Health and social situation of illicit drug users and the aid they receive from the respective social and healthcare institutions in the Czech Republic This thesis is composed of two main parts: theoretical and practical. Theoretical part contains chiefly categorization of illicit drugs, where we learn how they are divided according to their origin, effects, and their chemical composition, as well as their seriousness for the society. The thesis also maps the development of the illicit drug scene before and after 1989 and also discusses the importance of the year 1994{---}considered a breakthrough{---}since even before the convertibility of the Czech currency, it witnesses a massive invasion of high-quality and cheap heroine import. Furthermore, the harmful effects of drug abuse and their categorization is presented. Health hazards are correlated with data covering the HIV and viral hepatitis diffusion in the Czech Republic. This part also contains a list and description of institutions dealing with illicit drug abuse and issues connected with it. An analysis of social, health, and economic situation of illicit drug users, those filed in a L/K center. In conclusion, the thesis deals with the illicit drug use policy in the Czech Republic, where prevention, repression, prohibition and regulations are discussed, within the framework of sample of other national drug policies. The reader will find here the description of individual illicit drugs as well. The thesis aims to map the activities of K-centers, and the way their work{---}in its result, the aid to illicit drug users{---}is being made harder by the low-threshold institutions. Low-threshold institutions were chosen to represent the group of relevant institutions since they are attended by the illicit drug users most often, as well as being the first institution of this kind the users come to. The author also explored what suggestions of improvement the centers present. Three hypotheses were set: 1. The offer of services is broad in K-centers 2. Low-threshold institutions lack resources 3. Low-threshold institution representatives hold serious reservations to the illicit drug use policy in the Czech Republic The data were collected in questionnaires and secondary analysis of data from annual reports of K-centers. The questionnaires were filled in by low-threshold centers representatives. The data confirmed the set hypotheses. In the discussion, the author debates the results of his research and discusses expert literature, while explaining difficulties that he encountered composing this thesis. The conclusion deals with the suggestions for improvement, particularly of the illicit drug use policy and sums up the thesis.

x Klíčová slova: harm reduction - sociální služba - zdravotní péče - adiktolog Abstract Objective: The study is a institutional analysis of harm reduction services in the Czech Republic: possibilities and limits of providing health care in their context and the state of readiness on a combi- nation of health and social services to different target groups. Background: In the Czech Republic, there is currently a network of harm reduction services, especially for users of illegal drugs. These centres and programs are very diffrent in provided services, procedures, conditions for providing care and also in the status (registered social service x registered medical service x unregistred service). By analyzing the current status of harm reduction services, we can outline possible future development. Research file: The study was addressed to all contact centers and outreach programs for drug users in the Czech Republic (N = 96). Information will be provided by competent persons, mostly from senior staff. Methods: Data collection was conducted through a questionnaire survey. The questionnaire is structu- red, divided into 3 parts. If necessary, we will use the possibility of telephone interviews and analysis of documents. Contribution of the work: Achieved results may facilitace orientation in discussed posibility of...

The thesis describes the course and results of the research into the field of Harm Reduction (HR) through the internet websites in the Czech language. Nowadays the internet forms an inseparable part of most people's lives from all social classes. This fact is reflected in the interests of both service providers for drug users and laymen interested in drug issues. Unfortunately, according to current research we do not know much about what information and in which quality and range can people find about drug Harm reduction on the internet. Therefore, the aim of this thesis was to identify and evaluate internet websites in the field of harm reduction intervention focused on the users of illegal drugs in the Czech Republic. Internet websites were evaluated not only with respect to the contents and range of the information provided but also with respect to topicality, functionality and objectivity. What was found were 13 Czech complex websites, 7 professional HR organisations and also 6 non-professional HR websites. The websites of professional organisations in most cases fulfilled the essential criteria of authority, objectivity and topicality. Among non-professional websites there were high-quality ones containing a wide range of information and correct approach to drug issues but there were also two...

Syftet med studien var att belysa hur professionella inom beroendevården resonerade kring harm reduction insatser och nolltolerans. Vi ville även undersöka möjligheter till förändringsprocesser hos de personer som använder narkotika med hjälp av harm reduction insatser. Den metodologiska utgångspunkten bestod i hermeneutiken och det empiriska materialet samlades in genom en kvalitativ ansats med semistrukturerade intervjuer. Intervjuerna bestod av sex professionella från tre olika kommuner. Resultatet är analyserat utifrån teorier från Moira von Wright och Michel Foucault. Studien visar att professionellas upplevelse av harm reduction i stora drag är positiva trots att mer problematisering behövs. Några av slutsatserna är att harm reduction möjliggör förändringsprocesser hos personer som använder narkotika där man kan nå och motivera personer till vidare behandling. Skadereducerande insatser försvåras dock av narkotikapolitiken som stämplar både de som använder narkotika och de professionella. En annan slutsats är att harm reduction inte kan jämföras med legalisering.

