Aims: The initial aim of this thesis was to understand the relationship between non-psychotropic medication and risk of suicidality. This was achieved by conducting a systematic review, which, among other conclusions, identified the need for improved estimation of risk of suicide and attempted suicide associated with antiepileptic drugs (AEDs). This stimulated this programme of research which sought to estimate the risk of suicide and other causes of unnatural death in people with epilepsy, the role of AEDs in fatal poisonings, the risk of self-harm in people with epilepsy and factors associated with self-harm amongst those people with epilepsy. Methods: Cohorts of individuals with prevalent epilepsy were identified separately in two population-based linked-primary care datasets: the Clinical Practice Research Datalink (CPRD) in England and the Secure Anonymised Information Linkage (SAIL) in Wales. Individuals were matched on age, gender and general practice to up to 20 people without epilepsy. The risks of cause-specific types of unnatural death (e.g. suicide, accident) were estimated using stratified Cox proportional hazards models, adjusted for level of deprivation. From each of the prevalent epilepsy cohorts, individuals with incident epilepsy, no history of self-harm and who were new users of the AEDs; carbamazepine, lamotrigine or valproate, were identified. The risk of first self-harm event associated with each AED compared to valproate was estimated using Inverse Probability of Treatment Weighting propensity score analysis. Estimates from each dataset were combined in a random effects meta-analysis. In the CPRD, the risk of self-harm in the incident epilepsy cohort versus a comparison cohort was estimated using a stratified Cox proportional hazards model. From this cohort, a nested case-control study was constructed. Individuals with a first self-harm event (cases) were matched to up to 20 people with no history of self-harm (controls). Conditional logistic regression was used to estimate the risk of self-harm associated with various factors including history of mental illness diagnoses, referrals and AED utilisation. Results: There were 44,678 and 14,051 people in the prevalent epilepsy cohorts and 891,429 and 279,365 in the comparison cohorts, in the CPRD and the SAIL respectively. Increased risks of suicide (HR 2.15, 95%CI 1.51-3.08) and accidental death (HR 2.97, 95%CI 2.54-3.48) were observed for people with epilepsy versus the comparison cohort, from the deprivation-adjusted meta-analysed estimates. Overall, AEDs were involved in 9.7% (95%CI 3.6%-19.9%) of the 62 poisoning deaths in people with epilepsy. There were 5,107 new users of carbamazepine, lamotrigine or valproate with incident epilepsy in the CPRD and 2,654 in the SAIL. No increased risk of self-harm was evident for carbamazepine (HR 1.53, 95%CI 0.89-2.64) or lamotrigine (HR 1.35, 95%CI 0.79-2.29), compared to valproate, from the meta-analysed estimates. In the CPRD, there were 11,690 individuals with incident epilepsy and 215,569 in the comparison cohort. The deprivation-adjusted hazard ratios for first self-harm event were 5.31 (95%CI 4.08-6.89) in the year following diagnosis and 3.31 (95%CI 2.85-3.84) in subsequent years. The nested-case control study derived from this incident epilepsy cohort included 273 cases of first self-harm and 3,790 controls. An increased risk of self-harm was associated with history of a mental illness diagnosis (OR 4.08, 95% CI 3.06-5.42) or referral to specialist psychiatric services (OR 3.41, 95% CI 2.63-4.43), compared to none; or being prescribed no AEDs (OR 1.47, 95% CI 1.01-2.12) or two AEDs (OR 1.84, 95% CI 1.33-2.55) in the 90 days prior to index date, compared to a single AED. Augmentation of AED treatment carried an elevated risk (OR 2.12, 95% CI 1.38-3.26) whereas there was no evidence to indicate that switching from one AED to another altered risk (OR 0.69, 95% CI 0.21-2.23). Conclusions: Compared to those without the condition, people with epilepsy are at an elevated risk of unnatural death, including suicide and accidental death, and nonfatal self-harm. The risk of self-harm is particularly elevated in the year following diagnosis of epilepsy but persists beyond this. Factors associated with increased risk of self-harm within the epilepsy population include prior mental illness and referral to psychiatric services. There was no evidence of difference in the risk of self-harm associated with carbamazepine or lamotrigine compared to valproate, but further replication of this result would be beneficial. However, treatment with multiple AEDs and augmentation of AED treatment increase the risk of self-harm within this population. These may be markers of uncontrolled epilepsy.

