Background: In Kazakhstan, opioid substitution therapy (OST) has been a controversial topic since its introduction in 2008. Aim: To examine and analyse factors influencing approach towards OST among OST patients, opioid-dependent drug users who could re-consider engagement in this therapeutic method, as well as attitudes of selected key organisations and their representatives. Methods: A survey method complemented by semi-structured individual and group interviews has been selected. One hundred respondents participated in the study between October and December 2015. The first group consisted of 46 OST patients. The second group consisted of 54 respondents who met criteria for opioid dependence. This group included patients of residential treatment centres, former OST patients and current injecting drug users. Key persons were interviewed about their attitudes. Results: Patients receiving OST, with the average treatment duration of 29.4 months, reported improved health, improved social functioning and financial well-being, as well as reduction of their involvement in crime. This group showed better results in all examined categories. Most (80 %) were satisfied with the treatment, even though a number of shortcomings have been reported. All OST patients considered necessary to expand the availability...

Ergebnisse einer breit angelegten Repräsentativerhebung zur Substitutionstherapie in Deutschland an 2694 Patienten zeigen, dass trotz hoher und komplexer Ko- und Multimorbidität mit psychischen Erkrankungen nur selten Psychiater an der Therapie beteiligt sind. Nur 16% der Substitutionsärzte (n=223) sind Psychiater oder Psychotherapeuten und nur 21% der substituierten Drogenabhängigen werden von Psychiatern behandelt. Die meisten substituierenden Psychiater sind in Institutsambulanzen psychiatrischer Kliniken tätig (51,3%), kaum in eigener Praxis (7,2%). Der Großteil der Substitutionsversorgung wird von Allgemein- und Hausärzten geleistet. Die relative Abstinenz psychiatrischer Kollegen bei der Substitution drogenabhängiger Patienten wird kritisch diskutiert. / Results of a nationally representative study in 2,694 patients reveal that most physicians (n=223) involved in substitution treatment of opioid-dependent patients are general practitioners, while only 16% have a psychiatric/psychotherapeutic background and only 21% of the addictive patients are treated by psychiatrists. This contrasts with the remarkably complex pattern of co- and multimorbidity with other mental disorders in such patients. Most psychiatrists engaged in substitution treatment work in specialized outpatient wards (51.3%), and few were operative in their own or private practice (7.2%). Implications of these critical findings are discussed.

The purpose of this study is to describe and analyze how health care providers, working at care facilities providing maintenance treatment programs for opiate dependence, perceive and manage the legal framework governing the treatment. The study is limited to a few particular rules within this framework which over the recent decade have been the subject matter of debate regarding i.a. their alleged lack of relation to scientific research and their frequently disastrous implications for program participants. The empirical material consists of interviews with five respondents working at four different care facilities and has been analyzed by using Lipskys theory on street-level bureaucrats as policymaking agents. The results of the study show that the rules are looked upon and dealt with in a liberal fashion and that the primary loyalty of the maintenance treatment staff is clearly directed towards promoting the well-being of their patients and helping them reach their treatment goals rather than strictly following the rules.

Denna studie syftar till att beskriva patienters upplevelse av läkemedelsassisterad behandling för opiatberoende (LARO), även kallad underhållsbehandling. I studien undersöks hur upplevelsen av LARO är och hur den beskrivs utifrån två olika patientgrupper; de patienter med en mindre välfungerande behandling som dagligen går till mottagningen för att ta medicin övervakat och som lämnar urinprov två gånger i veckan, samt de patienter med en välfungerande behandling som går till mottagningen två gånger i veckan för att lämna urinprov men hämtar medicin på apoteket. I uppsatsen har sex patienter intervjuats om hur de upplever LARO. Uppsatsens resultat illustrerar bland annat upplevd brist på delaktighet och empowerment i behandlingen samt vikten av en god relation mellan patienter och personal på LARO-mottagningen. Studiens slutsats är att Patient empowerment bör vara grundstenen i all arbete med omvårdnad och behandling. / This study aims to describe patients' experiences of medication-assisted treatment for opioid dependence (LARO), also called maintenance therapy. The study examines how the patients experience LARO is and how the experience is percieved among the two patient groups: those patients with a less well functioning treatment that daily goes to the clinic to take medication supervised, and submit urine samples twice a week, as well as those patients with a functioning treatment that goes to the clinic twice a week to provide a urine sample but retrieves medicine from the pharmacy.In the paper, six patients were interviewed about how they experience LARO. Results of the thesis illustrate, among other things, the experienced lack of participation and empowerment in the treatment and the importance of a good relationship between patients and staff at LARO reception. The study concludes that patient empowerment should be the cornerstone of all the work with care and treatment.

