published_or_final_version / Social Work / Master / Master of Social Work

Ho Man Choi. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 178-215). / Abstracts and appendices in English and Chinese. / ACKNOWLEDGEMENT --- p.ii / ABSTRACT --- p.iii / 研究摘要 --- p.vi / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1. --- Heroin --- p.1 / Chapter 1.1.1. --- Manufacture --- p.1 / Chapter 1.1.2. --- Administration --- p.2 / Chapter 1.1.3. --- Physical and Psychological Effects --- p.4 / Chapter 1.1.4. --- Heroin Metabolism --- p.5 / Chapter 1.1.5. --- Treatments for Heroin Dependence --- p.6 / Chapter 1.2. --- Opioids and Analgesia --- p.8 / Chapter 1.2.1. --- Pain Transmission --- p.8 / Chapter 1.2.2. --- Pain Modulation and Endogenous Opioid System --- p.9 / Chapter 1.2.3. --- Clinical Application of Opiates in Pain Management --- p.11 / Chapter 1.2.4. --- Narcotics and Pain --- p.11 / Chapter 1.3. --- Biological Basis of Drug Addiction --- p.12 / Chapter 1.3.1. --- Mesocorticolimbic Reward System --- p.13 / Chapter 1.3.2. --- Molecular Neurobiology of Drug Addiction --- p.16 / Chapter 1.3.2.1. --- "Cyclic Adenosine-3',5'-Monophosphate and Protein Kinase A" --- p.16 / Chapter 1.3.2.2. --- Transcription Factors: cAMP-Response Element Binding Protein and Delta-Fos B --- p.18 / Chapter 1.3.2.3. --- Neurotrophic Factors --- p.23 / Chapter 1.4. --- Biological Basis of Relapse --- p.25 / Chapter 1.4.1. --- Environmental Stimuli --- p.26 / Chapter 1.4.2. --- Drug Re-exposure/Priming --- p.26 / Chapter 1.4.3. --- Acute Stress Exposure --- p.27 / Chapter 1.5. --- Gene Polymorphisms and Opioid Dependence --- p.30 / Chapter 1.5.1. --- Opioidergic System --- p.31 / Chapter 1.5.2. --- Dopaminergic System --- p.36 / Chapter 1.5.3. --- Serotoninergic System --- p.41 / Chapter 1.5.4. --- Noradrenergic System --- p.43 / Chapter 1.5.5. --- GABAergic System --- p.44 / Chapter 1.6. --- Aim of Research --- p.45 / Chapter CHAPTER 2 --- METHODS OF STUDY / Chapter 2.1. --- Subject Recruitment and Demographic Data Collection --- p.49 / Chapter 2.1.1. --- Heroin-dependent Subjects --- p.49 / Chapter 2.1.1.1. --- Phenotype Assessment --- p.49 / Chapter 2.1.1.2. --- Socio-demographics Data and Substance Use History --- p.50 / Chapter 2.1.1.3. --- Addiction Severity Index (ASI) --- p.51 / Chapter 2.1.1.4. --- History of Detoxifications and Relapse --- p.51 / Chapter 2.1.2. --- Control Subjects --- p.51 / Chapter 2.2. --- Pain Response Assessment using Cold-Pressor Test (CPT) --- p.52 / Chapter 2.3. --- Personality Trait Assessment --- p.53 / Chapter 2.4. --- Genotype Analysis --- p.55 / Chapter 2.4.1. --- DNA Extraction --- p.55 / Chapter 2.4.2. --- Genotyping --- p.56 / Chapter 2.4.2.1. --- MORA118G --- p.56 / Chapter 2.4.2.2. --- DOR T921C --- p.56 / Chapter 2.4.2.3. --- COMTVal108/158Met --- p.57 / Chapter 2.4.2.4. --- Prodynorphin 68bp-VNTR --- p.58 / Chapter 2.4.2.5. --- DRD2 TaqI A --- p.59 / Chapter 2.4.2.6. --- DRD4 -521C/T --- p.59 / Chapter 2.4.2.7. --- 5HT1B G861C --- p.60 / Chapter 2.5. --- Saliva Collection and Salivary Cortisol Measurement --- p.61 / Chapter 2.6. --- Statistical Analysis --- p.62 / Chapter CHAPTER 3 --- RESULTS / Chapter 3.1. --- Demographics --- p.64 / Chapter 3.1.1. --- Age --- p.64 / Chapter 3.1.2. --- Ethnicity --- p.64 / Chapter 3.1.3. --- District of Residence and Type of Housing --- p.64 / Chapter 3.1.4. --- "Education, Employment and Income" --- p.68 / Chapter 3.1.5. --- ASI Scores --- p.71 / Chapter 3.1.5.1. --- Family/Social Relationship --- p.71 / Chapter 3.1.5.2. --- Employment and Support Status --- p.73 / Chapter 3.1.5.3. --- Medical Status --- p.73 / Chapter 3.1.5.4. --- Legal Status --- p.75 / Chapter 3.1.5.5. --- Psychiatric Status --- p.75 / Chapter 3.1.5.6. --- Drug Use Status --- p.76 / Chapter 3.1.5.7. --- Alcohol Use Status --- p.79 / Chapter 3.1.6. --- Tranquillizer Use Status --- p.79 / Chapter 3.1.7. --- Smoking Status --- p.81 / Chapter 3.1.8. --- Detoxification and Relapse --- p.83 / Chapter 3.2. --- Cold-Pressor Test (CPT) --- p.88 / Chapter 3.3. --- Personality Traits --- p.90 / Chapter 3.3.1. --- NEO PI-R --- p.90 / Chapter 3.3.2. --- BIS/BAS --- p.93 / Chapter 3.3.3. --- SSS-V --- p.93 / Chapter 3.4. --- Salivary Cortisol Levels --- p.93 / Chapter 3.5. --- Genotype and Allele Frequencies of Gene Polymorphisms --- p.96 / Chapter 3.5.1. --- MOR A118G Polymorphism --- p.96 / Chapter 3.5.2. --- DOR T921C Polymorphism --- p.96 / Chapter 3.5.3. --- COMT Val108/158Met Polymorphism --- p.99 / Chapter 3.5.4. --- Prodynorphin 68bp-VNTR --- p.99 / Chapter 3.5.5. --- DRD2 TαqI A Polymorphism --- p.102 / Chapter 3.5.6. --- DRD4 -521C/T Polymorphism --- p.102 / Chapter 3.5.7. --- 5HT1B G861C Polymorphism --- p.105 / Chapter 3.6. --- "Association of Gene Polymorphisms, Personality Traits and CPT" --- p.105 / Chapter 3.7. --- Association of Gene Polymorphisms and CPT --- p.108 / Chapter 3.7.1. --- COMT Val108/158Met Polymorphism --- p.108 / Chapter 3.7.2. --- DRD4 -521C/T Polymorphism --- p.108 / Chapter CHAPTER 4 --- DISCUSSIONS AND CONCLUSIONS / Chapter 4.1. --- Demographics and Potential Environmental Factors of Relapse --- p.111 / Chapter 4.1.1. --- Medical and Psychological Status --- p.114 / Chapter 4.1.2. --- Substance Use Status --- p.116 / Chapter 4.1.3. --- Detoxification and Relapse --- p.118 / Chapter 4.2. --- Cold-Pressor Test (CPT) --- p.121 / Chapter 4.3. --- Personality Traits --- p.123 / Chapter 4.4. --- Salivary Cortisol --- p.125 / Chapter 4.5. --- "Association of Gene Polymorphisms, Personality Traits and Cold-Pressor Test" --- p.127 / Chapter 4.5.1. --- MORA118G Polymorphism --- p.127 / Chapter 4.5.2. --- DOR T921C Polymorphism --- p.129 / Chapter 4.5.3. --- COMT Val108/158Met --- p.130 / Chapter 4.5.4. --- Prodynorphin (ProDYN) 68bp-VNTR --- p.133 / Chapter 4.5.5. --- DRD2 A Polymorphism --- p.134 / Chapter 4.5.6. --- DRD4 -521C/T Polymorphism --- p.138 / Chapter 4.5.7. --- 5HTlB G861C Polymorphism --- p.141 / Chapter 4.5.8. --- Personality Traits --- p.142 / Chapter 4.6. --- Limitations --- p.144 / Chapter 4.7. --- Potential Clinical Application --- p.145 / Chapter 4.8. --- Conclusion --- p.146 / APPENDIXES --- p.148 / APPENDIX 1 Addiction Severity Index (ASI) with Additional Questions for Heroin Users / APPENDIX 2 Detoxification and Relapse History Questionnaire / APPENDIX 3A Questionnaire for Control Subjects (Chinese version) / APPENDIX 3B Questionnaire for Control Subjects (English version) / APPENDIX 4A NEO PI-R (Chinese version) / APPENDIX 4B NEO PI-R (English version) / APPENDIX 5A BIS/BAS (Chinese version) / APPENDIX 5B BIS/BAS (English version) / APPENDIX 6A SSS- V (Chinese version) / APPENDIX 6B SSS- V (English version) / REFERENCES --- p.178

