BakgrundNågot exakt antal personer med beroende är svårt att få fram då mörkertalet är stort då inte alla söker vård. Det finns en stor kunskapslucka om beroende vilket kan leda till negativa attityder och sämre vård för dessa patienter. Problemen blir ännu större om smärtproblematik förekommer.   SyfteSyfte med denna litteraturstudie var att beskriva sjuksköterskors erfarenhet av att bemöta patienter med beroendeproblematik samt att beskriva vilka datainsamlingsmetoder som använts i de inkluderade studierna.   MetodLitteraturstudie med deskriptiv design och de elva valda artiklarna söktes fram i databasen CINAHL, deras ansats är både kvalitativa och kvantitativa. HuvudresultatResultatet i studien visar att sjuksköterskors utbildningsnivå är signifikant med deras attityder mot patienter med beroendeproblematik, detta ger även en osäkerhet i mötet med dessa patienter vilket leder till otillräcklig omvårdnad och smärtbehandling. Den otillräckliga utbildningen leder till att sjuksköterskorna tvingas ta hjälp av varandra för att bemästra omvårdnaden samt bemötandet av patienter med beroendeproblematik på bästa sätt. Erfarenhet i arbete med beroendepatienter är en stor tillgång för sjuksköterskor som inte inhämtat vidare utbildning kring omvårdnad av dessa patienter.   SlutsatsPatienter med beroendeproblematik är en växande patientgrupp i dagens samhälle och sjuksköterskor träffar dessa individer på många olika inrättningar oavsett vilken utbildning de besitter. För bästa möjliga utgång för både patient och sjuksköterska är det därför av stor vikt att sjuksköterskan är så förberedd som möjligt genom att redan i grundutbildning erhålla fördjupad utbildning kring denna patientgrupp. Sedan vidare i arbetslivet erbjudas fler kurser och utbildningar/fortbildningar i omvårdnad av patienter med beroendeproblematik. / BackgroundThere is no specific number of people with addiction because it is difficult to obtain when the number of unreported cases is high because not everyone seeks care. There is a large gap in knowledge about addiction which can lead to negative attitudes and worse care for these patients. The problems gets more difficult if it includes pain. AimThe purpose of this litterturereview is to describe nurses 'experience of responding to patient´s with addictions and to describe what data collection methods used in the included studies. MethodA literature study with descriptive design and the eleven selected articles were searched in the database called CINAHL, and their approach is both qualitative and quantitative ResultsThe results of the present study show that nurses' education are significant in their attitudes toward patients with addiction, this also gives an uncertainty in the meeting with these patients, which leads to insufficient care and pain management. The inadequate education forces the nurses to help each other to master the care of patients and the best reply with addiction best way possible. Experience of working with patients with addiction is a major asset for nurses who have not obtained further education about care of these patients. Conclusionpatients with addiction are a growing population in today's society and nurses meet these individuals in many different workplaces whatever education they possess. For the best possible outcome for both patient and nurses, is it very important that the nurse is as prepared as possible by already in the basic education receive in-depth training about these patients. Then while working be offered more courses and education / in-depth courses in the care of patients with addiction.