Studiens syfte är att undersöka individens subjektiva upplevelse av att genomgå läkemedelsassisterad behandling för opioidberoende (LARO). För att besvara studiens syfte och frågeställningar har vi använt oss av kvalitativ metod i form av både fokusgruppintervju och individuella intervjuer. I fokusgruppintervjun intervjuade vi tre yrkesverksamma för att bredda våra kunskaper inom ämnet och även för hjälp till utformningen av intervjuguiden för de individuella intervjuerna. De individuella intervjuerna bestod av sex intervjupersoner, tre som har LARO-behandling i dagsläget och tre som tidigare har haft det. Materialet från fokusgrupp- och de individuella intervjuerna presenteras i empirin med hjälp av en tematisk analys. Empirin har sedan analyserats med hjälp av tidigare forskning och Goffmans teori om stigma. Studien visar att det finns flera olika aspekter som framkommer som viktiga i individens upplevelse av att ha LARO-behandling. I studien har särskilt fysiska biverkningar och känslomässig avstängdhet lyfts som en viktig aspekt. Även sidomissbruk verkar vara något studiens deltagare anser vara ett viktigt problem. Hämtningen av medicin och kontroll är också en aspekt som verkar vara en stor del av att ha LARO-behandling. En viktig aspekt är även behandlingens livräddande förmåga, men trots denna verkar dessutom en bundenhet till behandlingen upplevas som ett problem av deltagarna. Studien visar en variation i hur individen med LARO-behandling påverkas av sociala sammanhang. Å ena sidan verkar relationerna till närstående och familj i vissa fall ha fortsatt varit fungerande, eller till och med bättre. Å andra sidan beskrivs relationerna ha försämrats. Vi kan även se hos samtliga deltagare att de varit varsamma med vilka de var öppna för om sin behandling. Studien visar att i vissa fall kunde omgivningen vara förstående, i andra fall kunde omgivningen se ner på individen. Hos våra intervjudeltagare är upplevelsen av personalens bemötande i stort positiv. Studien diskuterar skillnader i åsikter gällande frågan kring huruvida man kan vara drogfri under pågående LARO-behandling. Vissa respondenter anser att man kan vara drogfri, men lyfter sidomissbruk som ett hinder. Andra respondenter anser att man inte riktigt kan klassas som drogfri ifall man erhåller substitutionsbehandling. / The purpose of the study is to examine individuals’ subjective experiences of undergoing medication-assisted treatment for opioid dependency (LARO). To address the study’s purpose and research questions we used a qualitative method, utilizing both focus group interviews and individual interviews. In the focus group interview we interviewed three professionals to broaden our knowledge of the subject and to assist in the development of the interview guide for the individual interviews. The individual interviews included six participants: three currently undergoing LARO-treatment and three who have previously undergone it. The material from the focus group and individual interviews is presented in the empirical section using thematic analysis. The empirical data were then analyzed with the help of previous research and Goffman’s theory of stigma. The study reveals several important aspects of individuals’ experiences with LARO treatment. Physical side effect and emotional numbness were highlighted as significant issues. Concurrent substance abuse also appears to be a major concern among the study’s participants. The process of medication retrieval and monitoring is another significant aspect of LARO treatment. While the treatment’s life-saving potential is acknowledged, participants also expressed a sense of dependency on the treatment as problematic. The study shows variability in how individuals undergoing LARO-treatment are affected by social contexts. On one hand, relationships with close ones and family sometimes remained functional or even improved. On the other hand, some relationships are described as deteriorated. All participants were cautious about whom they disclosed their treatment to. The study shows that the surrounding environment could be understanding in some cases. While in other cases, individuals were looked down upon. The participants’ experiences with the staff’s attitude are generally positive. The study discusses differing opinions on whether one can be considered drug-free while undergoing LARO treatment. Some respondents believe that one can be drug-free but highlight concurrent substance abuse as an obstacle. Other believe that one cannot be truly considered drug-free if receiving substitution treatment.

