M.A. / This study is an exploratory pilot study that investigates the relationship between a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) and adult substance use disorders. The existing literature suggests four links in this relationship, namely: self – medication, the priming effect of psycho – stimulants, adult attention deficit hyperactivity disorder (ADHD) and psychiatric comorbidity. This study found that the relationship is not as linear as what the literature suggests. The full impact of the relationship between a childhood attention deficit hyperactivity disorder (ADHD) and adult substance use disorders should be investigated in terms of the lifelong development of ADHD. A deve-lopmental approach to psychopathology should be adopted. This study also identified a number of risk and protective factors in the development of psychopathology. These risk and protective factors are another area for further research.

The purpose of this study was to increase understanding of beliefs of substance abuse counselors regarding multiple relationships. The association between beliefs and the variables of educational level, recovery status, experience, and supervision were explored. Purposeful sampling and multiple criteria were used to select seven states of the 31 that responded to a request for information regarding licensure or certification in their state. Participants were chosen from the following seven states: Arizona, Illinois, Maine, Maryland (D.C.), Montana, North Carolina, and Wyoming. Twenty percent (20 %) of individuals from each of the seven states were selected to participate. Random sampling was utilized to select participants from each of the seven mailing lists. Participants were mailed a cover letter, demographic questionnaire, and a researcher-developed instrument entitled the Multiple Relationship Survey for Substance Abuse Counselors (MRS SAC). Of the 765 surveys that were assumed to have been delivered, 387 usable surveys were returned for a return rate of 50.6%. Results of the study showed that two variables were indicative of a lower total score on the MRS SAC, which indicated participants viewed more items as ethically problematic. Non-recovering individuals obtained a lower total score on the MRS SAC and individuals currently receiving supervision obtained a lower total score. This indicated non-recovering individuals and individuals receiving supervision found more multiple relationship behaviors to be ethically problematic than recovering individuals and individuals not receiving supervision. Highest degree obtained, experience prior to licensure, and supervision prior to licensure were not associated with lower total scores on the MRS SAC indicating these factors did not contribute to beliefs regarding multiple relationship behaviors. The results of this study have implications for substance abuse counselors, counselor educators, and national and state certification boards. Recommendations for further research were offered.

Sammanfattning Tvångsvården av missbrukare har en historisk förankring som går tillbaks till 1900-talets början. Under andra halvan av samma sekel uppkom ett tilltagande missbruk av narkotiska preparat. Under 1980-talets inledande år kände sig regeringen manad att vidta åtgärder, och tillsatte därför en ny lagstiftning som skulle regleras under SoL. Den nya lagen kom att benämnasLagen om vård av missbrukare i vissa fall (LVM 1981:1 243). Intentionen med lagen kan något förenklat sägas vara att stoppa upp en för individen, till följd av missbruk, destruktiv livsföring. Lagen var kraftigt ifrågasatt redan under utredningsfasen. Den har därefter fram tills dagens datum varit föremål för kontroverser. Vissa har menat att den inte visat sig utgöra en effektiv behandlingsform för missbrukare. Somliga menar dock att den fungerar enligt angivet syfte. Under 2000-talet har kraven på insatsers kvalitet inom vården höjts. Den evidensbaserade teoribildningen har idag fått en väsentlig betydelse för utvärderingen av insatser inom vården och det sociala arbetsfältet. Med anledning av den redovisade bakgrunden har det varit min intention att försöka anlägga ett evidensbaserat perspektiv på den rådande LVM-vården. Jag har försökt att ta reda på vad klienter som genomgått vårdformen haft för åsikter om den vård som erbjudits dem. Jag har också försökt att ta fasta på personalens perspektiv på förutsättningarna att bedriva en framgångsrik tvångsvård av missbrukare. Avslutningsvis har jag försökt att ta reda på vilka resurser som stått personalen och klienterna till förfogande i strävan efter att kunna erbjuda en fördelaktig behandlingsform. De resultat som framkommit tyder på att personalen betraktar arbetet med missbrukarna som utmanande och inte sällan påfrestande. Relationskapandet till klienten anses vara deras främsta redskap i sin strävan att göra klienterna motiverade till fortsatt behandling och godartade livsstilsförändringar.Klienterna å sin sida är inte sällan skeptiska till tvångsvårdens förutsättningar att motivera dem till behandlingsdeltagande och fortsatt drogfrihet. Inte sällan framställs det att behandlande och motiverande inslag inom LVM-vården lyser med sin frånvaro. Tvångsvården förutsätts ta emot personer som inte är behandlingsmotiverade. De studier som jag tagit del av tenderar dock att påvisa att graden av motivation till drogfrihet, i allra högsta grad varierar även bland dem som ådömts tvångsvård, och är av stor betydelse för i vilken utsträckning klienten tar till sig LVM-vårdens rehabiliterande ansats. Nyckelord: LVM-vård, tvångsvård, klienter, personal, resurser, motivation och behandling Keywords: LVM-treatment, coercive treatment, staff, resources, motivation and treatment

