The need to understand the reinforcing properties of smoking and potential precipitants of relapse is exemplified by evidence that relapse rates exceed 95%. The Self-Control Strength model, which proposes that self-control is dependent upon limited resources and susceptible to fatigue, may offer insight into the relapse process. Indeed, there is empirical support that engaging in a task that requires self-control, relative to a comparable control, results in performance decrements on subsequent self-control tasks. The primary goal of the current study was to test whether self-control depletion (SCD) may serve as a novel antecedent for cessation failure, using a validated laboratory analogue of smoking lapse and relapse. We also aimed to compare SCD effects to those of a well-established relapse precipitant (i.e., nicotine deprivation), and test craving and behavioral economic indices as mechanisms for increased cessation failure. We used a 2 X 2 (12-hour deprivation vs. no deprivation; SCD vs. no SCD), crossed-factorial, between-subjects design (N=128 smokers). Replicating prior research, nicotine deprivation significantly increased craving, cigarette demand, delay discounting, and lapse behavior. Furthermore, craving was the only mediator of deprivation effects on lapse behavior. Finally, the primary hypothesis of the study was supported, as SCD increased lapse behavior (p = .04). Although no main effects were found for SCD on putative mediators (i.e., craving, demand, discounting), SCD was found to increase craving among nicotine deprived smokers (p = .04), which mediated cessation failure. SCD appears to play in important role in smoking behavior and may be a viable candidate for intervention.

Recreational drug use peaks in the developmental stage of adolescence in humans. In this dissertation, we used a rodent model of adolescence and behavioral assessments of intravenous (i.v.) cocaine self-administration and reinstatement of cocaine-seeking to explore age differences in these cocaine-related behaviors, and then tested for the influence of environmental enrichment and for correlations between behavior and expression of plasticity genes. Although taking similar amount of cocaine, male rats trained to self-administer cocaine during adolescence (adolescent-onset) showed attenuated cue-induced reinstatement of cocaine seeking compared with adults. This attenuated cue-induced reinstatement did not generalize to a natural reward, sucrose pellets. Then we asked whether the attenuated reinstatement may be due to rapid developmental re-organization of reinforcement circuits (high plasticity) in adolescent-onset groups. To stimulate or inhibit neuroplasticity, subjects experienced environmental enrichment or impoverishment during abstinence. Environmental manipulations had no effect in adolescent-onset groups, whereas the enriched environment attenuated cue-induced reinstatement in adults compared with their impoverished counterparts. Thus, we turned to internal factors that may contribute to age-differences in reinstatement of cocaine seeking. Using in situ hybridization to quantify the mRNA for two neuroplasticity-related genes, activity-regulated cytoskeletal-associated gene (arc) and brain-derived neurotrophic factor (bdnf), we identified that overall, arc expression in the nucleus accumbens (NAc) and bdnf expression in the medial prefrontal cortex (mPFC) was higher in adolescent-onset than in adult groups. Together our data suggest that adolescence in rodents may be a period of relative biological resistance to some long-term drug effects.

