Syftet med studien var att undersöka hur personer med ett injektionsmissbruk, som medverkade i sprututbytesverksamhet i Sverige, upplevde att deras livskvalitet blivit annorlunda. Vidare undersöktes också vilka insatser de blivit erbjudna och om de upplevde att de hade ett minskat riskbeteende. Frågeställningarna som användes i studien för att undersöka detta var:  Vilka insatser inom sprututbytesverksamheten erbjuds personer med injektionsmissbruk att ta del av?  Hur använder sig personer som medverkar i sprututbytesverksamhet av den kunskap de erhåller om hur de ska minska sitt riskbeteende?  Hur upplever personerna som deltar i sprututbytesverksamheten att deras livskvalitet blivit annorlunda? För att kunna svara på frågeställningarna användes en enkät som skickades till sprututbytesverksamheter i Sverige. De centrala begrepp som går att återfinna i studien är harm reduction och livskvalitet och dessa begrepp är väsentliga när det gäller konstruktionen av enkäten i relation till syfte och frågeställningar. Slutligen inkom 15 stycken enkäter av de 60 stycken som hade skickats ut, vilket gjorde att resultatet som kom fram inte gick att generalisera. Enkäterna behandlades i datorprogrammet SPSS för att kunna ge en tydlig bild av hur respondenterna svarat. Det som framkom i resultatet var att respondenterna främst använde sig av insatser som byte av sprutor, vaccinationer och att testa sig för sjukdomar. Smittskydd och smittspridning var de områden där respondenterna uppgav att de erbjöds mest information, vilket också var de områden de ansåg sig ha bäst kunskap om. Det framkom även att respondenterna ansåg att deras livskvalitet hade blivit bättre sedan de började i sprututbytesverksamheten. Insatser som syftade till att personerna som deltog skulle avsluta sitt narkotikamissbruk var inte något som det angavs att det erbjöds speciellt mycket av. Slutsatsen som drogs av studien var att de insatser som erbjöds på sprututbytesverksamheten i första hand syftade till att minska riskbeteende och smittspridning av HIV

Thesis (M.A.)--Bowling Green State University, 2009. / Document formatted into pages; contains vii, 71 p. Includes bibliographical references.

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).

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: 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

Starting point: The subject matter of this degree work is Analysis of European Harm Reduction magazines targeting illegal addictive substances users with the exception of marihuana. The research complex is formed from 11 magazines. The common criteria for their selection was a processing of the first number published in 2015. Twenty-nine variables were monitored in all magazines. This work was inspired by Jany Reekers'article (Adiktologie, 2012) where the author tried to map out magazines for addictive substances users all over the world. Aims: The object of this study is to map out magazines for illegal addictive substances users which are published in Europe. The magazines for marihuana users are not subsumed in this work. The further object is to detail the magazines from the viewpoint of formal criteria and do their content analysis. Methods: The analysis of documents, one of the basic types of the research in qualitative approach was used in this study. Acquired data was processed via Coding manual of the printed report about addictive substances and themes which involve them: The appplication for magazines coding which are given for problem illegal addictive substances users (Gabrhelík et A1., 2012). The basic research complex consisted of 11 magazines, 14 magazines were identified. Results:...

Cannabis is the most used illicit drug globally. Nevertheless, cannabis users often do not have sufficient knowledge about cannabis. Definition of cannabis "quality" can include both desirable effects and safety profile of the product. Harm reduction approach is commonly deployed for other illicit substances and it is also necessary to advance it for cannabis. The aim of this research was to reveal what Czech cannabis users consider as "quality" cannabis and how they assess it. Respondents were asked what help them to prevent mental and physical harms and how it influenced the intoxication. For the purposes of this thesis, ethnographic research was chosen (Janeček, 2014). Collection of qualitative data was performed using the method of qualitative semi-structured interviews (Miovský, 2006). The interviews were coded using a method of grounded theory (Strauss & Corbin, 1999). Respondents' motivation for use was based on bio-psycho-socio-spiritual approach. Most of the participants distinguished "quality" cannabis by smell, level of intoxication, taste, structure and "health" aspects that depend on a method of cultivation. If cannabis users asked about the origin of cannabis, in few cases they did not get the information at all. Inexperienced respondents are not able to distinguish cannabis...