Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / There is a paucity of data relating to the psychology of heroin addiction. It was the purpose of this investigation to generate some meaningful data which might have utility for the adequate understanding, prevention, and treatment of this ·serious social-psycholog ical problem. Heroin addicts were contrasted with non-addict controls with respect to three important psychological dimensions: self-esteem, future time perspective, and locus of control. Three major hypotheses were based on the assumption that heroin addict subjects had low self-esteem, a foreshortened future time perspective, and an external locus of control. Three minor or secondary hypotheses were also developed which assumed a positive interrelationship between self-esteem, future time perspective and locus of control. / 2031-01-01

El projecte model alemany per al tractament assistit amb heroïna en addictes als opiacis va suposar un canvi en la política de drogues en aquest país. El tractament assistit amb heroïna i el tractament de manteniment amb metadona van ser comparats en un estudi multicèntric de 1015 pacients en 7 ciutats d'Alemanya. El grup tractat amb heroïna va mostrar una millor retenció en el tractament i una major resposta en la millora de salut física i mental, així com reducció de consum de drogues il·legals. En aquest treball es presenten cinc articles relacionats amb els factors clínics i psicosocials que influeixen en la recuperació d'aquests pacients i han de ser tinguts en compte per al seu adequat tractament. En concret s'analitzen el consum d'alcohol i benzodiazepines, els efectes de la comorbiditat psiquiàtrica, la influència de les experiències anteriors de tractament i les diferències de gènere. Es van detectar fortes reduccions en el consum d’alcohol en el grup d’heronïna, i aquests pacients van tenir millors resultats en quant a millora de salut i reducció del consum de drogues, tant per als pacients dependents d'alcohol com per als no dependents. Es van trobar resultats superiors del tractament assistit amb heroïna en pacients sense experiència en tractaments de manteniment pel que fa a la reducció del consum de drogues i la reducció de l'activitat il·legal, però no en la millora en salut. El tractament amb heroïna va tenir millors resultats estadísticament en pacients amb experiència prèvia en tractaments enfocats a l'abstinència, tant pel que fa a salut com al consum de drogues il · legals. Es va trobar un consum de drogues significativament major entre els pacients amb un diagnòstic comòrbid tant al principi com al final del tractament. L'heroïna va tenir un resultat superior a la metadona pel que fa a la reducció del consum de drogues en els pacients comòrbids i no comòrbids, però l'efecte va ser més feble en el grup comòrbid. L'heroïna va funcionar millor que la metadona en la millora de la salut per als pacients no comòrbids, però, aquesta diferència no es va mantenir en els pacients amb comorbiditat psiquiàtrica. L'ús de benzodiazepines durant el tractament va tenir una relació negativa amb els resultats de millora en salut en ambdós grups de tractament, però, en analitzar els resultats de l'ús de drogues, les diferències van ser estadísticament significatives només quan tots dos grups de tractament van ser combinats. La proporció de positius de benzodiazepines en orina durant el tractament va disminuir més en el grup tractat amb heroïna que en el grup tractat amb metadona. Els homes van tenir millors resultats per a la reducció del consum de drogues il · legals, però no pel que fa a la millora en salut o en retenció. En analitzar el grup de dones, es van trobar diferències estadísticament significatives entre els tractaments (heroïna o metadona) només en analitzar retenció. Després de realitzar una anàlisi multivariant incloent diverses característiques psicosocials, només l'exercici de la prostitució va predir pitjors resultats entre les dones. Finalment es presenten quatre models de predicció de resultats sobre la reducció del consum de drogues il·legals i la millora de l'estat de salut tant en la mostra total (utilitzant variables de la línia base) com en els pacients que van acabar l'estudi (utilitzant variables longitudinals). Segons els nostres resultats, podem donar suport a les següents conclusions: 1) Són necessàries intervencions específiques en pacients que consumeixen alcohol o benzodiazepines, o amb una infecció d'hepatitis C. 2) L'ús de tractaments previs de manteniment s'ha de reconsiderar com un requisit per a l'entrada en tractament assistit amb heroïna. Els pacients sense experiències prèvies de tractaments enfocats a l'abstinència tenen un quadre clínic més complicat. 4) Els pacients duals (és a dir, pacients diagnosticats amb trastorns psiquiàtrics comòrbids) han de tenir intervencions específiques. 5) El suport social sembla ser un factor clau per a la recuperació. 6) Les dones constitueixen un grup de risc especial. / El proyecto modelo alemán para el tratamiento asistido con heroína en adictos a opiáceos supuso un cambio en la política de drogas en este país. Se comparó el tratamiento asistido con heroína y el tratamiento de mantenimiento con metadona en un estudio multicéntrico de 1015 pacientes en 7 ciudades de Alemania. El grupo tratado con heroína mostró una mayor retención y respuesta en la mejoría de salud física y mental, así como reducción de consumo de drogas ilegales. En este trabajo se presentan cinco artículos relacionados con factores clínicos y psicosociales que influyen en la recuperación de estos pacientes y deben ser tomados en cuenta para su adecuado tratamiento. En concreto se analizan el consumo de alcohol y benzodiacepinas, los efectos de la comorbilidad psiquiátrica, la influencia de las experiencias anteriores de tratamiento y las diferencias de género. Se detectaron fuertes reducciones en el consumo de alcohol en el grupo de heroína, y estos pacientes tuvieron mejores resultados en cuanto a mejoría de salud y reducción del consumo de drogas, tanto para los pacientes dependientes de alcohol como para los no dependientes. Se encontraron resultados superiores del tratamiento asistido con heroína en pacientes sin experiencia en tratamientos de mantenimiento en cuanto a la reducción del consumo