No description available.

Tho present thesis represents a summary or research done by the author (and others) that was conducted with heroin addicts and drug abusers undergoing behavioral and pharmacological therapy at Stockton State Hospital, Stockton, California. From June 1970 to December 1970 the Research Department of Stockton State Hospital, in conjunction with the Drug Abuse Program at Stockton State Hospital, conducted research investigating a number of difference facets relating to inpatient programs for heroin addicts undergoing methadone maintenance and drug abusers. These facets included the investigation and evaluation of (a) motivational factors; affecting the voluntary participation of inpatient heroin addicts and drug abusers in behavioral and pharmacological therapy, (b) the effectiveness of the synthetic narcotic methadone hydrocloride as a primary reinforcing technique for appropriate behavior, (c) the effectiveness of various therapeutic approaches used in conjunction with behavioral modification techniques, and (d) the effect of methadone on perceptual and motor functioning in the heroin addict under-going methadone maintenance. The present thesis is a compilation cf these research projects.

In February 2017, Tanzanian President John Magufuli publicly declared a war on drugs, an unexpected change in policy in a country previously leading the way in harm reduction in Sub-Saharan Africa. The war on drugs, a set of policies aimed at reducing drug supply and use through the punishment, forced treatment and criminalization of drug users, is a part of Magufuli’s strategy to ‘clean up’ Tanzanian society. Prior to his election, the Tanzanian government largely ignored treatment and drug policy, and foreign NGOs, in partnership with local activists, funded and implemented harm reduction interventions. This thesis seeks to understand a puzzling reversal from harm reduction to repression, posing the questions: 1) How did the Tanzanian government implement a war on drugs that went against the goals of a number of powerful foreign actors funding services for drug users? 2) What have been the outcomes for drug users in Tanzania as a result of the drug policies and programming implemented since the election of Magufuli? 3) How does Tanzania’s war on drugs shape international and domestic approaches to drug use and drug policy in the country? In the fall of 2018, I interviewed foreign and local NGO workers, officials from major international organizations and former drug users and activists in Dar es Salaam, Tanzania. Using interviews and observations during this fieldwork, I explore the realities on the ground underlying both the drug policy changes towards drug users implemented over 2016/17, and the more public crackdown on drug use in 2017. I rely on a constructivist methodology to challenge and interrogate the narratives being produced by the Tanzanian government, which echoed harsh, war on drugs ideology but also boasted about comprehensive harm reduction programming, a contradictory position I also explore in this thesis. In answer to my first research question, I argue that the Tanzanian government evaded donor pressure or interference in pursuing an anti-drug user agenda through strategies of appeasement, intimidation and the exploitation of a neglected policy area. The Tanzanian government touted its harm reduction program at the international level to produce a narrative of continued support for drug users, appeasing donors and foreign agencies while, in reality, narrowing the scope of treatment to the detriment of people who use drugs. The government also used intimidation tactics, threatening the work of foreign NGOs working with vulnerable population, which chose to stay and provide limited services rather than risk being kicked out of the country. The Tanzanian government, with limited resources, took advantage of donors’ focus on HIV/AIDS and lack of commitment to drug users, to maneuver and achieve a repressive policy agenda without interference. I build on this argument using the evidence I gathered during fieldwork to answer to my second research question. I argue that the outcomes of the Tanzanian drug war agenda were increased police harassment, higher drug prices and fear of punishment among drug users which led to riskier drug use, greater difficulty in accessing services and greater economic vulnerability. Drug users had to go farther, spend more money on drugs and face harassment as they tried to avoid dopesickness. Policy changes resulted in the closure of harm reduction centres frequented by drug users, limited access to needle exchange and limited the outreach efforts of local and international NGOs, making life much more difficult for people who use drugs. During my research, I found that, contrary to some of the literature I read which posited the war on drugs as a Western strategy of political control, the Tanzanian government was actually producing war on drugs narratives, and using these narratives to justify its repressive policies. This finding supports the answer to my third research question. I argue that the Tanzanian government produced narratives of drugs hindering development, causing corruption and threatening national unity. I also argue that donors such as the United Kingdom, and foreign agencies working in HIV/AIDS, are reproducing these narratives and are following an agenda, set by the Tanzanian government, that does not meet the needs of drug users and supports the centralization and repression of the Magufuli regime. Foreign agencies shifted from supporting drug users, to instead following an agenda that does not meet their goals in reaching drug users. Donors did not notice or prioritize the increased abuse of drug users’ human rights at all, accepting the provision of methadone as evidence of support for drug users and continuing to provide general budget support to the Tanzanian government and even providing specific funding to limit drug supply in the country. The effectiveness of Tanzania producing such narratives, and enacting the repressive policies war on drugs narratives justify, reveals global antipathy towards actually supporting people who use drugs and advancing the rights of people who use drugs. In upholding old war on drugs narratives and implementing policies that attack people who use drugs, Tanzania is contributing to an international consensus that the war on drugs is justified as long as basic treatment is provided. This thesis, using the voices of activists and advocates on the ground, deconstructs the Tanzanian war on drugs. I argue for the inclusion of those with lived experiences in shaping and changing the repressive drug policies and epistemologies that are being produced by the Tanzanian state and are being accepted by the international community.