The motivation for this study is the increase of treatment needs of heroin dependents at SANCA, (South African National Council of Alcohol and Drug Abuse) Witbank. SANCA Witbank wants to ensure that the most effective treatment can be supplied. Research goals are to:  Do a literature study of out-patient treatment programmes.  Assess the needs of heroin out-patient dependents with regard to out-patient treatment programmes.  Make recommendations with regard to out-patient treatment programmes for heroin dependents. It was an exploratory research subject and the data collection methods were qualitative and quantitative. Interview schedules were used as research tools. Schedule B was completed by the researcher with heroin dependents that visited SANCA Witbank for the period 31 January 2005 to 4 February 2005. Schedule A was completed by the researcher with personnel of SANCA out-patient clinics and the questions were discussed and completed telephonically. The conclusion is that the treatment programme of SANCA Witbank is in line with the rest of the drug dependent field and only minimal recommendations were made. / Social Work / MA(SS)(MENTAL HEALTH)

Heroin use and dependency is a growing concern within South Africa, individuals face difficulty in remaining abstinent from the use of heroin due to constant relapse. The opioid antagonist known as the naltrexone pellet implant offers an alternative form of aid to relapse prevention in the recovery and abstinence from heroin dependency. This qualitative study explored the subjective experiences and perceptions of heroin dependent individuals, that made use of the naltrexone pellet implant. This study was rooted in the interpretive, qualitative paradigm where a phenomenological research design was used. Participants were selected using a purposive, snowball sampling technique and four individuals who had made use of the naltrexone pellet implant for the aid in heroin dependency for a minimum of three-months were interviewed. Interpretative Phenomenological Analysis (IPA) was used to extract recurrent themes across participants. The findings suggested that the use of the naltrexone pellet implant was beneficial in the aid for relapse prevention from heroin use. Furthermore, the exploration of difficulties that were faced in remaining abstinent, the attempt to make use of the naltrexone pellet implant and the physical and psychological aspects regarding the use of this alternative method of remaining abstinent were explored in this study. / Psychology / M.A. (Psychology (Research Consultation))

The motivation for this study is the increase of treatment needs of heroin dependents at SANCA, (South African National Council of Alcohol and Drug Abuse) Witbank. SANCA Witbank wants to ensure that the most effective treatment can be supplied. Research goals are to:  Do a literature study of out-patient treatment programmes.  Assess the needs of heroin out-patient dependents with regard to out-patient treatment programmes.  Make recommendations with regard to out-patient treatment programmes for heroin dependents. It was an exploratory research subject and the data collection methods were qualitative and quantitative. Interview schedules were used as research tools. Schedule B was completed by the researcher with heroin dependents that visited SANCA Witbank for the period 31 January 2005 to 4 February 2005. Schedule A was completed by the researcher with personnel of SANCA out-patient clinics and the questions were discussed and completed telephonically. The conclusion is that the treatment programme of SANCA Witbank is in line with the rest of the drug dependent field and only minimal recommendations were made. / Social Work / MA(SS)(MENTAL HEALTH)

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))