Deux paradigmes se côtoient dans le traitement de la dépendance au Québec. Tout d’abord, il y a le paradigme de l’abstinence avec un modèle d’intervention souvent basé sur les Alcooliques Anonymes. Avec ce modèle, l’alcoolisme (ou la toxicomanie) est défini comme une maladie. En ce qui a trait à la réduction des méfaits, cette dernière vise la réduction des effets néfastes de l’usage de drogues plutôt que l’élimination de leur usage (Brisson, 1997). Nous nous sommes intéressés à une intervention inscrite dans ce paradigme soit le programme de substitution à la méthadone. Cette étude avait comme but de connaître les perceptions de personnes inscrites à ce programme, comprendre comment est vécu le rétablissement à travers la participation au programme et connaître les perceptions de ces personnes en ce qui a trait aux conséquences de la dépendance. Un cadre théorique s’inscrivant dans la perspective de l’interactionnisme symbolique a été choisi. Plus précisément, les processus de transformations normatives de Maria Caiata Zufferey, la théorie de l’étiquetage d’Howard Becker et le concept de stigmate d’Erving Goffman ont été retenus. Ensuite, dix entrevues semi-dirigées auprès d’hommes et de femmes majeures inscrites à un programme de substitution à la méthadone ont été réalisées. En ce qui a trait au chapitre portant sur les résultats, il a mis en lumière différents rapports à la méthadone vécus par les participants. Pour ce faire, trois figures construites à l’aide de l’analyse typologique ont été développées. Il ressort que pour certaines personnes, la méthadone fut décrite comme un substitut nécessaire, pour d’autres, elle correspondait à une aide dont ils veulent se débarrasser et pour une minorité, elle suscitait de l’ambivalence. En définitive, bien que la substitution demeure le traitement de choix pour la dépendance aux opioïdes, il est difficile de parler de sortie du monde de la drogue à l’aide de la méthadone puisque ce traitement apparaît comme étant presque aussi stigmatisé que la dépendance à l’héroïne (Lauzon, 2011). À première vue, la méthadone permet de prendre une distance avec le monde de la drogue (l’argent facile, les vols, la prostitution) et permet de se reconstruire une existence sur la base de repères stables, mais à bien considérer les choses, elle confine les personnes interrogées dans une situation d’ambivalence puisqu’elle les rattache à une identité de toxicomane. Mots-clés : dépendance, programme de substitution à la méthadone, perception, participant, réduction des méfaits, stigmatisation. / Two paradigms are frequent when treating addiction in Quebec. First, there is the paradigm of abstinence with an intervention model often based on Alcoholics Anonymous. With this model, alcoholism (or addiction) is defined as a disease. The second paradigm, harm reduction, is aimed to reduce the harmful effects of drug use rather than eliminating their use (Brisson, 1997). We are particularly interested in an intervention found in this paradigm named methadone maintenance treatment. This research was aimed to identify the perceptions of people enrolled in this treatment, understand their recovery process while participation in this treatment and understanding the perceptions of users of methadone in regards to the consequences of addiction. A theoretical framework found in the symbolic interactionist perspective was selected. More specifically, the process of normative transformations of Maria Caiata Zufferey, the labelling theory of Howard Becker and the stigma theory of Erving Goffman were selected. A qualitative methodology was retained. Ten semi-structured interviews with men and women enrolled in a methadone maintenance treatment were conducted. The chapter that focussed on the results highlighted various reports on how methadone maintenance treatment was experienced by the participants. To do this, three figures constructed using typology analysis were developed. For some people, methadone was described as a necessary substitute, for others, it corresponded to a help that they wanted to eliminate and for a minority, it aroused ambivalence. One thing is certain, although the substitution remains the treatment of choice for opioid dependence, it is difficult to speak of the output of the drug world with the help of methadone because this treatment appears to be almost as stigmatized as the dependence on heroine (Lauzon, 2011). At first glance, the use of methadone can help distance a person from the world of drugs (easy money, theft, prostitution) and can help rebuild their lives on a basis of landmark stability, but to carefully consider, it confines the respondents in a state of ambivalence as it relates to the identity of an addict. Keywords : harm reduction, methadone maintenance treatment, perception, participant, stigma, dependency.

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No description available.