Im Rahmen der RELAZA-Studie sollte die Wirksamkeit sowie die Sicherheit von AZA in der Verzögerung bzw. Vermeidung eines hämatologischen Rezidivs bei Patienten mit CD34+ MDS oder AML bei fallendem CD34-Spenderchimärismus nach allogener SZT untersucht werden. Als primäre Zielparameter galten hierbei die Ansprechrate im Sinne eines CD34-Spenderchimärismusanstiegs auf ≥ 80% (majores Ansprechen) etwa einen Monat nach Ende des 4. Zyklus AZA sowie die Dauer dieses Ansprechens. Ferner sollte der weitere Krankheitsverlauf, das Gesamt- und auch rezidivfreie Überleben sowie die Verträglichkeit und die Beeinflussung der GvHD untersucht werden. Dazu wurde der Anteil CD34+ Spenderzellen im peripheren Blut von insgesamt 53 Patienten im Abstand von drei bis vier Wochen und ab dem 9.-24. Monat nach allogener SZT alle sieben bis acht Wochen bestimmt. Die 20 Patienten, die während dieser Screeningphase einen CD34-Spenderzellabfall auf < 80% zeigten, aber gleichzeitig kein hämatologisches Rezidiv und transfusionsunabhängig > 3 Gpt/l Leukozyten sowie > 75 Gpt/l Thrombozyten aufwiesen, wurden in die Therapiegruppe aufgenommen. AZA wurde pro Zyklus unter entsprechender antiemetischer Prophylaxe in einer Dosis von 75 mg/m2/Tag über sieben aufeinanderfolgende Tage subkutan verabreicht. Der Abstand zwischen dem jeweiligen Beginn zweier Zyklen betrug circa 28 Tage. Es wurden zunächst nur vier Zyklen AZA in Folge appliziert. Einen Monat nach Ende des 4. Zyklus erfolgte die Bewertung des Ansprechens durch Zuordnung der einzelnen Patienten zu den Gruppen „majores Ansprechen“ (CD34-Spenderzellchimärismus ≥ 80%), „minores Ansprechen“ (CD34-Spenderzellchimärismus < 80%, aber kein Rezidiv) und „Rezidiv“. Um bei Patienten, die bis dahin nur ein minores Ansprechen erreicht hatten oder deren CD34-Spenderzellchimärismus wieder auf < 80% abgefallen war, ein (erneutes) majores Ansprechen zu induzieren, konnten im Anschluss an Block 1 (Zyklus 1-4) im Rahmen von Block 2 und 3 jeweils weitere vier Zyklen AZA gegeben werden. Vor jedem neuen Zyklus erfolgte die Kontrolle wesentlicher Laborparameter (großes Blutbild, ALAT, ASAT, GGT, Creatinin, Harnstoff, Natrium, Kalium, Bilirubin, CRP) sowie die Bewertung der GvHD. Nach dem 2. und 4. Zyklus jedes Blocks fanden eine erneute Knochenmarkpunktion sowie die Analyse des CD34-Spenderchimärismus statt. Der CD34-Spenderchimärismus der 20 Patienten der Therapiegruppe war im Median 169 Tage nach der letzten SZT auf < 80% abgefallen, sodass die Therapie mit AZA bei diesen Patienten begonnen wurde. Nach nur vier Zyklen AZA konnte bei 16 von 20 (80%) Patienten eine Stabilisierung oder Verminderung der MRD festgestellt werden. Insgesamt zeigten zehn der 20 (50%) Patienten ein majores Ansprechen. Dieses war zum Studienabschluss im Januar 2011 allerdings nur noch bei drei Patienten (medianes follow up von 300 Tagen (Spannweite 181–899 Tage) nach Ende des 1. Blocks) nachweisbar. Sechs (30%) Patienten zeigten nach dem 4. Zyklus ein minores Ansprechen und vier (20%) waren bereits im Rezidiv. Von den 16 Patienten, die entweder ein majores oder minores Ansprechen zeigten, begannen 11 Patienten mit dem zweiten und vier auch noch mit dem dritten Block. Durch diese Wiederbehandlung mit AZA konnte allerdings nur bei einer Patientin ein (erneutes) majores Ansprechen erreicht werden, welches jedoch nur etwa einen Monat anhielt. Zusammenfassend betrachtet haben bis zum Studienabschluss 13 von 20 (65%) Therapiepatienten