This thesis offers an analysis of the possible harm of death, posing three questions: Who is the subject of the harm? What is the nature of the harm? And, when does the harm take place? Epicurus demonstrates on hedonistic grounds that given the irreversible annihilation of the subject and the impossibility of experience, death cannot harm the one who dies at any time. The experience condition is central to this claim, stating that experience is necessary for harm. Despite the strength of the Epicurean inspired No- Subject Thesis, it remains counter to pretheoretical intuitions regarding the harmfulness of death. This thesis proposes an alternative justification for the belief that death is harmful by extending the possible subjects of harm to include the bereaved. It is my view that the No-Subject Thesis successfully shows that death is not harmful to the one who dies, and in support of the Epicurean position, it will be defended against variations of Thomas Nagel’s antithetical position. Nagel’s view is motivated by the belief that death is bad because it deprives the deceased of some good he or she could have had, had death taken place at a later time. Criticisms of the Deprivation Thesis relate to the effectiveness of counterexamples to the experience condition, and the challenge of the temporal location problem, given that we will assume, along with Epicurus, that death annihilates the subject. However, this thesis argues that it is a restricted understanding of the possible subjects of harm that causes the counter-intuitive conclusion of the No-Subject Thesis. By extending the possible bearers of harm to include the bereaved, and characterising the nature of the harm as the loss experienced by the bereaved, one can posit an unproblematic account of the nature and subject of the harm of death. Indeed, by identifying a living person as the subject of harm, the experience condition can be satisfied. Furthermore, a clearly delineated temporal location of the harm can be identified insofar as the bereaved are harmed from the time at which he or she learns of the death of the loved other. However, it will be argued that the harm diminishes over time, reflecting the experience of the bereaved that he or she can recover after the loss of the beloved. A defence of this position will be offered, responding to the Epicurean claim that the death of a loved other does not constitute a significant loss in virtue of the belief that individual subjects are replaceable. By extending the scope of the possible harm of death to account for the social context within which death occurs, one can retain the logical strength of the Epicurean inspired No-Subject Thesis, and yet justify the intuition that death remains a bad thing for the bereaved, giving rational grounds for fearing death in terms of social deprivation.