<p>Studiens syfte var att undersöka om naturläkemedlet Ibogain kunde vara en bra behandling för missbruk. För att kunna besvara detta har kvalitativa intervjuer genomförts med fyra personer som genomgått Ibogain-behandling och en psykolog/psykoterapeut på en beroendeklink, Lars Lundell. Utöver dessa intervjuer har en klinik i London besökts som utför Ibogain-behandling. På kliniken gjordes en observationsstudie av behandlingen, samt intervjuer med klinikchefen Dr Brackenridge och en av hans patienter, i uppsatsen kallad Will. Studiens perspektiv utgår från informanterna och våra egna observationer om Ibogain-behandling. Intervjufrågorna har bildats utifrån dessa 3 frågeställningar:</p><p>1. Hur går en behandling tillväga rent praktiskt?</p><p>2. Hur har livet påverkats av Ibogain-behandling?</p><p>3. Vilken syn har informanterna på Ibogain-behandling?</p><p>I analysen söktes gemensamma nämnare och skillnader i informanternas svar, uppdelat i de tidigare nämnda frågeställningarna. Sedan tolkades denna information med hjälp av litteratur, observationer och egna tankar.</p><p>I studien ges en mycket samstämmig syn på att utan Ibogain-behandling hade troligtvis inte informanterna varit i livet idag.</p><p>Resultatet visar tydligt på att informanterna upplever att de fått en mycket bättre livskvalité efter behandlingen.</p><p>Av de uppgifter som framkommit i studien anser vi att Ibogain är att rekommendera.</p> / <p>The purpose of this study was to investigate if the naturally occurring substance Ibogaine could be a good treatment for substance abuse. In order to answer this question, qualitative interviews have been performed with five persons who have been subject to Ibogain treatment and one psychologist/psychotherapist at an addiction treatment clinic, Lars Lundell.</p><p>In addition to these interviews an Ibogaine treatment clinic located in London has been visited. At the clinic an observational study of the treatment was carried out as well as interviews with the responsible physician Dr Brackenridge one of his patients, named Will in this paper. The perspective of this study is substance abuse treatment with Ibogaine based on the informants experiences and our own observations.</p><p>The interviews have been formed based on the following three questions:</p><p>1. How is a treatment carried out?</p><p>2. How have their lives been affected by the Ibogain treatment?</p><p>3. What are the informant’s views on Ibogain treatment?</p><p>The analysis was made looking for similarities and dissimilarities in the informants answers, divided into the three previously described questions. This information was subsequently interpreted using literature, observations and our own thoughts.</p><p>The study shows that among the informants there is an almost unanimous opinion that without the Ibogaine treatment they would not be alive today.</p><p>The study clearly shows that the informants feel that they have a much better quality of life after the treatment. The conclusion of this study is that Ibogaine can be a successful treatment for substance abuse.</p>

Studiens syfte var att undersöka om naturläkemedlet Ibogain kunde vara en bra behandling för missbruk. För att kunna besvara detta har kvalitativa intervjuer genomförts med fyra personer som genomgått Ibogain-behandling och en psykolog/psykoterapeut på en beroendeklink, Lars Lundell. Utöver dessa intervjuer har en klinik i London besökts som utför Ibogain-behandling. På kliniken gjordes en observationsstudie av behandlingen, samt intervjuer med klinikchefen Dr Brackenridge och en av hans patienter, i uppsatsen kallad Will. Studiens perspektiv utgår från informanterna och våra egna observationer om Ibogain-behandling. Intervjufrågorna har bildats utifrån dessa 3 frågeställningar: 1. Hur går en behandling tillväga rent praktiskt? 2. Hur har livet påverkats av Ibogain-behandling? 3. Vilken syn har informanterna på Ibogain-behandling? I analysen söktes gemensamma nämnare och skillnader i informanternas svar, uppdelat i de tidigare nämnda frågeställningarna. Sedan tolkades denna information med hjälp av litteratur, observationer och egna tankar. I studien ges en mycket samstämmig syn på att utan Ibogain-behandling hade troligtvis inte informanterna varit i livet idag. Resultatet visar tydligt på att informanterna upplever att de fått en mycket bättre livskvalité efter behandlingen. Av de uppgifter som framkommit i studien anser vi att Ibogain är att rekommendera. / The purpose of this study was to investigate if the naturally occurring substance Ibogaine could be a good treatment for substance abuse. In order to answer this question, qualitative interviews have been performed with five persons who have been subject to Ibogain treatment and one psychologist/psychotherapist at an addiction treatment clinic, Lars Lundell. In addition to these interviews an Ibogaine treatment clinic located in London has been visited. At the clinic an observational study of the treatment was carried out as well as interviews with the responsible physician Dr Brackenridge one of his patients, named Will in this paper. The perspective of this study is substance abuse treatment with Ibogaine based on the informants experiences and our own observations. The interviews have been formed based on the following three questions: 1. How is a treatment carried out? 2. How have their lives been affected by the Ibogain treatment? 3. What are the informant’s views on Ibogain treatment? The analysis was made looking for similarities and dissimilarities in the informants answers, divided into the three previously described questions. This information was subsequently interpreted using literature, observations and our own thoughts. The study shows that among the informants there is an almost unanimous opinion that without the Ibogaine treatment they would not be alive today. The study clearly shows that the informants feel that they have a much better quality of life after the treatment. The conclusion of this study is that Ibogaine can be a successful treatment for substance abuse.