rezidiviert. Das rezidivfreie Überleben dieser Patienten betrug im Median 231 Tage (Spannweite 56–558 Tage), das Gesamtüberleben lag bei im Median 470 Tagen (Spannweite 182-1440 Tage) nach dem initialen Abfall des CD34-Subsetchimärismus < 80%. Neun von ihnen sind im Median 293 Tage (Spannweite 182 – 1159 Tage) nach CD34-Spenderchimärismusabfall verstorben. Vier der 20 Patienten haben bis zum Abschluss der Studie, das heißt im Median 347 Tage (Spannweite 297 – 998 Tage) nach dem ersten Abfall des CD34-Subsetchimärismus < 80%, rezidivfrei überlebt. Drei von ihnen zeigten zum Studienabschluss ein bis dahin im Median seit 300 Tagen (Spannweite 181 – 899 Tage) nach Therapieende bestehendes stabiles majores Ansprechen. Die restlichen drei der 20 Therapiepatienten sind nicht Rezidiv-assoziiert verstorben. Das Gesamtüberleben aller Therapiepatienten lag bei im Median 347 Tagen (Spannweite 162–1440 Tage) nach Abfall der CD34+ Zellen unter die 80% Grenze. Die Hauptnebenwirkung von AZA bestand in der Induktion schwerer Zytopenien, die bei sechs von 20 Patienten zu Infektionen führten. Diese konnten jedoch entweder ambulant oder stationär gut beherrscht werden, sodass sie weder zum Abbruch der Studie noch zum Tod eines Patienten führten. Ansonsten konnte durch Dosisanpassungen, Zyklusverschiebungen sowie durch die Gabe von Wachstumsfaktoren (G-CSF) eine Regeneration des Blutbilds erreicht werden. Gravierende Verschlechterungen bestehender GvHD wurden nicht beobachtet. Hingegen konnte die immunsuppressive Medikation unter den ersten vier Zyklen AZA bei vier von sechs Patienten beendet werden. Die RELAZA-Studie hat gezeigt, dass AZA unter akzeptablen Nebenwirkungen in der Lage ist, das Auftreten eines hämatologischen Rezidivs bei Abfall des CD34-Spenderzellchimärimus nach allogener SZT zumindest zu verzögern. Allerdings mussten wir feststellen, dass nur die Hälfte der Patienten ein majores Ansprechen zeigte und dieses bei den meisten Patienten nur von kurzer Dauer war. Deshalb gehen wir davon aus, dass sowohl zur Induktion eines majoren Ansprechens als auch zum Erhalt desselben vier Zyklen AZA in Folge nicht ausreichend sind. Der Effekt eines dahingehend veränderten Applikationsschemas wird bereits im Rahmen der RELAZA-II-Studie untersucht.

Personality, motives, and self-efficacy have all been recognized as factors contributing to relapse, and the interaction among these factors has been outlined in Witkiewitz and Marlatt&rsquo;s contemporary relapse model. However, there is limited empirical research examining the mechanisms involved in this theory. This study aimed to better understand the relationship between personality risk, drinking motives, and confidence to resist drinking during high-risk situations among adults who have changed their drinking. Results indicate that prior to participants&rsquo; change in drinking, introversion/hopelessness was associated with coping motives and confidence in situations involving unpleasant emotions, anxiety sensitivity was associated with coping motives, and impulsivity was associated with conformity motives. Following participants&rsquo; change, two specific motives (i.e., coping and conformity) were found to moderate the association between two of the personality profiles (i.e., introversion/hopelessness and anxiety sensitivity) and confidence to resist drinking during specific high-risk situations (i.e., negative emotional and social pressure to use).