Mellan rusets himmel och abstinensens helvete – En kvalitativ studie om kvinnor som injicerar heroin. Examensarbete i socialt arbete/30 högskolepoäng. Malmö högskola: Fakulteten för hälsa och samhälle, institutionen för Socialt arbete, 2016.Syftet med studien var att undersöka hur kvinnor som injicerar heroin upplever sin livssituation och sitt handlingsutrymme. Ett centralt tema berör drogens betydelse i deras liv samt vilka möjligheter kvinnorna ansåg sig ha att förändra sin droganvändning och livssituation i stort.Uppsatsen är en kvalitativ studie och empirin har inhämtats med hjälp av semi-strukturerade intervjuer med åtta kvinnor som injicerar heroin. Kvinnorna rekryterades via sprutbytesmottagningen i Malmö, där de är regelbundna besökare.Slutsatserna var att kvinnorna tillhör en mycket utsatt och marginaliserad grupp. Våld, sexuella övergrepp, hemlöshet, kriminalitet och prostitution fyller kvinnornas vardagsliv. Heroinets effekt beskrevs som avgörande när kvinnorna började använda heroin, till stor del på grund av sitt dåliga mående medan de i nuläget jagar pengar och heroin främst för att undvika abstinenssymtom. Kvinnorna har i flera omgångar varit i behandling i såväl medicinsk- som psykosocial form. Sju av åtta kvinnor är ointresserade av de vård- och behandlingsinsatser som är tillgängliga i dagsläget. Deras behov av skadebegränsande insatser är stort och sprutbytet framkommer som en mycket viktig insats för målgruppen. / Between the heaven of highs and the hell of withdrawal – A qualitative study of women who inject heroin. Degree in Social Work/30 credits. Malmö University: Faculty of Health and Society, Department of Social Work, in 2016.The purpose with the study was to investigate how women who inject heroin are experiencing their life situation and their action space. A central theme involves the drug´s importences in their lives and what possibilities the women felt they had to change their use of drugs and their situation in the whole.The thesis is a qualtitative study and the empirical evidence has been collected by semi-structured intervjues of eight women who inject heroin. The women were recruited at the reception of needle and syringes exange in Malmoe, where they are regular visitors. The conclusions were that the women belong to a high risk and marginalizad group. Violence, sexual assaults, homelessness, criminality and prostitution fill the everyday-life of the women. The effect of the heroin is being described as crusial when the women started using heroin, largely because they felt bad but now they are chasing money and heroin mainly to avoid symptoms of abstinence. The women have several times been in treatment, both medical and physical. Seven out of eight women are not interested in the care actions or the treatment actions offered today. Their needs of limitations of injuries is high and the exchange of syrings are revealed as very important actions for the target group. Key words: Action space, heroin, intravenous druguse, women, living conditions, exposure, everyday life

No description available.

