Substance use disorders cause significant neurological damage, cognitive impairment, and maladaptive behaviors that negatively affect a person's quality of life. The purpose of this study was to explore the effect gender and primary drugs have on locus of control. Generalized expectancy theory helped to explain the behavior of patients diagnosed with substance use disorders and their inability to control ongoing drug use. The research question focused on to what extent drug-related locus of control scores differ by primary drug (narcotic vs. stimulant), gender (male vs. female), and their interaction. Data measuring locus of control from 553 participants provided a subset of 410 participants who identified narcotics or stimulants as their primary drug. A 2x2 full factorial ANOVA was conducted. The results of this study indicated there is a significant interaction between primary drug use and gender. The results could have positive social change implications for the addiction field because of the value of understanding the interdependency of internal-external thought processes related to drug use, the ability to change stigma associated with addiction and gender, and the value of understanding the need for individualized treatment as locus of control shifts from external to internal. It is recommended that the drug-related locus of control instrument become part of treatment protocol along with evidence-based interventions.

Background: In light of the opioid epidemic, reducing excess prescription quantities while tailoring to patient need is key. We previously created an opioid prescribing guideline using retrospective institutional data to satisfy the majority of patients’ opioid needs following inpatient colorectal surgery. Objective: This study sought to prospectively validate an institutional prescribing guideline based on previously-defined opioid consumption patterns following inpatient colorectal operations. Methods: We carried out a cohort study comparing opioid prescribing and consumption patterns before (7/18 – 1/19) and after (9/19 – 2/20) adoption of a tiered opioid prescribing guideline for inpatient elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center. Opioid use was quantified as Equianalgesic 5mg Oxycodone Pills (EOP), and patients were grouped in three tiers based on opioid consumption in the 24-hours prior to discharge: Tier 1 (0 EOP), Tier 2 (0.1-3 EOP), and Tier 3 (>3 EOP). Our guideline recommended maximum prescriptions of 0 EOP for Tier 1, 12 EOP for Tier 2, and 30 EOP for Tier 3. Results: The study included 100 patients before and 101 after guideline adoption. Demographic and operative variables were similar before and after guideline adoption. Guideline adherence was 85%. Overall, there was a 41% reduction in mean prescription quantity and 53% reduction in excess pills per prescription with no change in opioid consumption or refill rates. Conclusion: Adoption of a tiered opioid prescribing guideline significantly reduced opioid prescription quantity with no change in consumption or refill rates. Standardization of discharge prescriptions based on patient consumption in the 24 hours prior to discharge may be an important step towards minimizing excess prescribing.

OBJETIVO: Analisar como o Poder Judiciário vem garantindo o direito social à assistência farmacêutica e qual a relação do sistema jurídico e político na garantia a esse direito. MÉTODOS: Foram analisados os processos judiciais de fornecimento de medicamentos pelo Estado de São Paulo, de 1997 a 2004. Utilizou-se o Discurso do Sujeito Coletivo para identificar os discursos dos atores que compõem os processos judiciais. RESULTADOS: Os discursos dos juízes subsidiaram a condenação do Estado em 96,4% dos casos analisados. O Estado foi condenado a fornecer o medicamento nos exatos moldes do pedido do autor, inclusive quando o medicamento não possuía registro na Agência Nacional de Vigilância Sanitária (9,6% dos casos analisados). Observou-se que 100% dos processos estudados foram propostos por autores individuais; em 77,4% o autor requer o fornecimento de medicamento específico de determinado laboratório farmacêutico e; em 93,5% dos casos, o medicamentos são concedidos judicialmente ao autor em caráter de urgência, por meio de medida liminar. CONCLUSÕES: O Poder Judiciário, ao proferir suas decisões, não toma conhecimento dos elementos constantes na política pública de medicamentos, editada conforme o direito para dar concretude ao direito social à assistência farmacêutica. E assim, vem prejudicando a tomada de decisões coletivas pelo sistema político nesse âmbito, sobrepondo as necessidades individuais dos autores dos processos às necessidades coletivas. / OBJECTIVE: To evaluate how the Judicial Power safeguards the social right to pharmaceutical assistance as well as the relationships between the legal and political systems to safeguard this right. METHODS: There were assessed decisions in lawsuits of drug supply in the state of São Paulo, Southern Brazil, between 1997 and 2004. Discourse of the Collective Subject of procedural actors was the methodological approach used. RESULTS: In 96.4% of the cases analyzed, judges discourse sentenced the State. these cases, the State was obliged to provide drugs exactly as requested by the plaintiff, even when drugs were not registered in the National Health Surveillance Agency (9.6% of cases). Also, 100% of the lawsuits were proposed by individual plaintiffs; in 77.4% of the cases the plaintiff requested an specific drug of a specific pharmaceutical company; and in 93,5%, the drugs were provided to the plaintiff through an urgent preliminary order. CONCLUSIONS: The Judicial Power is not taking into account in its decisions political elements of drug policies, established to enforce the social right to pharmaceutical assistance. The Judicial Power is hindering the collective decision making process by the political system, prioritizing plaintiffs individual needs over community interests.