Syftet med uppsatsen är att studera den subjektiva upplevelsen av upphörandeprocessen från kriminalitet hos unga vuxna som vid upprepade tillfällen begått brott under sin barndom och ungdomstid. Frågeställningarna berör både yttre och inre faktorer som påverkat upphörandet samt faktorer som upprätthåller en ickekriminell livsstil. I studien ingick åtta personer, sex män och två kvinnor, som upphört med kriminalitet före 25 års ålder. Hur länge sedan det var personerna slutade begå brott varierade mellan några veckor och åtta år. Studiens genomförande var kvalitativa semistrukturerade intervjuer varav fem utfördes vid personliga möten och tre över telefon. I analysen tillämpades teorin om sociala band, vändpunkter och ett perspektiv på upphörandet som en process. I det empiriska materialet framkommer att upphörandet inledningsvis påverkades av ett samspel mellan specifika händelser som fungerade som vändpunkter, hjälp från andra personer samt egen motivation och mognad. Informanterna betonar egen motivation mest, vilket överensstämmer med tidigare studier av ungdomar i synnerhet. Därutöver identifierades en andra fas av upprätthållande där informanterna aktivt arbetade för att avhålla sig från brott. I denna fas började de omförhandla sin identitet från kriminell mot ickekriminell. Många hade dock kvar tankar på att begå brott och upplevde sig vara ”laglydiga kriminella” snarare än ickekriminella. Detta fenomen har vi inte hittat i tidigare forskning på området. Nedanstående faktorer i ett samspel identifierades av informanterna som nödvändiga för att kunna sluta begå brott, vilket bortsett från den sista punkten överensstämmer väl med tidigare forskning på området. Yttre faktorer: Upphöra med missbruk. Bryta kontakten med andra personer i aktivt missbruk och kriminalitet. Stöd från andra personer eller professionella. Gemenskap och anknytning till andra. Sysselsättning. Inre faktorer: Motivation och egen vilja. Mognad och ökad ålder. Förmåga att hantera tankar på brott. Sökord: upphöra, kriminalitet, brott, ungdom, återfall / The purpose of this paper is to study the subjective experiences of the desistance process from crime in young adults who repeatedly committed crimes during childhood and adolescence. The questions address both external and internal factors that influenced desistance from crime and factors that maintain a non-criminal lifestyle. The study included eight people, six men and two women who desisted from crime before the age of 25. The time since they desisted ranged from a few weeks up to eight years. The study was performed using qualitative semi-structured interviews, five by personal meetings and three by telephone. In the analysis the theories of social bonds, turning points and a perspective on desistance as a process was applied. The findings of this study were that desistance initially was influenced by a combination of specific events that served as turning points, support from other people as well as motivation and maturity. The informants emphasized their own motivation the most, which is consistent with previous studies of adolescents and young adults in particular. In addition, a second phase of maintenance were identified where the informants had to make efforts to refrain from crime. In this phase they started to renegotiate their identity from criminal towards non-criminal. However, many still had thoughts of committing crime and perceived themselves to be "law-abiding criminals" rather than non-criminals. This is something we have not found in previous research. These factors were identified by the informants as necessary to desist from crime, which apart from the last point is consistent with previous research in this area. External factors: • Desistance from substance abuse. • Breaking contact with people with active addiction and criminal behavior. • Support from other people or professionals. • Sense of community and attachment to others. • Occupation. Internal factors: • Motivation and determination. • Maturity and increasing age. • Ability to deal with thoughts of crime. Keywords: desistance, crime, criminality, youth, relapse

Personality, motives, and self-efficacy have all been recognized as factors contributing to relapse, and the interaction among these factors has been outlined in Witkiewitz and Marlatt&rsquo;s contemporary relapse model. However, there is limited empirical research examining the mechanisms involved in this theory. This study aimed to better understand the relationship between personality risk, drinking motives, and confidence to resist drinking during high-risk situations among adults who have changed their drinking. Results indicate that prior to participants&rsquo; change in drinking, introversion/hopelessness was associated with coping motives and confidence in situations involving unpleasant emotions, anxiety sensitivity was associated with coping motives, and impulsivity was associated with conformity motives. Following participants&rsquo; change, two specific motives (i.e., coping and conformity) were found to moderate the association between two of the personality profiles (i.e., introversion/hopelessness and anxiety sensitivity) and confidence to resist drinking during specific high-risk situations (i.e., negative emotional and social pressure to use).