This thesis applies lessons drawn from a historical-cultural analysis of rural power structures in Afghanistan to understand the nature of the threat posed by that country's opiate economy and to assess the counter-narcotics policies of the United Kingdom, the Government(s) of Afghanistan, and the United States. It argues that that the opiate economy should be considered an Afghan-specific problem involving narcotics, not a "drug war" problem involving Afghanistan. Specific lessons are taken from a chapter dedicated to Afghan culture, history, and rural power structures, and applied in chapters analyzing the opiate economy and current counter-narcotics policies. Several insights that are critical to sound policy, and that are not found in existing literature, are developed. Overall, the current policy emphasis on aggressive eradication of opium poppy is incongruent with local cultural and political realities and undermines central government stability. Counter-narcotics policy makers should adopt a roll-back strategy, eliminating cultivation from minor-cultivation provinces first for democraticgovernance, cultural, and counter-narcotics reasons. Counter-trafficking should be prioritized over eradication efforts and should particularly target anti-government forces, many of which are legacy groups of the anti-Soviet jihad and are not accountable to or culturally integral to rural society.

by Cheung Wai-ting. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 131-142). / Abstracts in English and Chinese. / Chapter Chapter 1 --- The Research Problem --- p.1 / Chapter Chapter 2 --- Literature Review / Chapter 2.1 --- Prohibitionist Approach --- p.7 / Chapter 2.2 --- Medical-Treatment Approach --- p.8 / Chapter 2.3 --- How Should We Understand Post-Treatment Drug Use Behavior ？ --- p.14 / Chapter Chapter 3 --- Analytical Framework / Chapter 3.1 --- Social Capital Theory --- p.24 / Chapter 3.2 --- Differential Association Theory and Social Capital --- p.26 / Chapter 3.3 --- Control Theory and Social Capital --- p.31 / Chapter 3.4 --- Labeling Theory --- p.39 / Chapter 3.5 --- Self-Efficacy Theory --- p.44 / Chapter 3.6 --- The Hypotheses --- p.48 / Chapter Chapter 4 --- Methodology / Chapter 4.1 --- Data and Sample --- p.52 / Chapter 4.2 --- General Profile of Respondents --- p.54 / Chapter 4.3 --- Conceptualization and Operationalization of Variables --- p.57 / Chapter 4.4 --- Method of Data Analysis --- p.66 / Chapter Chapter 5 --- Results / Chapter 5.1 --- Quantitative Analysis --- p.68 / Chapter 5.1.1 --- Bivariate Analysis / Chapter 5.1.2 --- Path Analysis / Chapter 5.1.3 --- Verification of Hypotheses / Chapter 5.2 --- Qualitative Analysis --- p.86 / Chapter Chapter 6 --- Summary and Discussion / Chapter 6.1 --- The Study --- p.112 / Chapter 6.2 --- Summary of Findings --- p.113 / Chapter 6.3 --- Theoretical Implications --- p.117 / Chapter 6.4 --- Practical Implications --- p.120 / Chapter 6.5 --- Limitations and Suggestions for Future Research --- p.122 / Appendix I Interview Schedule --- p.125 / Appendix II Socio-demographic Profile of the Ten Informants --- p.127 / Bibliography --- p.130

Presentación El siguiente trabajo es un ejercicio reflexivo sobre una experiencia própia: Un estudio etnográfico sobre usuarios/as de heroína realizado en un barrio de Barcelona entre los años 1993-1995. Todo empezó dos años después de escribir la etnografía, al decidir regresar al barrio para explicar a los participantes el trabajo que había escrito sobre aquella experiencia. En esos momentos tomé la decisión de realizar un estudio sobre el papel que yo había desarrollado durante todo el trabajo de campo con esas personas, cómo me había influido, como les había influido, por qué había relatado aquellas cosas sobre sus vidas, qué efectos provocaba lo escrito a posibles lectores, etc. Y así surgió el tema de esta tesis. ObjetivosEn este trabajo me propongo ponerme al lado de los datos que en otro momento recogí y comenzar a analizarlos a la luz de potentes teorías y presupuestos -principalmente de la psicología social-. He tratado de "hacer" un ejercicio reflexivo sobre un caso, una experiencia científica en la qué "yo" he estado implicada. El objetivo fundamental es mostrar en qué consiste una práctica reflexiva, entendida como una forma de hacer "objetivable" el conocimiento (aspecto que correspondería a una dimensión racional- epistemológica), y también entendida como una forma de encontrar resistencias a discursos dominantes en el conocimiento psicosocial (aspecto que correspondería a una dimensión ético-política). Como objetivos específicos me propongo: -señalar un procedimiento que permita conectar al auditorio o lectores con la experiencia particular de la investigadora -cuestionar mi propia práctica de producción de conocimiento psicosocial -explorar los "yoes" o subjetividades en el proceso investigador Marco teórico y metodología He definido un tipo de práctica reflexiva tomando una perspectiva construccionista crítica localizada en la posición del observador/a, donde el valor de la reflexividad, más que instrumento de comprensión o validación, es un instrumento de cambio. Procederé a través del análisis del discurso de mi práctica social o experiencia de conocimiento científico, junto con conceptos provenientes de la etnometodología, interaccionismo simbólico y fenomenología. Los métodos han sido la etnografía de laboratorio (basada en Latour y Woolgar), la descripción etnometodológica (de Potter) y el análisis discursivo (los repertorios interpretativos de Potter y Wheterell, y las formaciones discursivas basadas en Foucault). Mis datos han sido 44 entrevistas en profundidad, a modo de conversaciones con los usuarios y no usuarios significativos en aquel contexto de observación. Casi todas transcritas. Y 5 libretas con notas de campo tomadas durante la observación participante en las que constaban multitud de comentarios personales, interpretaciones sobre el tema y situaciones compartidas entre ellos y "yo". Resultados y discusión Como resultado del análisis del discurso he encontrado la confrontación entre formaciones discursivas "naturalizadoras" y "sociologizadoras", acentuando mucho más en mis datos la formación "sociologizadora" (cuestiones legales, relacionales, culturales, etc.), que "naturalizadora" (cuestiones sensoriales, farmacológicas, psicológicas, fisiológicas, etc.). Este dialogismo entre unas y otras formaciones permite tomar consciencia de formas de acción que no son demasiado relevantes en un contexto sociohistórico dado, pero si se activan o "actúan" en contextos específicos de acción donde las personas tienen capacidad agéntica. La observación participante ha sido fundamental para contextualizar los datos, construidos en su "contexto cotidiano de acción", además, ha dado sentido a las conversaciones y a las entrevistas en profundidad. El procedimiento empleado, conforma un tipo de modelo que pone en relación di versos constructos: contexto discursivo (o interactivo), posición discursiva y formaciones discursivas, y que se articulan alrededor de un espacio intersubjetivo "yo-alter" que es lo que constituye la unidad básica donde opera la reflexividad. Se construyen distintos "yoes" en cada momento y trayectoria de la experiencia relatada. Al introducir el "yo" en el trabajo de campo (tanto el mío como el de alter), provoco una problematización de los datos y a la vez, me obliga a reconceptualizar ese "yo" o "yoes" y resignificar esos datos. Se me plantea mi condición de liminalidad (o de otra manera, decir que no estoy ni dentro ni fuera de la cultura que estudio), donde los contornos de mi identidad se subvierten y donde la condición de ser, es que ninguna subjetividad es permanente. Mi aproximación a "alter" supone una continuidad entre "yo-alter" y en ocasiones resulta amenazante, en la medida en que se confunden los límites y se difuminan con el fin de conseguir una "experiencia empática". Pero no se trataría tanto de una fusión "yo-alter", de manera que sería una dilución de ambos, sino de una permeabilidad de los límites, originando así, un espacio potencial para crear, para conectar y donde se resuelva la tendencia a controlar o contener un "yo" al otro. ConclusionesLa posibilidad de la práctica reflexiva está en el espacio intersubjetivo "yo-alter". Mi intento de conexión con "alter" me constituye temporalmente en mediadora: "estar en medio de". Esto significa: l-socavar los cimientos y el orden construido, a través de buscar fisuras, inconsistencias y contradicciones en los discursos manejados, a partir de las cuales hay potenciales trayectos que no se han producido, 2-incorporar diferentes voces o dialogismo en la historia que cuento y no un monólogo de la autora, sino una participación de alternativas posibles y espacios de enunciación, junto con las subjetividades emergentes. Para ello, dos condiciones son ineludibles: -la agentividad para subvertir lo establecido, las identidades -el recuperar contextos que sean potencialmente relevantes para actuar discursos. Considerar las subjetividades también es la manera de tener a "alter" presente. "Alter" se comprende en "mi" a través de un trayecto en el que se marcan las afinidades mutuas y no tanto las identidades, en el que "representar" a "alter" es trazar un trayecto de conocimiento local y situado (como apunta Haraway), pues sólo así es posible generar una praxis transformadora fiel a la parcialidad. / AN ETHNOGRAPHIC STUDY ON HEROIN USERS. Psycho-social