de drogas y la reducción de la actividad ilegal, pero no en la mejoría en salud. El tratamiento con heroína tuvo mejores resultados en pacientes con experiencia previa en tratamientos enfocados a la abstinencia, tanto en lo referente a salud como al consumo de drogas ilegales. Se encontró un consumo de drogas significativamente mayor entre los pacientes con un diagnóstico comórbido tanto al principio como al final del tratamiento. La heroína tuvo un resultado superior a la metadona en lo referente a la reducción del consumo de drogas en los pacientes comórbidos y no comórbidos, pero el efecto fue más débil en el grupo comórbido. La heroína funcionó mejor que la metadona en la mejora de la salud para los pacientes no comórbidos, sin embargo, esta diferencia no se mantuvo en los pacientes con comorbilidad psiquiátrica. El uso de benzodiacepinas durante el tratamiento tuvo una relación negativa con los resultados de mejoría en salud en ambos grupos de tratamiento, pero, al analizar los resultados del uso de drogas, las diferencias fueron estadísticamente significativas sólo cuando ambos grupos de tratamiento fueron combinados. La proporción de positivos de benzodiacepinas en orina durante el tratamiento disminuyó más en el grupo tratado con heroína que en el grupo tratado con metadona. Los hombres tuvieron mejores resultados para la reducción del consumo de drogas ilegales, pero no en cuanto a la mejoría en salud o en retención. Al analizar el grupo de mujeres, se encontraron diferencias estadísticamente significativas entre los tratamientos (heroína o metadona) sólo al analizar retención. Después de realizar un análisis multivariante incluyendo varias características psicosociales, sólo el ejercicio de la prostitución predijo peores resultados entre las mujeres. Finalmente se presentan cuatro modelos de predicción de resultados sobre la reducción del consumo de drogas ilegales y la mejora del estado de salud tanto en la muestra total (utilizando variables de la línea base) como en los pacientes que terminaron el estudio (utilizando variables longitudinales). Según nuestros resultados, podemos apoyar las siguientes conclusiones: 1) Son necesarias intervenciones específicas en pacientes que consumen alcohol o benzodiacepinas, o con una infección de hepatitis C. 2) El uso de tratamientos previos de mantenimiento debe ser reconsiderado como un requisito para la entrada en tratamiento asistido con heroína. Los pacientes sin experiencias previas de tratamientos enfocados a la abstinencia tienen un cuadro clínico más complicado. 4) Los pacientes duales (es decir, pacientes diagnosticados con trastornos psiquiátricos comórbidos) deben tener intervenciones específicas. 5) El apoyo social parece ser un factor clave para la recuperación. 6) Las mujeres constituyen un grupo de riesgo especial. / The German model project for heroin assisted treatment of opiate addicts implied a change in the drug policy of this country. Heroin Assisted Treatment and Methadone Maintenance Treatment were compared in a multicentre study among 1015 patients in 7 cities in Germany. The heroin group showed better retention in treatment and greater response on physical and mental health improvement as well as illicit drug reduction. In this dissertation we present five papers relating to clinical and psychosocial factors that influence the recovery of these patients and should be taken into account for their proper treatment. Specifically, the consumption of alcohol and benzodiazepines, the effects of psychiatric comorbidity, the influence of prior treatment experiences and gender differences are analysed. Stronger reductions in alcohol consumption were detected in the heroin group, and these patients had better outcomes in health improvement and in reduction of illicit drug use both for alcohol dependent and non-dependent patients. The superiority of heroin in patients with no previous maintenance treatment experience was found on reduction of illicit drug use and the reduction of illegal activity, but not in the improvement of health. Heroin superiority in outcome was statistically significant for patients with previous abstinence treatment experience both for health and illegal drug consumption. Drug use was found to be significantly higher among patients with a comorbid diagnosis at the beginning and the end of treatment. Heroin had a better outcome than methadone for the reduction of illicit drug use in both comorbid and non-comorbid patients, but weaker effects were found in the comorbid group. Heroin worked better than methadone in improvement of health for non-comorbid patients; however, this difference was not present among patients with psychiatric comorbidities. Benzodiazepine use during treatment was found to have a negative association with health outcome in both treatment groups but, when analysing drug use outcome, differences were only statistically significant when both treatment groups were combined. The proportion of benzodiazepine positive urine tests during treatment decreased more in the heroin than in the methadone group. Men had significant better outcomes for the reduction of illegal drug use but not for health or retention. Among women, statistically significant differences between treatments (heroin or methadone) were only found for retention. After multivariate analyses including various possible psychosocial characteristics, only prostitution was found to predict worse outcomes among women. Finally we present four models predicting outcomes on reducing illegal drug use and improving health status in both the total sample (using baseline variables) and in patients who completed the study (using longitudinal variables). According to our results, we can support the following conclusions: 1) Specific interventions are needed in alcoholic, HCV and benzodiazepine consuming patients. 2) Previous maintenance treatment should be reconsidered as a requirement for Heroin Assisted Treatment entry. Patients without previous drug free experiences have a more complicated clinical picture. 4) Dual diagnosis patients (i.e. patients diagnosed with comorbid psychiatric disorders) need to have specific interventions. 5) Social support appears to be a key factor for recovery. 6) Women constitute a special risk group.