With approximately 7% of the adult population reporting to have taken illicit substances over the course of a year and the chronically relapsing nature of substance use disorders there is a great need for effective forms of treatment and therapies to reduce relapse. Deep brain stimulation (DBS) is a process of neuromodulation where electrodes are implanted in a target region to modulate the electrophysiological activity of the target region. DBS has been postulated as a potential therapy for treatment-refractory addiction, with a great deal of focus on the nucleus accumbens (NAc). Forty male Long Evans rats were implanted with unilateral stimulating electrodes within the right NAc prior to exposure to chronic cocaine self-administration (0.5 mg/kg/infusion). Following self administration, the animals were withdrawn from cocaine and treated with 14 consecutive days of sham, low frequency (LF, 20 Hz) or high frequency (HF, 160 Hz) stimulation sessions (30 min/day). The animals underwent drug seeking tests on days 1, 15 and 30 of the withdrawal phase with context-induced relapse paired with a drug challenge (5 mg/kg i.p). Relapse rates were highest on day 15 after withdrawal, with both LF and HF attenuating cocaine during this drug-seeking test, however this was not the case for tests on days 1 and 30. Motivation to respond for saccharin solution (0.1 %) remained intact following both LF and HF stimulation intake sessions. These results demonstrate that unilateral DBS of the NAc effectively attenuated cocaine-seeking following chronic exposure to stimulation although these beneficial effects appeared to diminish following cessation of daily treatment with stimulation. The results obtained in this experiment provide support for DBS as a potential therapy for patients with treatment-resistant cases of substance use disorders.

This study was designed to investigate risk factors for resumption of alcohol use during the early period following treatment. Specifically, the influence of cognitions, stressful life events, subjective appraisal of stress, expectancies about alcohol use, and personal coping responses was explored.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-06T18:27:12Z No. of bitstreams: 1 Diss MP Fabiola Leal. 2014.pdf: 656656 bytes, checksum: c93965bc227e7f040c0864ea593f13a3 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-04-15T14:34:34Z (GMT) No. of bitstreams: 1 Diss MP Fabiola Leal. 2014.pdf: 656656 bytes, checksum: c93965bc227e7f040c0864ea593f13a3 (MD5) / Made available in DSpace on 2015-04-15T14:34:34Z (GMT). No. of bitstreams: 1 Diss MP Fabiola Leal. 2014.pdf: 656656 bytes, checksum: c93965bc227e7f040c0864ea593f13a3 (MD5) / A hanseníase persiste como importante problema de saúde pública para o Brasil. Uma das estratégias para controle da endemia da hanseníase é o tratamento adequado dos pacientes com o regime de poliquimioterapia recomendado pela Organização Mundial de Saúde (OMS). Portanto, o monitoramento dos casos de recidiva assume importância por se constituir como o melhor método para medir a eficácia do tratamento. Segundo dados da OMS, o Brasil é o país com maior registro de casos de recidiva no mundo; são poucos os estudos nacionais sobre o tema e nenhum no estado da Bahia. Objetivo: Descrever o perfil clínico e epidemiológico de todas as entradas no Sistema Nacional de Agravos de Notificação (SINAN/BA) por recidiva diagnosticadas no estado da Bahia e na unidade de referência estadual para tratamento de pacientes com hanseníase. Método: Estudo transversal de todas as entradas no sistema de informação por recidiva em hanseníase diagnosticada pelas unidades de saúde do estado da Bahia e pela unidade de referência estadual , no período de 2001 a 2012. As informações foram obtidas do SINAN/BA fornecidas pelo setor de vigilância epidemiológica da Secretaria Estadual de Saúde (SESAB). Resultados: Foram registrados 1329 entradas por recidiva na Bahia no período de 2001 a 2012, sendo 90 na unidade de referência estadual. Do total de casos, a média de idade foi de 43,3 anos e 59,2% eram do sexo masculino, 70,9% tinha a forma dimorfa ou virchoviana e 77% foram classificados como multibacilares. Entretando apenas 20,6% dos pacientes realizaram baciloscopia e somente 21,4% tinham informação sobre comprometimento neural. Conclusão: O percentual de recidivas no estado da Bahia é influenciado pelos casos notificados em municípios sem centros de referência. È essencial melhorar a precisão diagnóstica nos serviços de saúde do estado, inclusive da unidade de referência estadual, e facilitar o acesso dos pacientes com suspeita de recidiva aos serviços especializados.