OBJETIVO: Analisar como o Poder Judiciário vem garantindo o direito social à assistência farmacêutica e qual a relação do sistema jurídico e político na garantia a esse direito. MÉTODOS: Foram analisados os processos judiciais de fornecimento de medicamentos pelo Estado de São Paulo, de 1997 a 2004. Utilizou-se o Discurso do Sujeito Coletivo para identificar os discursos dos atores que compõem os processos judiciais. RESULTADOS: Os discursos dos juízes subsidiaram a condenação do Estado em 96,4% dos casos analisados. O Estado foi condenado a fornecer o medicamento nos exatos moldes do pedido do autor, inclusive quando o medicamento não possuía registro na Agência Nacional de Vigilância Sanitária (9,6% dos casos analisados). Observou-se que 100% dos processos estudados foram propostos por autores individuais; em 77,4% o autor requer o fornecimento de medicamento específico de determinado laboratório farmacêutico e; em 93,5% dos casos, o medicamentos são concedidos judicialmente ao autor em caráter de urgência, por meio de medida liminar. CONCLUSÕES: O Poder Judiciário, ao proferir suas decisões, não toma conhecimento dos elementos constantes na política pública de medicamentos, editada conforme o direito para dar concretude ao direito social à assistência farmacêutica. E assim, vem prejudicando a tomada de decisões coletivas pelo sistema político nesse âmbito, sobrepondo as necessidades individuais dos autores dos processos às necessidades coletivas. / OBJECTIVE: To evaluate how the Judicial Power safeguards the social right to pharmaceutical assistance as well as the relationships between the legal and political systems to safeguard this right. METHODS: There were assessed decisions in lawsuits of drug supply in the state of São Paulo, Southern Brazil, between 1997 and 2004. Discourse of the Collective Subject of procedural actors was the methodological approach used. RESULTS: In 96.4% of the cases analyzed, judges discourse sentenced the State. these cases, the State was obliged to provide drugs exactly as requested by the plaintiff, even when drugs were not registered in the National Health Surveillance Agency (9.6% of cases). Also, 100% of the lawsuits were proposed by individual plaintiffs; in 77.4% of the cases the plaintiff requested an specific drug of a specific pharmaceutical company; and in 93,5%, the drugs were provided to the plaintiff through an urgent preliminary order. CONCLUSIONS: The Judicial Power is not taking into account in its decisions political elements of drug policies, established to enforce the social right to pharmaceutical assistance. The Judicial Power is hindering the collective decision making process by the political system, prioritizing plaintiffs individual needs over community interests.