This study serves two aims, to shed light on the rule of darura in Islamic law and to examine the justification for the Harm Reduction Programme in Malaysia using the said rule. In an attempt to fathom the real understanding of this rule, I have employed two methods: a critical approach to the darura theoretical discussions and an analysis of darura cases presented in fiqhi treatises. The study demonstrates that the usuliyun have formulated a narrow scope of darura theory although the applications of the rule in fiqhi treatises suggest other ways in which the principle can be applied. The jurists tend to apply the rule in a much wider sense in the various fiqhi works, either in true and factual cases or in hypothetical ones. This research also finds that the modern jurists have expanded the application not only to protect the necessity of an individual person but to protect the necessity of the public at large. It can also be suggested that the rule of darura has provided measures derogating obligations; however, this must only be to the extent required by the exigencies of the situation. A rigorous understanding of this rule is crucial for the field of Islamic law in order to avoid any possible abuse. Based on the above understanding of darura, this study finally investigates whether darura can justify the Harm Reduction Programme in Malaysia. This programme has been promulgated to reduce HIV/AIDS cases by providing drug users with methadone, syringes and needles. The programme was assessed thoroughly using the legal requirements and preconditions of darura. Having examined the philosophy, its modus operandi and jurists' attitude towards drugs, the study concludes that this programme is justified from a shari`a perspective on the basis of necessity. However, strict precautions and regulations need to be continuously employed throughout this controlled programme to avoid any abuse which might impair its legality. The research also aims to enhance the public's understanding of the rule of darura and to improve the collaboration between Malaysian government and religious groups in minimising HIV/AIDS and drug cases in Malaysia.

Potential reduced exposure products (PREPs) are marketed to reduce smoking’s harm, despite little information concerning their effects. This study adapts previously reported clinical laboratory methods used to evaluate combustible PREPs to investigate the acute effects of four non-combustible PREPs (Ariva, Camel Snus, Marlboro Snus, Commit nicotine lozenge) relative to own brand cigarettes, sham smoking, and one combustible PREP that delivers no measurable nicotine (Quest). Twenty-eight smokers participated in 7 Latin-squared ordered, 2.5-hr sessions in which each product was administered twice (60-minute inter-administration interval). Sessions differed by product and were separated by > 48 hours. Plasma nicotine, heart rate, expired air carbon monoxide (CO), and subjective effects were assessed. Relative to own brand, non-combustible PREPs decreased nicotine and CO exposure, did not suppress abstinence symptoms fully, and were less acceptable. These short-term clinical laboratory methods are reliable and provide valuable information concerning non-combustible PREPs for smokers.

This thesis explores the experiences of an urban population who are considered to exist at the social margins of society, but who paradoxically spend much of their time in urban public space. Often referred to as ‘street people,’ the issues they face, such as homelessness and drug addiction, become public issues. In this thesis, I introduce and develop the concept of the marginal public to refer to this population, exploring their experience of the city not through the lens of their marginalization but through their relationship to the spatial and social realms of urban life. I explore the ways in which the marginal public, through their visibility and presence in the city, are not marginal to urban life but deeply embedded in it. Their marginality is lived simultaneously yet in contestation with dominant ways of being. This manifests in the marginal public’s relationship to others in the city, as well as through debates about the placing of facilities that serve them which I explore through the unsanctioned supervised consumption site of Overdose Prevention Ottawa (OPO). Finally, through the concept of heterotopia, I explore the margins as places of otherness as well as possibility.

Background. The prevalence of alcohol dependence, defined as being physically and psychologically dependent on alcohol, among homeless people is 8%-58% compared to 4%-16% of alcohol dependence prevalence in the general population. Homelessness also contributes to alcohol dependence, and alcohol dependence is more difficult to treat and manage when combined with homelessness and alcohol-related harms. Alcohol harm reduction strategies for those with severe alcohol dependence and experiencing homelessness are gaining traction. There are 22 Managed Alcohol Programs (MAPs) in several cities across Canada. MAPs can reduce harms for people with severe alcohol dependence who live with acute, chronic, and social harms. In this research, I report on MAP participants views in the first six months of being in a MAP to provide insights into implementation of MAPs. Research Question. My central research question was: What are MAP participants perspectives of MAP during the early period of transition into MAP? With an objective to understand implementation from participants perspectives, I specifically asked: How are MAP participants situated in the world, what are their experiences, and what are the relational shifts that occur during early transition into MAP? Methodology and Theoretical Perspective. In my research, I used interpretive description informed by constructivism. I drew on relational theory to interpret my findings. The use of interpretive description, informed by constructivism and relational theory, brought forth greater insight into MAP participants views of and subsequent shifts in their relationships with the environment, alcohol, themselves, and others before and during MAP. Results/Findings. Participants perspectives focused on four key findings: (a) participants shifting perspectives of non-beverage alcohol when beverage alcohol was available in MAP, (b) participants motivation to change and insights into their own drinking, (c) reasons for drinking outside of MAP, and (d) relational insights and shifts in their connections with others. Conclusions. For individuals experiencing homelessness and severe alcohol dependence and its inherent associated harms, MAPs help to support relational shifts that support safer drinking patterns and/or meaningfully interrupt cycles of uncontrolled drinking as well as help to re-establish new relationships with alcohol, themselves, family, and friends. / Graduate

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.

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