As ideias políticas e filosóficas que influenciaram a criação da regra da legalidade penal e do princípio da ofensividade têm origem no Iluminismo. Principalmente durante a Idade Média e o Antigo Regime, confundia-se crime com pecado e as pessoas podiam ser punidas por mero capricho do soberano, sem que existisse lei. As arbitrariedades eram gritantes. A finalidade de ambas as teorias surgidas no período da Ilustração, portanto ao pregarem que era necessária a existência de lei prévia para que alguém fosse punido (regra da legalidade) e que o crime pressupunha uma lesão a direito ou bem jurídico de terceiro (princípio da ofensividade) , era a mesma: limitar o poder punitivo. No entanto, a regra da legalidade penal foi muito mais absorvida pelo discurso dogmático-jurídico do que o princípio da ofensividade, sendo oportuno, pois, analisar as razões pelas quais isso ocorreu. Algumas delas serão analisadas neste estudo como, por exemplo, a ausência de previsão explícita desse princípio nas Constituições, a suposta incompatibilidade desse princípio com a separação de poderes e com a própria regra da legalidade penal e a insegurança jurídica que a aplicação de princípios poderia gerar. Além disso, há um fator político de destaque: a consolidação da burguesia exigia a imposição de limites formais ao poder estatal, mas não limites materiais. Outro fator importante foi o advento do positivismo criminológico, no final do século XIX, que, ao confundir crime com doença, retornou ao paradigma do direito penal do autor que havia vigorado na Idade Média. Finalmente, para demonstrar o que impediu a consolidação do princípio da ofensividade especificamente no Brasil, será analisada a influência da doutrina europeia na dogmática nacional. / The political and philosophical ideas that influenced the creation of the principle of legality and the harm principle came from the Age of Enlightenment. Mainly during the Middle Age and the Old Regime, there was a confusion between crime and sin and people could be punished simply because of the whim of the sovereign, with no law. The arbitrariness were enormous. The reason for both theories that were born at the Age of Reason which required that the legal rules would have to be declared beforehand (principle of legality) and that the crime presupposed a harm or injury to other individuals (harm principle) were the same: to limit the power of punishment. However, it can be seen that the rule of the legality has been taken by the dogmatic and legal speech much more deeper than the harm principle, being opportune then, to analyze the reasons it happened. Some of them will be analyzed in this research, for instance, the absence of this explicit principle in the Constitutions, the alleged incompatibility of this principle with the separation of powers and the legality rule itself and the legal uncertainty that the application of principles could trigger. Furthermore, there is a major political factor: the consolidation of the bourgeoisie demanded the imposition of formal limits to the power of the state, but not material limits. Another important factor was the advent of positivist criminology, in the late nineteenth century, which, by confusing crime with illness, brought the paradigm of criminal law of the author, which was applied in the Middle Ages, back. At last, to show what stopped the consolidation of the harm principle specifically in Brazil, there will be an analysis of the influence of European doctrine in the Brazilian dogmatic.

Substance use disorders (SUDs) are a serious public health concern contributing to health risks for individuals and communities. Recovery capital are client strengths associated with SUD recovery. Employment represents recovery capital associated with positive SUD treatment outcomes. However, the relationship between employment mechanisms and SUDs are not well understood. The present study investigates how specific employment variables at SUD treatment intake predict (a) successful treatment completion, (b) abstinence at six-month treatment follow-up, (c) reduced use at six-month treatment follow-up. Additionally, employment variable change is explored. A retrospective, cross-sectional investigation with logistic regression modeling to predict substance use at six-months post SUD treatment follow-up was used. Clients in the study period (1999-2016, N = 8,925) were a mean age of 31.7 (SD=11.8), mostly male (67.2%), and primarily White (86.6%). Results demonstrated that employment variables at intake predicted greater successful treatment completion, Wald χ2[36]=185.3, p<0.0001. However, greater employment strengths were predictive of maintained use at six-month follow-up rather than abstinence or reduced use. Further investigation showed, the best predictors of post-treatment recovery were months employed change (AOR=1.53, 95% CI=1.34-1.75) and days missed from work change (AOR=2.43, 95% CI=2.00-2.96). Counseling psychologists can help to improve substance use outcomes and the quality of life for those in SUD treatment by becoming involved in intervention design, consultation, and policy making that focuses on increasing employment length and reducing absenteeism due to substance use. Employment is one route to engagement that can help to improve the lives for those involved.

This study described self-injury within a general adolescent population. This study involved secondary analysis of data gathered using the middle school Youth Risk Behavior Survey (YRBS) from 1,748 sixth- and eighth-grade students in eight middle schools in a large, southeastern county in Florida. A substantial percentage of students surveyed (28.4%) had tried self-injury. The prevalence of having ever tried self-injury did not vary by race or ethnicity, grade, school attended, or age but did differ by gender. When controlling for all other variables in the multivariate model including suicide, having ever tried self-injury was associated with peer self-injury, inhalant use, belief in possibilities, abnormal eating behaviors, and suicide scale scores. Youth who knew a friend who had self-injured, had used inhalants, had higher levels of abnormal eating behaviors, and higher levels of suicidal tendencies were at increased risk for having tried self-injury. Youth who had high belief in their possibilities were at decreased risk for having tried self-injury. During the past month, most youth had never harmed themselves on purpose. Approximately 15% had harmed themselves one time. Smaller proportions of youth had harmed themselves more frequently, including two or three different times (5%), four or five different times (2%), and six or more different times (3%). The frequency of self-injury did not vary by gender, race or ethnicity, grade, or school attended. Almost half of students surveyed (46.8%) knew a friend who had harmed themselves on purpose. Peer self-injury demonstrated multivariate relationships with gender, having ever been cyberbullied, having ever tried self-injury, grade level, and substance use. Being female, having been cyberbullied, having tried self-injury, being in eighth grade, and higher levels of substance use placed youth at increased risk of knowing a peer who had self-injured. Chi-squared Automatic Interaction Detection (CHAID) was used to identify segments of youth at greatest and least risk of self-injury, frequent self-injury, and knowing a friend who had harmed themselves on purpose (i.e., peer self-injury).