Knowledge and Reflexive Practice This study is a reflexive exercise based on own experience: an ethnographic study of heroin users carried out in a Barcelona city neighbourhood between 1993 to 1995. The aim was to analyse data collected using social psychology theoretic perspectives. I will try to demonstrate what reflexive practice is, understood both as a way of making knowledge "objectivable" (rational-epistemological issues), as well as a way of finding resistance to dominant discourses in psychosocial knowledge (ethical-political issues). The specific aims are: -to indicate a procedure that would approximate the audience or reader with the particular experience of the researcher, -to criticise my own production practice of psycho-social knowledge, -to explore the "self" o subjectivity in the research process. The methods used were: laboratory ethnography (Latour and Woolgar), ethno-methodological description (Potter), discursive analysis (Potter and Wheterell) and discursive training (Foucault). I have carried out 44 interviews and employed 5 fieldwork research reports. In the procedure used, I have linked: discursive context, position and discursive training. These elements are articulated around an "alter-self" inter-subjective space, constituting the basic unit out of which reflexivity operates. In my narrative, "sociologising" training discourses (i.e. legal, relational, cultural matters etc.) have predominated over those which are "naturalising" (i.e. sensorial, pharmacological, psychological matters etc.). Different "self" are formed at every moment and throughout the development of the narrated experience. By introducing the "self" in the tieldwork (both the "self" as well as the "alter"), I introduce a problemising of the data. At the same time, I reconceptualise the "self" and resignify the data. In conclusion, it is worth pointing out that the possibility of reflexive practice is on the "alter-self" intersubjective space, and my attempt to connect with the "alter", temporarily makes me a "mediator". This means: -undermining the foundations and the order built, by searching for weaknesses and inconsistencies in discourses. Starting from this generates ways that had not been made. -Incorporating different voices o dialogisms in the history, together with emerging subjectivities. Two conditions are unavoidable: - the agentivity for subverting what is established, the identities, - to recuperate contexts which are potentially relevant for carrying out discourses.

L’addiction aux drogues peut être considérée comme une maladie neurologique chronique avec des rechutes récurrentes en période d’abstinence qui constituent le problème majeur dans le traitement de l’addiction aux drogues. Grâce à un modèle animal de rechute, il a été montré qu’un rongeur pouvait réinstaller un comportement de recherche de drogue lorsqu’il était réexposé à la drogue elle-même, à des indices associés à la drogue, ou encore à un stress. Dans notre équipe, nous avons évalué la contribution relative des différentes propriétés de la cocaïne, de l’héroïne et de la nicotine (incitative, discriminative et renforçante) dans la réinstallation d’un comportement de recherche de nourriture. Afin de dissocier les propriétés discriminatives et renforçantes, les rats ont été entraînés à s’auto-administrer une récompense alimentaire. Nous avons alors trouvé que : 1) La cocaïne et la nicotine agissent comme des stimuli internes qui acquièrent un contrôle discriminatif sur le comportement, étant donné que la cocaïne et la nicotine, contrairement à l’héroïne, peuvent réinstaller un comportement éteint de recherche de nourriture lorsque ce comportement a été préalablement acquis sous les effets de la cocaïne et de la nicotine, respectivement. 2) La réinstallation induite par la cocaïne et la nicotine est indépendante de la valeur actuelle de la récompense, ce qui indique que la cocaïne et la nicotine contrôlent l’activation de comportements automatiques, habituels, liés à la drogue. Puis, afin d’identifier la façon dont les drogues d’abus entraînent la formation d’habitudes, nous avons également étudié les effets d’une sensibilisation à la cocaïne à différents moments d’un apprentissage instrumental pour une récompense alimentaire, après une dévaluation de la récompense. Nous avons alors trouvé que la sensibilisation à la cocaïne ne favorisait pas le développement de comportements de type habituel. Cette série d’expériences constitue une première étape dans la comparaison des processus automatiques produits par la cocaïne et la nicotine. Si l’activation de comportements de type habituel, automatique, peut être généralisée à d’autres drogues d’abus, nous pourrons considérer que la rechute vers la recherche