is increasingly recognised as a serious public health problem globally, and in South Africa. Determining the socio demographic and clinical correlates for those at increased risk of suicidal behaviours, provides useful information on identifying vulnerable patients. This allows clinicians to improve patient risk assessment and public health awareness interventions may be closer targeted to at risk groups

BACKGROUND: Historically, the addiction field used total abstinence as the primary marker of recovery. Although harm reduction is increasingly accepted, abstinence remains a primary treatment outcome and central goal of mutual aid groups. Recovery research often measures success primarily in terms of abstinence. This focus limits knowledge about recovery progress and outcomes for non-abstinent individuals and the field’s ability to support this population. This dissertation advances research in the field because it studies a community, rather than a treatment sample; it focuses on early recovery, which is a crucial period in the recovery trajectory; and studies a rarely researched population – individuals who identify as having resolved an addiction and are non-abstinent. AIMS: This three-paper dissertation explores insights into the perceptions of individuals in a community sample about their experiences in early recovery. The first two papers used data from a survey to achieve the following aims: (1) Recruit a sample of abstinent and non-abstinent individuals with diverse substance use and treatment histories; (2) Compare abstinent and non-abstinent participants’ responses to the pre-screen questionnaire; (3) Compare participants’ addiction and treatment history and mental health and wellness (e.g., depression and difficulty regulating emotions) by abstinence-status. The third paper used interview data to achieve the following aims: (1) Explore motives for cannabis substitution; (2) Describe the experience of using cannabis; and (3) Examine whether cannabis use supported or harmed recovery. METHODS: The Socioecological Framework and Harm Reduction principles provided the theoretical and philosophical underpinnings for this dissertation. Participants completed online surveys about substance use, mental health, and life experiences known to impact recovery (e.g., addiction-stigma, racial and ethnic discrimination). Individuals were eligible for the study if they self-identified as having “resolved an addiction” evidenced by (1) reduced use, OR (2) reduced negative consequences, OR (3) improved social or occupational experiences. I recruited interview participants by posting advertisements on Facebook and Reddit in groups specifically related to addiction and recovery. Participants were eligible who reported that they had resolved an addiction to opioids or stimulants and subsequently increased their cannabis use (i.e., cannabis substitution). I analyzed the pre-screen questionnaire data via content analysis. Descriptive statistics and regression models were computed in SAS. I took a grounded theory approach to analyzing the interview data. First, I coded the data deductively for motivations in the Motivational Model and characterization of substitution effects. Then I coded inductively for emergent themes including additional motives (e.g., to manage withdrawal). RESULTS & DISCUSSION: Criteria for self-identification of resolving an addiction successfully enrolled abstinent and non-abstinent adults (N=267). Forty-five percent reported abstinence; the most common primary substances were alcohol (46%), opioids (23%), and stimulants (17%). Surprisingly, pre-screen responses about resolving an addiction did not differ according to abstinence-status. In bivariate analysis, abstinent participants had more often been to treatment and mutual aid groups, however there was no difference in past use severity. In regression modeling, abstinence-status was not associated with depression, though it was associated with difficulty regulating emotions. These results suggest that abstinence-status affects distinct mental health outcomes differently, and that positive recovery experiences may be achievable in some domains for non-abstinent adults. In paper three, interview participants (N=14) revealed a series of motives for cannabis use, including those identified in the Motivational Model and those that emerged from the data. Participants viewed cannabis use as compatible with their recovery. Though many participants reported negative side effects, for example increased social anxiety, they did not believe these outweighed the benefits of cannabis use. CONCLUSIONS: Counter to common assumptions in the addiction field about the necessity of abstinence in recovery, survey responses from both abstinent and non-abstinent participants proved to be more similar than different. Insight into how these groups perceive the process of resolving an addiction (1) enhance our understanding of recovery, including non-abstinent recovery, and (2) can facilitate engagement with individuals resolving addictions, even when abstinence is not one of their identified goals. The interview data offered additional insights into the role of cannabis in non-abstinent recovery, demonstrating its potential to support individuals during cravings. Clinicians in addiction treatment settings and other medical and mental health settings who see clients who are working on recovery can benefit from the findings reported here by supporting their clients regardless of the client’s abstinence goals. / 2025-10-24T00:00:00Z

no / Background: Self-harm (self poisoning and self-injury) is broadly characterised as any act intended to harm one's own body, without a conscious intent to die. Research indicates that when practitioners encounter self-harm they often remain anxious, fearful, frustrated, and challenged about such individuals, principally because they are constrained to understand and respond to self-harm almost exclusively within a problematised discourse (Walker, 2006). That is, a problem that must be diagnosed and contained. Women who self-harm with a diagnosis of BPD are often portrayed as being risky, chaotic and their identity can be unstable. The aim of this study was to examine and explore the subjective experiences of women who self-harm with a diagnosis of BPD. Participants: Four women who had a history of self-harming behaviour with the diagnosis of BPD volunteered for the study. Method: Face-to-face, in-depth narrative interviews were undertaken and were analysed within a framework which drew upon aspects of the ¿performance¿ (Langellier, 1989; 2001) and ¿narrative thematic¿ approaches (Reissman, 1993). Findings: Two of the participant's accounts illustrate how their self-harming appeared to have affected their selfhood and sense of agency. They discuss how the external signs of self-harm may take over their identity and how others communicate and interact with them. Despite the problematic nature of self-harm implications for practice are highlighted which practitioners may draw upon in their work around self-harm.