Denna uppsats behandlar ett antal stigmatiserade individers möjligheter att återinträda i samhällsgemenskapen efter ett liv i missbruk eller på institution. Detta har skildrats genom individernas livsresa, från inspärrning/inskrivning på totala institutioner till det vakuum som uppstår när de blivit frisläppta eller utskrivna, och vad de därefter har för möjligheter att förändra sin identitet och bli en del av samhällsgemenskapen. Vi har inriktat oss på en verksamhet, som fångar upp personer i ett mellanläge, efter inspärrning men före samhällsintegrering. Verksamheten har till skillnad från statliga behandlingsverksamheter en acceptans för Harm Reduction. I tidigare forskning har vi beskrivit missbruksvården och den svenska narkotikapolitiken. Studien utgår ifrån en kvalitativ metodik och det perspektiv vi antagit är symbolisk interaktionism. Vi har använt oss av teorier kring totala institutioner, stämpling och identitet. Som metod använde vi den hermeneutiska. I studiens slutsats framkom det att nolltoleransen inte alltid fungerar som ett sätt för individer med missbruksproblem att återinträda i samhällsgemenskapen. Det framkom att Harm Reduction istället kan skapa vissa möjligheter för dessa individer. Till sist framkom det även att våra informanter formas av institutioner. / This essay relates with some stigmatized individuals' opportunities to re-enter the society after a life of addiction or at an institution. This has been portrayed by the individual's life journey from imprisonment/enrollment in total institutions, to the vacuum that occurs when they have been released or discharged, and what they then have for opportunities to change their identity and become part of the society. We have focused on an organization that captures people in its mid-position after imprisonment but before social integration. The organization has, unlike other public treatment centers, an acceptance of Harm Reduction. In previous research, we have described addiction-treatment and the Swedish drug policy. The essay is based on a qualitative methodology and the perspective we have adopted is symbolic interactionism. We have used the theories of total institutions, labeling, and identity. As the method we used the hermeneutic. The study concludes showed that zero-tolerance does not always work as a way for individuals with addiction problems to re-enter the society. It was revealed that Harm Reduction instead may create some opportunities for these individuals. Our final conclusion was that our informants were shaped by institutions. / Zero-tolerance, Harm Reduction, Labour, Identity, Addiction, Self-image, Integration, Institution

Addiction to opiates is a complex public health issue affecting thousands of Canadians. Methadone Maintenance Treatment (MMT) is considered the gold standard in Canada, and the world, for treating opiate dependence. In the past, Canadian research into opiate addiction and the effectiveness of MMT has mostly focused on larger cities: Toronto, Montreal, and Vancouver. This community based research study employed a mixed method approach to gain understanding of the experiences and satisfaction with MMT and other health services available to opiate users in Belleville, Ontario (population 48,000). Surveys (N = 53), focus groups, participant-observation methods and key informant interviews were used to gather data. The results provide an overall picture of the quality of life for opiate users and MMT clients, the quality of care clients receive, and the perceptions of community members regarding MMT. Challenges related to smaller locales are identified along with recommendations for improving MMT health services. / UOIT