O crack, subproduto da cocaína, introduzida na década de 80 no Brasil, é um potente estimulador do Sistema Nervoso Central (SNC), desde a sua introdução no país, verificou-se que os efeitos no convívio social e familiar do usuário são quase imediatos, levando a sociedade e o estado a terem uma preocupação maior com o seu uso e controle. Devido à magnitude dos efeitos da abstinência das substâncias psicoativas (no caso o crack), a recaída apareceu como um fator comum no cotidiano dos usuários, para analisar esse fato se propôs na década de 70 um modelo de tratamento denominado Prevenção de Recaída (PR), baseado no modelo compensatório (Terapia cognitivo-comportamental) em que não há julgamento ou atribuição de culpa ao indivíduo pelo uso da droga, mas o leva à reflexão sobre seus atos e a se responsabilizar pelas mudanças de comportamento. Assim o objetivo desse estudo foi identificar os determinantes intrapessoais e interpessoais do processo de recaída em usuários de crack, além de identificar o perfil sociodemográfico, o inicio do uso e padrão de uso de crack e outras drogas (lícitas e ilícitas). Trata-se de um estudo qualitativo de teor descritivo. A pesquisa ocorreu em um CAPS ad II em uma cidade do interior de Minas Gerais e a amostra foi de conveniência. Foram realizadas entrevistas semi- estruturas em duas etapas, com intervalo de três meses cada uma com os mesmos participantes, foi aplicada a análise de conteúdo no tratamento dos dados qualitativos. Os dados sociodemográficos concordaram com a literatura nacional; exceto no que tange a média de idade. O início do consumo de drogas ocorreu com o uso de drogas lícitas na adolescência e a relação dos usuários de crack com as demais SPA (lícitas e ilícitas) mostrou-se ambivalente, não sendo reconhecidas como \"drogas\", particularmente o álcool, percebido também como gatilho ou porta de entrada para o uso do crack, já as recaídas apareceram atreladas a fatores intrapessoais e interpessoais, sendo que eles se retroalimentam, criando um círculo vicioso. O estudo mostrou que, no atendimento ao usuário de crack deve-se trabalhar com todas as facetas do uso ou do motivo da recaída, e identificar juntamente com o usuário, os gatilhos de recaída e a rede de apoio de que dispõe, fortalecendo-o na busca de mecanismos de autocontrole do uso / The crack, a byproduct of cocaine, introduced in the 80s in Brazil, is a potent stimulator of the central nervous system (CNS), since its introduction in the country, it was found that the effects on social and family life of the user are almost immediate , leading the society and the state to have a major concern with its use and control. Due to the magnitude of the effects of abstinence l of psychoactive substances (in this case crack), relapse appeared as a common factor in the daily lives of users, to analyze this fact was proposed in the 70\'s a model of treatment called Relapse Prevention (RP) based on the compensatory model (cognitive behavioral therapy) in which there is no judgment or blaming the individual for drug use, but leads to reflection on their actions and take responsibility for behavior change. Therefore the aim of this study was to identify intrapersonal and interpersonal determinants of relapse process in crack users, and identify the sociodemographic profile, the start of use and crack cocaine use pattern and other drugs (licit and illicit). This is a qualitative study of descriptive content. The research took place in a CAPS II ad in a city in Minas Gerais and the sample was a convenience. Semi-structures interviews were conducted in two stages, with an interval of three months each with the same participants were given the content analysis in the treatment of qualitative data. Socio-demographic data agreed with the national literature; except with respect to mean age. The start of drug use occurred with the use of illicit drugs in adolescence and crack users compared with other SPA (legal and illegal) proved to be ambivalent, not being recognized as \"drugs\", particularly alcohol use has also noticed as a trigger or gateway to crack use, since relapses appeared linked to intrapersonal and interpersonal factors, and they feed back, creating a vicious circle. The study showed that, in the care of crack users must work with all aspects of the use or reason of relapse, and identify with the user, the relapse triggers and the support network available to it, strengthening it in the pursuit of self- control mechanisms usage