Magister Psychologiae - MPsych / Recent increases in intellectual, social, infrastructural and economic resources available for the treatment of substance related mental disorders in the Western Cape reflects the national surge towards health promotion and eradication of the burden created by substance abuse. This large number of people who relapse and return to active substance abuse after receiving treatment obstruct this aim. This study aimed to determine the differences in self efficacy and assess for the risk for relapse during the first twelve months of recovery. Albert Bandura’s social cognitive theory provided a suitable framework for the objectives of this study. A cross-sectional survey research design was implemented. Research participants were recruited from different aftercare groups across Western Cape using cluster sampling. The sample consisted of 105 English literate, consenting adult residents of Western Cape who completed an inpatient substance abuse rehabilitation program within twelve months spanning April 2014- April 2015. Data was collected from respondents using two instruments; a demographic information sheet, and an adapted alcohol abstinence self-efficacy scale (AASE). This instrument showed high validity and reliability during a pilot study conducted to ascertain its reliability in a South African sample. Ethics clearance and project registration was given by the Senate Research Committee of the University of the Western Cape. All ethics principles were adhered to and attention was paid particularly to ensuring confidentiality, informed consent, voluntary participation and the right to withdraw without risk of loss or negative consequence. The data was analysed using descriptive statistics, correlation matrices and regression analysis. The results indicated that self-efficacy was highest during the first days and weeks following discharge from a treatment facility. Respondents who remained gainfully employed during recovery reported higher overall self-efficacy and coped better with negative emotions, withdrawal, physical discomfort and urges to use. Respondents’ perceived ability to cope with negative emotions, and resist withdrawal and urges to use again decreased as post-discharge time increased, with females reporting lower self-efficacy than males and respondents’ age showing no significant effect on recovery outcomes. In conclusion, high abstinence self-efficacy has proven to be a predictor of sobriety. After care, interventions can focus on activities to strengthen abstinence self-efficacy levels. Employment stands out as a vital factor to consider in helping people maintain sobriety.

Purpose: Accounting practices vary not only across firms, but also across countries, reflecting the respective legal and cultural background. Attempts at harmonization therefore continue to be rebuffed. The purpose of this paper is to argue that different wordings in national laws, and different interpretations of similar wordings in national laws, can be explained by taking recourse to the philosophy of language, referring particularly to Searle and Wittgenstein. Design/methodology/approach: The example of the substance over form principle, investigated in seven countries, is particularly suitable for this analysis. It is known in all accounting jurisdictions, but still has very different roots in different European countries, with European and international influences conflicting, which is reflected in the different wording of the principle from one country to the next, and the different socially constructed realities associated with those wordings. Findings: This paper shows that, beyond accounting practices, the legal and cultural background of a country affects the wording of national law itself. The broad conclusion is that different socially constructed realities might tend to resist any attempt at harmonized socially constructed words. Originality/value: The paper contributes to the debate surrounding the possible homogenization of accounting regulations, illustrating the theory of the social construction of both "reality" and "language" on the specific application of one common principle to various Member State environments.