et la prise de drogue est en partie sous le contrôle de processus automatiques, ce qui pourrait expliquer la forte probabilité de rechute, même après de longues périodes d’abstinence et malgré la connaissance des conséquences néfastes qui en découlent. / Drug addiction can be considered as a chronic brain disease with recurrent relapse during abstinence periods which remains the major problem for the treatment of drug addiction. Using an animal model of drug relapse, it has been shown that a rodent can reinstate a drug-seeking behavior when re-exposed to the drug itself, drug associated cues or stress. In our research group, we assessed the relative contribution of the different properties of cocaine, heroin and nicotine (incentive, discriminative and reinforcing) in food-seeking reinstatement, and in order to dissociate the discriminative from the reinforcing properties, rats were trained to self-administer a non-drug reward (food). We found that: 1) Cocaine and nicotine act as internal stimuli that acquires discriminative control over behavior, since cocaine and nicotine, but not heroin, can reinstate an extinguished food-seeking behavior when this behavior has been previously performed under the effects of cocaine and nicotine respectively. 2) Cocaine- and nicotine-induced reinstatement is independent of the current value of the outcome, which indicates that cocaine and nicotine control the activation of automatic, drug-related habitual behaviors. Then, in order to identify the way drugs of abuse lead to the formation of habits, we also examined the effects of cocaine sensitization at different stages of instrumental training for a food reward after outcome devaluation. We found that, globally, cocaine sensitization does not promote the development of habit-based behaviors. This series of experiments represent a first step in the comparison of automatic processes produced by cocaine and nicotine. If the activation of automatic, habit-based behaviors can be generalized to other drugs of abuse, we could consider that relapse to drug-seeking and drug-taking is partly under the control of automatic processes, which could explain the high probability of relapse, even after extended periods of abstinence and despite the knowledge of the adverse consequences.

Poisoning is frequently associated with psychological and physiological co-morbidities that can be assessed in order to improve patients' management and reduce cost. The primary objective of this study is to conduct a review of emergency department (ED) poisonings to characterize its demographics and assess associated co-morbidities. The second objective is to explore correlation between personal history of diseases and poisonings. Predictors for poisonings and its outcomes were investigated and risk factors for suicidal poisoning and how it relates to mental illnesses were explored. Six hundred and forty nine cases admitted to ED between 2004 and 2007 were studied. Results indicate that difference in ethnic background was substantial as poisoning cases were predominantly African Americans (79.9%) between 36-45 years old with a male to female ratio of 1.3. Intentional illicit drug overdose was the greatest risk factor for ED poisonings, and among the 649 cases, heroin overdose was the most common cause of poisoning at 35.4% (n=230), cocaine overdose at 31.7% (n=206), heroin and cocaine overdose at 4.3% (n=28), multiple drug poisoning at 5.5% (n=36), and antidepressant/antipsychotic poisoning at 6% (n=39). A significant correlation between heroin poisonings and asthma (F=20.29, DF=1, p= .0001) was found, as well as between cocaine poisoning and hypertension (F=33.34, DF=1, p=.0001), and cocaine poisoning and cardiovascular diseases (F=35.34, DF=1, p=.0001). Another significant finding is the change in the pattern of the route of illicit drug use from injection to inhalation; it is thought this may reduce the rate of HIV and Hepatitis transmission via hypodermic needles among illicit drug users. As well, inhalation and insufflation may be risk factors that aggravate preexisting asthma. Mental illnesses, chiefly depression, remain one of the greatest risk factors for suicidal poisoning beside age, Hispanic race, gender, ingestion route and unemployment. This study provides supporting evidence that poisoning, particularly deliberate poisoning with illicit drugs remains a serious issue that significantly aggravates co-morbidities and raises treatment cost by increasing both the rate of hospitalization and hospital length of stay (LOS). Pragmatic guidelines and innovations in reducing heroin and cocaine abuse in these patients may lessen the severity of diseases and reduce its burden on the healthcare system and on society.