Abstract not available

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Made available in DSpace on 2016-06-02T20:25:08Z (GMT). No. of bitstreams: 1 3486.pdf: 964409 bytes, checksum: dc71f88a2d4ca3c054c8533cde46ae83 (MD5) Previous issue date: 2011-02-24 / Financiadora de Estudos e Projetos / This study has it s center in the relevance of the discourse in all social practices. Among these, are found the judicial practice, regulationed by laws, penal, civil and criminal codes that try regulation the most of social relations. Considering the drugs traffic crime, the objective of this work it is comprehend individual-position in the process of (des) construction of juridical individual (counsel), in penal process concluded with the absolution from one of the fouler defendant. Standing in the discourse formulation´s level (and/or of constitution), we work the argumentation from of the historical-discursive process where the position of counsel individual (lawyer) is formed, it enabling motions of reading/interpretation. The corpus of analysis is formed by the decision acórdão conceded by the Justice Court of Porto Alegre, Rio Grande do Sul. This corpus exposes the practice of narcotic traffic of 3 young (the age between 20-30), whose crime happened in a gaúcha city, in 2003. In the judicial discursive practices, the purpose of the counsel s discourse is give an answer to the problem of the defendant with the purpose of absolution. This answer it seems to situated, many times, in an illusory perspective of completeness in the language, be rational and close, thinking on this way, be resolving the case/fact. To the discursive reflexion, resort on works from the french philosopher Michel Pêcheux and Michel Foucault. It is on the lard of various knowledge areas, like Discourse Analyses, Philosophy and Law that this work proposes the theorical-discursive reflexion. We observed the following considerations: 1) the activation of the Registrar of discourse memory in the fabric of criminal fact, 2) the operation of the senses, the comparison of the utterances of the defendants from the Criminal Investigation conducted by the Public Defender, 3) the s sdr defendant's "Z" built statements wish absolution: a) pick up only / just a ride, and b) real part in the imputation that he was being made, thus the formulation functioned as an effect of truth, 4) the Insurgency in sdr the Public Defender and Appellate of the subject showed that the FD has led to the authorization of the acquittal of the accused "Z" and impeded discourses of guilt and punishment, listed in determination of conviction in Judgement, and 5) the Public Defender Brazilian made discourses constituting meanings of victimology, thereby weakening mechanisms of criminology. / Este estudo centra-se na relevância do discurso em todas as práticas sociais. Entre essas, encontram-se as práticas do judiciário, regulamentadas por leis, códigos penais, criminais, civis que tentam regular a maioria das relações sociais. Levando em conta o crime tráfico de drogas, o objetivo deste trabalho é compreender a posição-sujeito no processo de (des) construção do discurso do sujeito jurídico defensor, em processo penal concluso com absolvição de um dos réus infratores. Permanecendo no nível da formulação do discurso (e ou da constituição), trabalhamos a argumentação a partir do processo histórico-discursivo em que a posição do sujeito defensor (advogado) é constituída, possibilitando gestos de leitura/interpretação. O corpus de análise é composto pela peça acórdão , concedida pelo Tribunal de Justiça de Porto Alegre, Estado do Rio Grande do Sul. Esse corpus revela a prática do tráfico de entorpecentes de três jovens (entre 20 a 30 anos), cujo crime ocorreu em cidade gaúcha, no ano de 2003. Nas práticas discursivas judiciais, a finalidade do discurso do defensor é dar uma resposta ao problema do réu com intuito de absolvição. Essa resposta parece estar situada, muitas vezes, em uma perspectiva ilusória de completude de linguagem, seja racional e fechada, assim pensando em estar resolvendo o caso/fato. Para a reflexão discursiva, recorremos a trabalhos dos filósofos franceses Michel Pêcheux e Michel Foucault. É no entremeio de diversas áreas do conhecimento, como Análise do Discurso, Filosofia e Direito que este trabalho propõe a reflexão teórica-discursiva. Como resultados, obtivemos as seguintes considerações: 1) ocorreu o acionamento da memória discursiva do escrivão na tessitura do Fato Delituoso; 2) o funcionamento-confronto dos sentidos dos enunciados dos reús deram-se a partir da Instrução Criminal dirigida pelo Defensor Público; 3) a sdr do réu Z construiu declarações que encejou a absolvição: a) pegara apenas/só uma carona; e b) verdadeira em parte a imputação que lhe estava sendo feita, assim, a formulação funcionou como efeito de verdade; 4) a sdr na Insurgência do Defensor Público e na Apelação do sujeito DP sustentou a FD que levou à autorização da absolvição do réu Z e impediu discursos de culpabilidade e punição, elencados na determinação de condenação na Sentença; e 5) a Defensoria Pública Brasileira formulou discursos constituindo sentidos de vitimologia, dessa forma, enfraquecendo mecanismos de criminologia.