This thesis applies catFISH, a variant of the standard fluorescence in situ hybridisation technique, to study the neuronal ensembles activated by heroin and cocaine across brain structures involved in motivated behaviour, in the Sprague-Dawley rat. The first chapter reviews the pharmacology of heroin and cocaine, rodent models of drug-related behaviours, and heroin and cocaine's ability to trigger immediate-early gene expression when administered acutely or chronically. It is suggested that the empirical evidence points towards a significant separation between the neuronal systems engaged by the two drugs. The main goal of this thesis was to test whether this separation can be seen within brain areas playing a key role in motivation and reward (e.g. the nucleus accumbens). Since immediate-early genes serve as markers of neuronal activity, and catFISH is a technique which can detect the expression of such genes in response to two separate stimuli, the technique was chosen as the best method to test if heroin and cocaine activate the same neuronal ensembles when administered acutely. The second chapter summarises the methods used across experiments described in following chapters. The third chapter presents an experiment addressing the methodological issues associated with using catFISH to study pharmacological stimuli. The technique was originally used to study the hippocampus and brain activity triggered by stimuli with well-controlled on- and offset (e.g. exposure to a novel environment or discrete cues). Arguably, acute drug injections comprise a stimulus with an on- and offset which can only be controlled indirectly – they depend on the drug dose and route of administration, among other factors. It was shown that acute intravenous injections of heroin and cocaine at doses usually self-administered by animals are suitable stimuli to use with catFISH. Chapter four describes an experiment showing that, across the striatum, the neuronal ensembles activated by an injection of cocaine followed by an injection of heroin overlap significantly less than the neuronal ensembles activated by two consecutive injections of cocaine. This is interpreted as direct evidence for a significant separation between the neuronal pathways activated by heroin vs. cocaine, even in brain areas often considered a common neurobiological substrate for the effects of the two drugs. It must be noted that the magnitude and the nature of this separation depends on the particular part of the striatum and the order in which drugs are administered. Chapter five describes a pilot experiment attempting to incorporate the logic of the catFISH technique into a rodent drug self-administration paradigm. It was found that the rats preferred self-administering heroin over cocaine, and that there was no detectable expression of the homer 1a gene across the striatum in response to acute heroin and cocaine after extended experience with the two drugs. There was also no change from baseline expression of the homer 1a and arc genes in areas of the prefrontal cortex. Finally, chapter six summarises the main findings and the key methodological considerations from all three experiments. As a whole, it is suggested that the experiments in this thesis provide a proof of concept that heroin and cocaine are processed differently by the brain, even within brain areas considered to be common substrates for the reinforcing and addictive properties of the two drugs. Future studies should take this separation into account, as it may have important implications for understanding drug addiction as a whole. The appendices contain representative fluorescence microscopy images of brain tissue analysed for catFISH.

Magister Psychologiae - MPsych / Substance use is a major problem in South Africa, particularly within the Western Cape. The problem of substance use is prominent amongst adolescents in low socio-economic-status communities, and these prevalence rates are increasing. Literature regarding the onset of substance use is often limited and inadequate. It is for this reason that the South African Substance Use Contextual Risk Instrument (SASUCRI) was developed and employed to assess factors which contribute to adolescent substance use. The SASUCRI is a measure of the individual and contextual factors associated with adolescent substance use. It was developed to be used in low socio-economic-status communities to identify adolescents at risk for substance use as well as communities in which these risk factors are present. The initial validation study reports on the validity evidence for this instrument. The initial study identified items to be rewritten to improve the validity of the instrument. It further recommended the inclusion of additional items to improve reliability in some sub-scales. This contributed to the current study. The purpose of this study was to pretest the new and revised items. The researcher pretested both the English and the Afrikaans’s revised sub-scales of the SASUCRI. The following sub-scales were pretested; “School as support” (6 items), “School as a stressor” (6 items), “Tolerance for soft drugs” (6 items), Hopelessness individual”(11 items) and “Hopelessness community” (5 items). The theoretical framework employed was the Multi-Component Approach. The framework guided the data collection, analysis and partially the discussion of the findings. The study was of a qualitative nature. Two schools were selected from low socio-economic status communities. The study had 32 high school learners who participated. There were 4 focus groups conducted in total.

