Although previous research identified exposure to significant adverse childhood experiences (ACEs) as harmful to individuals in several psychological and physiological health domains, research examining the mechanisms of action driving this relationship has been lacking. As a result, the current study examined the role that psychological symptoms serve in the relationship between ACEs and substance misuse behaviors. The current study included a sample of 183 participants (i.e., 82 men and 101 women) who completed five questionnaires assessing exposure to ACEs; psychological symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD); and substance misuse behaviors. Correlational analyses indicated significant associations among the variables of interest. Exposure to ACEs was a significant predictor of substance misuse behaviors in both men and women. Additionally, depressive symptoms, anxiety symptoms, and PTSD symptoms were significant predictors of men's substance misuse behaviors, whereas only PTSD symptoms were a significant predictor of women's substance misuse behaviors. Symptoms of depression, anxiety, and PTSD each contributed unique and significant variance to the relationship between ACEs and substance misuse behaviors in men, consistent with partial mediations. A different pattern of prediction was evident for women. Such findings suggested that psychological symptoms of depression, anxiety, and PTSD may serve as a risk factor for substance misuse behaviors in men later in life, especially when they have had a history of ACEs. These results demonstrated the importance of promoting trauma-informed mental health care to remediate negative substance outcomes, particularly in those who have had significant ACEs. The importance of studying the relationships among these variables is discussed further.

The primary purpose of this study is to determine the occurrence of drug therapy adjustment in people with substance use disorder receiving medication-assisted treatment when admitted to an acute care facility for a comorbid condition. The secondary purpose is to understand the correlation between the presence of adjustment of therapy for substance use disorder and influence on recovery from comorbid conditions. A literature review exploring drug therapy for addicted individuals during hospitalization was performed using various databases, search terms included *substance use disorder or *substance abuse or *illicit drug use or *drug abuse or *MAT or *maintenance therapy, combined with *inpatient or *hospital or *acute care or *admission. The data was conformed into tables that synthesized the relationship between drug therapy adjustment for individuals with substance use disorder during an acute care admission. Initial review of the articles revealed 78 articles relative to the topic, 16 of those articles met inclusion criteria and were selected for a detailed analysis. Studies suggest the need for provider education and guidelines for treating individuals receiving MAT in an acute care facility. While individuals with substance use disorder often use acute care services, their medication-assisted treatment is rarely acknowledged or adjusted. Many studies focus on individuals with substance use disorder, yet, addressing medication-assisted therapy is still inconsistent, and lacks official guidelines.

Drug use is considered in many countries the plague of today's society. Researchers from medical, psychological and sociological fields, as well as lawmakers, are interested in finding more answers to this widespread phenomenon. All over the world there are known conflicts related to drug producing, transportation routes and distribution, that harm the economy and social standing of the involved communities or countries. Policies towards drug use vary from country to country, but this research focuses on how stigma affects the lives of individuals suffering from substance use disorder (SUD) in Albania. Substance use disorder is not often considered a disease, and more often individuals suffering from this disorder are stigmatized and not given the right care from their families, societies, or healthcare providers. Drug usage in Albania is closely linked to the country's geopolitics and its communism and dictatorship past history. This phenomenon has influenced the Albanian societal perceptions. Even though Albania became a democratic country in the 1990s, there are still old mentalities to be changed, with social stigma towards drugs being one of them. The purpose of this pilot research is to understand the connection between social stigma and the treatment that individuals with substance use disorder receive from their families, society, and medical institutions. This pilot study was based on interviews conducted in a small sampling of 18 individuals. The qualitative information collected through interviews falls into four categories: Medical professionals and psychologists, family members or people who have loved ones with substance use disorder, current users of cocaine or synthetic drugs who are in denial regarding their addiction and everything it entails, and heroin users currently in treatment programs. There are also different types of stigma associated with different types of drugs. These types of stigma are herein categorized based on the collected information which supports the premise of how social stigma affects these individuals' lives. This study is the first known research for this subject matter in the country of Albania, therefore, it intends to open the path for further research that is inclusive of more groups/individuals.

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Comorbid PTSD+SUD confers heightened risk of other mental health concerns, suicidality, mortality, and functional impairment. Current treatments for comorbid PTSD+SUD show inconsistent results, highlighting the need for a more comprehensive understanding of the associations between PTSD and SUD symptoms. The current dissertation aimed to characterize the associations between PTSD and SUD using structural equation modelling among three different samples with differing clinical severity and presentation: (1) concurrent disorders sample with a high prevalence of PTSD; (2) an in-patient sample seeking treatment for PTSD; and (3) a subclinical sample of healthcare workers and public safety personnel. Data were extracted from multiple clinical databases across different studies to evaluate the associations between PTSD symptoms and alcohol/cannabis/substance use-related problems. Furthermore, the role of underlying mechanisms such as dissociation and emotion dysregulation, which are associated with both PTSD and SUD, were analyzed. All analyses used a structural equation modelling framework to represent the complex clinical presentation of comorbid PTSD+SUD analytically. A relatively consistent pattern of results was observed across the three samples. Global PTSD symptoms were significantly associated with cannabis-related problems, alcohol-related problems, and other illicit substance-related problems. Among PTSD symptoms, the reactivity symptom cluster (characterized by symptoms of hypervigilance, irritability, reckless behaviour, problems with concentration and sleep disturbances) was significantly associated with alcohol/cannabis/substance-related v problems across among the three samples. Furthermore, underlying mechanisms such as dissociation and emotion dysregulation significantly mediated the relations between PTSD symptoms and alcohol/cannabis/substance-related problems. Overall, the current results contribute to the limited literature examining the associations between PTSD and SUD symptoms. Lastly, the current results have important clinical implications for identifying efficacious treatment targets for comorbid PTSD+SUD. / Dissertation / Doctor of Philosophy (PhD) / Psychological distress following a traumatic event, known as traumatic stress, is often associated with problematic alcohol and/or substance use. The co-occurrence of these two confers a heightened risk of other mental health problems. As such, studying how these phenomena are associated with one another and what about each thing is more important to the association is important to understand. The purpose was to examine the connection between these phenomena among three different groups of people: two treatment-seeking groups and non-treatment seeking group one group. Traumatic stress was associated with problematic substance use in all three groups. In addition, other factors like mentally escaping from your body and having difficulties with regulating your emotions explained how traumatic stress and problematic substance use were connected to each other. These findings can help clinicians hone their treatment programs to better help individuals struggling with traumatic stress and problematic substance use.