This thesis examines the amendments to Canada's Criminal Code which target the proceeds of crime by, inter alia, criminalizing money laundering and enabling the confiscation of assets. The amendments represent the central thrust of Canada's contribution in a global effort to stem the traffic in illicit drugs, Canada belatedly following the lead of the United States, Great Britain and Australia. In the thesis, I argue that the amendments go much further than earlier crime control initiatives and represent a paradigmatic shift from the traditional, single transaction, individual-oriented structure of criminal law to one which is both property-driven and premised upon multiple-transactions perpetrated by criminal organizations. The amendments focus on the proceeds of crime, as opposed to the offender, individual or corporate, their avowed purpose being to neutralize criminal organizations rather than punish offenders. The effectiveness of the amendments is inexorably tied to the speed by which criminal proceeds can be seized or restrained and thus they operate prospectively, in anticipation of a later conviction. In order to accomplish their objectives, the amendments draw upon concepts previously the preserve of the private law of contract and tort, introducing some which are foreign to the classic norms and traditions of criminal law and sentencing, both substantive and procedural. The thesis examines the amendments from both a textual and a Charter perspective. In so doing, considerable emphasis is accorded the presumption of innocence, a strong legitimating force in criminal law. Integral to the presumption is the Crown's burden of proof - beyond a reasonable doubt. The legislation's adoption of the civil balance of probabilities test is, therefore, considered its weakest link. Other aspects of the legislation give rise to interpretive and Charter challenges. The thesis also discusses the need for tracing mechanisms, mandatory financial transaction reporting, the development of a strike force approach to implementation and a sharing of proceeds by law enforcement agencies. Further, the thesis decries any use of the legislation as a tool for plea bargaining or to target petty criminals. / Law, Peter A. Allard School of / Graduate

The National Counternarcotics Strategy 2007,2011 proposed unsuccessfully to reduce the area illegally cultivated of coca leaf in Peru Although the mechanisms of crops control put in place for this purpose met its goals, they brought little to the overall objective This article points out that one of the constraints in this process has been the sub optimization of the public problem underlying the cultivation of coca leaf, so that the mechanisms of crop control fail to meet integrally and homogeneous the interests of farmers who grow coca illegally / La Estrategia Nacional de Lucha contra las Drogas 2007-2011 propuso, infructuosamente, reducir la superficie ilícitamente cultivada de hoja de coca Si bien los mecanismos de control de cultivos implementados para ese efecto cumplieron sus metas, aportaron poco al objetivo general El presente artículo señala que una de las limitaciones en ese proceso ha sido la suboptimización del problema público que subyace al cultivo de hoja de coca, de tal manera que los mecanismos de control de cultivos no llegan a atender de manera integral y homogénea losintereses de los agricultores que cultivan hoja de coca ilícitamente / A Estratégia Nacional da Luta Contra as Drogas 2007,2011, propôs infrutuosamente reduzira superfície ilegal da folha de coca no Peru Ainda que os mecanismos para o control dos cultivosalcançaram o seus objetivos, nao ajudaram ao logro do objetivo geral O presente artigoassinala que uma das limitações na formulaçao dessa politica foi a sub-otimização do problemapublico, dado que os mecanismos do control dos cultivos não chegaram a atender os interessesdos agricultores o que cultivam folha de coca ilicitamente

Leaders in some narcotics treatment programs struggle with change development and implementation. The objective of this single-case study was to explore strategies used by leaders in a narcotics treatment program to develop and implement organizational change initiatives successfully. Participants included 4 leaders who had developed and implemented successful change initiatives repeatedly for more than 10 years in a narcotics treatment program in the southeastern United States. Bertalanffy's general systems theory was the basis for the conceptual framework. Data collection included semistructured interviews of leaders of a narcotics treatment program and collection of archival data, such as reports relating to strategic planning, core value analysis, and risk assessments. Data analysis, using qualitative analysis software revealed 3 themes: communication, education through research, and resistance. The identified themes aligned with the conceptual framework, as the themes work together as a unit. Recommendations for action include further research for the application of social media in the treatment of patients. Leaders of narcotics treatment programs may use the findings to improve the success of social change development and implementation. Successful social change within these programs could result in the betterment of community relations and an increase in productive members of society who contribute to the economic health of the community.