Magister Artium (Psychology) - MA(Psych) / Substance use among pregnant women is a perennial problem in the Western Cape Province of South Africa. There are many influential factors are associated with substance use among women of childbearing-age. The study explored factors associated with substance use among pregnant women using a qualitative research design and the bio-ecological theoretical framework to explore and guide the researcher throughout the study. Participants were selected using purposive sampling. Only participants accessed from the Department of Social Development meeting the inclusion criteria of the study were interviewed using semi-structured interviews. Immediate referral for psychological intervention during the interview was available for participants who needed it. Braun and Clarke’s (2006) six phases of thematic analysis were utilised to analyse the data. The study adheres to ethical guidelines for the participants’ protection. Participants were informed about the study before the initiation of the interviews and the details of their voluntary participation were explained. The key findings from this study illustrate that socio-cultural factors, personal factors, emotional response and intimate relationships are the major contributing factors to substance use among pregnant women in this sample. The results outline the preventative measures that pregnant women implement. Lastly, the study reveals the positive and negative perceptions of substance use programmes that participants share. Some of the study findings are similar to the existing literature and some of the findings differed. Recommendations emanating from the study include that the stakeholders, rehabilitation centres, Department of Health and future researchers should act proactively against substance use during pregnancy.

Aims: (1) Analyze the roles of α7 and α4β2 nicotinic receptors (nAChRs) in nicotine sensitization in adolescent male and female rats neonatally treated with quinpirole as well as their effects on brain-derived neurotrophic factor (BDNF) and mammalian target of rapamycin (mTOR) 1 h and 24 h post drug treatment. (2) Analyze the effects of behavioral sensitization to nicotine on α7 and α4β2 nAChR density in the nucleus accumbens and dorsal striatum. Methods: Animals were neonatally treated with quinpirole (1 mg/kg) or saline from postnatal days (P)1-21. Beginning on P33, animals were ip injected with nicotine (0.5 mg/kg free base) or saline and tested every second day from P33-49. Approximately 30 min before injection, animals were ip injected with either the α7 nicotinic receptor (nAChR) antagonist methllycacontine (MLA; 2 or 4 mg/kg) or the α4β2 nAChR antagonist dihyro-β-erythrodine (DhβE; 1 or 3 mg/kg). Brain tissue was taken either 1 h or 24 h after the last day of testing. In a second experiment, animals were identically treated and brain tissue analyzed for nAChR density using the autoradiographic technique. Results: Neonatal quinpirole enhanced nicotine sensitization and the 3 mg/kg dose DhβE effectively blocked nicotine sensitization on Day 9 but enhanced the hypoactive response to nicotine on Day 1. MLA appears more important in the acute response to nicotine. Neonatal quinpirole sensitized the accumbal BDNF response to nicotine, but resulted in a decrease of accumbal mTOR. The nAChR density data will be presented. Conclusions: The α4β2 receptor played a critical role in the development of adolescent nicotine sensitization, and both nAChRs appear to be important in accumbal BDNF and in the mTOR response, demonstrating their important role in synaptic strength.

The purpose of this study was to explore beliefs about what works in substance abuse treatment among adolescents. This was a qualitative study that was comprised of fourteen counselors who were interviewed regarding what works in substance treatment with adolescents. The study identified four themes that contribute to our knowledge about what works in substance abuse treatment among adolescents. The study recommends that future research explore further what works with adolescents in substance abuse treatment, including collaborating with family members, identifying strengths in adolescents, building an authentic rapport with adolescents, and using the latest evidence-based practices.