Heroinberoende har en hög dödlighet och innebär stora kostnader för samhället, och den mest förekommande och effektiva behandlingen är läkemedelsassisterad behandling (LAB). Studiens syfte var att studera LAB vid heroinberoende ur ett omvårdnadsperspektiv. Omvårdnadsteorin som applicerades var ”Tidvattenmodellen” vars filosofi grundar sig på att det finns psykiska behov, att omvårdnad kan vara ett sätt att möta dessa behov, att människan redan har lösningen på sina livsproblem och att omvårdnad handlar om att ta fram dessa lösningar. En systematisk litteraturstudie gjordes. Resultatet baseras på tio kvantitativa artiklar och presenteras med tre teman: Bakgrundsfaktorernas roll, Personcentrerad omvårdnad och Accepterande omvårdnad. Olika bakgrundsfaktorer påverkar deltagande och fullföljande av behandlingen, så som att ha ett arbete samt civilstatus. För ett positivt resultat av LAB är det viktigt med en personcentrerad omvårdnad som erbjuder ett socialt stöd. För att öka deltagandet, och därmed tillgången till omvårdnad, måste behandlingens krav sänkas och omfattas av en högre acceptansnivå. I framtiden behövs det en bredare forskning gällande omvårdande insatser vid LAB samt diskussioner för att utforma en så säker vård som möjligt. / Heroin addiction has a high mortality and implies high costs to society, and the most common and effective treatment is maintenance treatment (MT). The study's aim was to study MT during a heroin addiction from a nursing perspective. The nursing theory applied was “The Tidal Model” whose philosophy is based on the existence of psychological needs, that nursing can be a way to meet those needs, that humans already have the solution to their problems of life and that nursing is about to develop these solutions. A literature review was made. The result is based on ten quantitative articles and presents three themes: The Meaning of Background Factors, Person-centered Care and Nursing Acceptance. Different background factors affect participation and retention in treatment, for example to have a job or the marital status. To get a positive outcome of the MT it is important with a person-centered care that provides a social support. To increase participation, and therefore the access to care, treatment policy must be lowered and have a higher level of acceptance. In the future we need comprehensive research on nursing during MT and discussions to design the safest care possible.

<p>Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. </p><p>In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala.</p><p>The aim of this thesis was to study the outcome of methadone treatment along various lines:</p><p>• An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. </p><p>• Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program.</p><p>• Retention in treatment.</p><p><b>Study subjects, methods and treatment goals: </b>Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. </p><p><b>Results: </b>Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission.</p><p><b>Conclusion: </b>The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.</p>

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. <b>Study subjects, methods and treatment goals: </b>Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. <b>Results: </b>Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission. <b>Conclusion: </b>The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.

Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed. / Psychology / (M.A.(Psychology))

Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed. / Psychology / (M.A.(Psychology))