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Introduction: Substance abuse syndrome is common in society. According to the Patient Act, each individual is always entitled to adapted care, according to maturity, age, experience, ethnicity and other individual aspects. Previous studies have shown that healthcare professionals feel insecure meeting patients with substance abuse syndrome, so it will be interesting to investigate how patients experience the response from healthcare professionals and what consequences leads to. Aim: The aim was to compile current research on how people with previous or ongoing substance use syndrome experience the treatment from healthcare professionals. As well as their views on the significance of the treatment for the impact on the care they receive. Method: The method used is a literature review with a qualitative approach. The data collection was done via the database PubMed, where 11 scientific studies were found and reviewed via SBU's review template. Results: Three main categories were identified and followed by subcategories. The main categories that were used were treatment, stigma and pain treatment. It demonstrated a need for healthcare professionals to become aware of the stigma and differences in power that arise at healthcare meetings with patients. This review of the literature showed that patients did not experience a satisfactory treatment, it also emerged that the patients experienced a better treatment from specialist trained staff in the subject of substance use syndrome. The consequences for the patients when the treatment from the care staff was not perceived as satisfactory was an inadequate pain relief, delayed care, premature discharge, self-medication and the patients completely refraining from seeking care. In the long run, the consequences became a longer and more difficult suffering for the patient. Conclusion: The nurse's previous experience and competence were decisive for how the patient experienced the treatment in the care search. A non-judgmental attitude created an increased sense of security for patients, to dare to open up and not use strategies to hide their substance use syndrome. Keywords: “substance use disorder”, “experience”, “nurses”, “stigmatization”, “patient experience”and “substance dependence”. / Introduktion: Substansbrukssyndrom är vanligt förekommande i samhället. Enligt patientlagen har alltid varje enskild individ rätt till en anpassad vård, efter mognad, ålder, erfarenhet, etnicitet och andra individuella aspekter. Tidigare studier har visat att sjukvårdspersonal känner sig osäkra inför mötet med patienter med substansbrukssyndrom, därför blir det intressant att undersöka hur patienterna upplever bemötandet från sjukvårdspersonalen och vad det kan ha för upplevda konsekvenser.  Syfte: Syftet var att sammanställa aktuell forskning om hur personer med tidigare eller pågående substansbrukssyndrom upplever bemötandet från vårdpersonal. Samt deras åsikter om bemötandets betydelse för inverkan på den vård de får.  Metod: Metoden som använts är en litteraturöversikt med kvalitativ ansats. Datainsamlingen gjordes via databasen PubMed, där 11 vetenskapliga studier hittades och granskades via SBU:s granskningsmall.  Resultat: Tre Huvudkategorier identifierades och följdes av underkategorier. Huvudkategorierna som togs fram var bemötande, stigmatisering och smärtbehandling. Det påvisade ett behov hos vårdpersonal att bli medvetna om stigmatisering och maktskillnader som uppstår vid vårdmötet med patienterna. Denna litteraturöversikt visade att patienter inte upplevde ett tillfredsställande bemötande, det framkom även att patienterna upplevde ett bättre bemötande från specialistutbildad personal inom ämnet substansbrukssyndrom. Konsekvenserna för patienterna när bemötandet från vårdpersonalen inte upplevdes som tillfredsställande var en icke adekvat smärtlindring, försenat vårdförlopp, för tidiga utskrivningar, självmedicinering och att patienterna helt avstod från att söka vård. I förlängningen blev konsekvenserna ett längre och svårare lidande för patienten.  Slutsats: Sjuksköterskans tidigare erfarenhet och kompetens var avgörande för hur patienten upplevde bemötandet i vårdsökandet. En icke dömande attityd skapade en ökad trygghetskänsla för patienterna, att våga öppna upp och inte använda strategier för att dölja sitt substansbrukssyndrom.  2 Nyckelord: missbruksrelaterade sjukdomar, upplevelser, sjuksköterskor, stigmatisering, patientens upplevelse, substansberoende

When adolescents enter residential treatment for difficulties experienced at school, with the juvenile justice system and/or their parent(s)r substance abuse is often not identified as a significant contributor to the presenting problem. However, the dynamics of adolescent substance abuse are described in the literature as interactive processes affected by family dysfunctions, inadequately learned coping skills and significant stressors. In this study, a treatment strategy was developed for families of adolescents in a residential treatment center setting, where adolescents, along with other identified problems were also determined to be actively abusing drugs and or alcohol. The treatment strategies focused on alcohol/drug abuse as a primary problem, and on relapse prevention through psycho education, family therapy and contingency contracting. Twelve adolescents and their families participated in the treatment program. A one year follow up was conducted. This thesis reports on four of these families indepth through the use of case studies. Comparisons and conclusions were drawn from the case studies which demonstrate that the treatment model is an effective auxiliary modality for use with substance abusing adolescents and their families. / Master of Science