The purpose of this study is to describe how, and if, discourses about self-harm in young people has been changed from the late 90-s until today. We chose to do this by studying films where the content of self-harm is a big factor. The study is built on a narrative research, we did however analyze it as a discourse method. The issues we have concentrated on are: Is there a significant quality that describes an individual who cut themselves? How can this phenomenon be seen from a gender point of view? Is there a specific group of people who is labeled as a person who cut themselves from the public? The result from this study show us that self-injury, from symptoms of a (bad) mental state, is a strong discourse where the views from the society lets it become more acceptable. However, there are other reasons for self-harm that is developed by the social difficulties, which is illustrated in these films. Norms and beliefs around what is male or female have not been changed from the beginning of the time period we have studied until today. Self-mutilation is still seen as a typical female thing – a woman problem. The persons who are pointed out as cutting themselves are typical white, young, dramatic girls. These girls also exhibit depth - and shame for the problem and its environment.

Tobacco remains the leading preventable cause of death in the world, and 5 million people worldwide continue to smoke. Further adding to the problem is the fact that smoking cessation rates are very low, and there are some smokers for whom quitting smoking is extremely difficult. Many smokers find nicotine replacement therapy (NRT) products unappealing, and even when used as directed NRTs only achieve modest cessation rates. Smokeless tobacco (ST) may be more appealing than NRT and deliver nicotine in a more palatable way to cigarette smokers. ST is also far less harmful than smoking. It is for these reasons that many scientists and health professionals have suggested the use of ST as a substitute for smoking to reduce tobacco-related harm. Although the health risk posed by ST appears to be much less than conventional cigarettes, the extent to which ST may serve as a harm reduction product is highly contentious. Furthermore, although ST products are legal and widely available, it remains unclear whether conventional cigarette smokers in Canada will use ST products as a substitute for cigarettes or as a cessation aid, if at all. And despite the strong evidence for the effectiveness of cigarette warning labels, there is little research on ST health warning labels. The current study investigated perceptions of ST products with and without HWLs and relative health risk messages among 611 young adult Canadian smokers aged 18-30. The study sought to examine the impact of ST health warning labels (HWLs) on appeal, willingness to use, and perceived health risk and addictiveness. Participants completed a survey during which they were asked to view and provide their opinions on a series of ST packages that were digitally altered according to each of six experimental conditions: (1) "standard" packages of leading ST brands, (2) "standard" packages + a relative risk message about the harm of cigarettes compared to ST added, (3) "Standard" packages + text HWL, (4) "Standard" packages + text HWL and relative risk message, (5) "Standard" packages + picture HWL, and (6) "Standard" packages + picture HWL and relative risk message. The findings indicate that many smokers are unaware that ST is less harmful to health compared to smoking. Despite this, approximately half of young adult Canadian smokers indicated that iv they were willing to try ST as a substitute for smoking and to help quit smoking. Picture warnings increased misperceptions about the health risk of ST and decreased smokers‘ willingness to try ST, whereas text warnings did not. Similarly, adding a relative health risk message to the warning label that communicates the lower risk of ST compared to cigarettes increased willingness to try ST when added to text warnings, and decreased willingness to try ST even further when added to picture warnings. This study is among the first to examine ST warning labels, and is the first to examine the impact of picture warning labels on ST. Overall, the findings suggest picture warnings may make it more difficult to communicate the differences in risk between ST and cigarettes.

In this thesis I will explore the relationship between Nozick’s self-ownership principle and freedom. I will defend G.A. Cohen’s critique of self-ownership and try to show how his argument that self-ownership is hostile to genuine freedom presents a problem for Nozick. I think it is clear that Nozick’s self-ownership does little to protect a meaningful sort of freedom; and a meaningful sort of freedom is exactly what Nozick aims to protect. This is true because eudaimonistic moral beliefs ought to undergird Nozick’s self-ownership thesis, and self-ownership can therefore be assessed in light of whether it actually promotes human flourishing in the relevant ways. This undergirding eudaimonism becomes clear when we see that self-ownership is intended to protect the ability of each individual to pursue and act upon her own conception of the good.