This thesis investigated uranium (U) migration behaviour at the Needle‟s Eye natural analogue site, located close to Southwick Water, South West Scotland. The results of this study are important for the prediction of U behaviour in the far-field environments of nuclear waste repositories over long time-scales. The Needle‟s Eye natural analogue site was selected because the processes involved in U mobilisation, the direction of water flow and the extent of retention of uranium in peaty soils had already been identified. To this end, previous results demonstrated that groundwater passing through the mineralisation oxidized U and transported it to the peaty area, where 80-90% of the released U has been retained. Sequential extraction of the peaty soils indicated that more than 90% of the solid phase U was bound to the organic fraction. However, in-depth characterisation of U associations within the soil porewaters and the peaty soils at this site was lacking. Therefore, the processes controlling the migration of uranium within this organic-rich system were the main focus of this study. There were five sampling trips carried out from 2007-2011, in which cave drip waters, bog waters and surface soil and soil core samples were selectively collected for analysis by a range of methods described below. The cave drip waters emerging from the mineralisation were oxidizing and slightly alkaline (7.6-7.8), U was mainly in truly dissolved (<3 kDa) forms (Ca2UO2(CO3)30, CaUO2(CO3)32- and UO2(CO3)22-). It is known that the formation of the ternary Ca-UVI-CO3 complexes inhibits the reduction of U and so it is likely that it is UVI that is present within the peaty soils and their associated porewaters. Sampling trip 1 quantified the U concentrations in cave waters and soil core porewaters. By 30 m from the cave, U concentrations in the soil porewaters had decreased by a factor of ~10. Ultrafiltration fractionated the colloidal fraction (3 kDa-0.2 μm) into large (100 kDa-0.2 μm), medium (30-100 kDa) and small (3-30 kDa) colloidal fractions. It was found that U was mainly associated with the large colloid (100 kDa-0.2 μm) but, with increasing distance from the mineralisation, the U distribution became bimodal with both large and small fractions being equally important. Iron (Fe) was exclusively associated with the large colloid fraction in the peaty soil porewaters. Gel electrophoresis and gel filtration, applied to study the interactions of U (and other elements) with humic substances (HS), showed that the associations were quite uniform with increasing depth of the cores and increasing distance from the U mineralisation. Uranium (and other elements including Fe) was associated with the largest humic molecules. Sampling trip 2 involved collection of three more soil cores and ultrafiltration again fractionated the total dissolved porewater into large, medium and small colloids. This time, the truly dissolved (<3 kDa) fraction was also analysed. Again, U was mainly associated with the large colloidal (100 kda-0.2 μm) fraction. With increasing distance and increasing depth, U was still predominantly associated with the large colloidal fraction, but the importance of the truly dissolved (<3 kDa) phase could not be neglected. At the same time, Fe was also mainly associated with the large colloidal fraction. The remainder of the experimental work on samples from trip 2 focused on determining the importance of U associations with both Fe and humic components of the solid phase. Sequential extraction of the whole soil mainly targeted different iron phases and found that U was mainly released in the sodium acetate and sodium dithionite solutions, which indicated U was associated with (i) Fe carbonates; and (ii) crystalline Fe oxides (e.g. goethite, hematite, and akaganetite). However, very little Fe was extracted in the “carbonate-bound” fraction and separate experiments showed that U was not associated with Fe carbonates but instead had been released from the surfaces of HS and humic-bound Fe surfaces. XRD spectroscopy showed that mineral compositions were in reasonable agreement with the sequential extraction results and SEM-EDX analysis indicated that U in the soil was generally not present in crystalline form, as only two particles with high U content were found after 4-hour searching. Exhaustive extraction of HS showed that >90% U was associated with organic substances, in agreement with previous work and novel experiments involving gel electrophoresis in conjunction with sequential extraction was used to study the relationships between U, Fe and the HS. It was demonstrated that ~20-25% U was weakly held by the HS or at humic-bound Fe surfaces, ~45% was incorporated into crystalline Fe oxides which were intimately associated with HS and the remainder was in the form of strong U-CO3-humic complexes. In sampling trip 3, U migration behaviour in the soil porewaters was the focus. A 30-m transect line, comprising seven0-5 cm soil samples, starting at the cave and passing through the peaty area towards the Southwick Water, was established. Soil porewaters from these surface soils were fractionated into colloidal (3 kDa-0.2 μm) fraction and truly dissolved (<3 kDa) phase. There was a major change in U speciation, from Ca2UO2(CO3)3 0,CaUO2(CO3)32- and UO2(CO3)22- in the truly dissolved fractions of waters close to the cave to a predominant association with the highly coloured colloidal fractions as soon as the boggy area was reached. With distance through the boggy area, it was clear that the colloidal U was being incorporated into the solid phase since porewater concentrations had decreased ~100-fold by 30 m from the cave. Ultrafiltration in conjunction with acetate extraction was then used to extract U from the porewater colloids isolated from a soil core (20 m from cave). In the organic-rich portion of the core (0-30 cm), ~60-70% U was colloidally associated and ~85-95% of this U was extracted from the colloidal fraction. This indicated that the interactions between U and the porewater colloids were weak. In sampling trip 4, U associations in the porewater colloids were still the main focus. Gel filtration of porewater colloids confirmed that U, Fe and humic colloids were intimately associated. It was concluded that although U in the cave drip water was mainly in truly dissolved forms, weak U----humic/Fe colloids were formed immediately when U entered the peaty area. In sampling trip 5, results for soil core porewaters showed that Fe in the whole core was mainly in the form of FeII. Thus strongly reducing conditions prevailed through the core which was situated within the peaty area. Combining the results from the five sampling trips, three zones within the peaty area were distinguished. Zone I was characterised by extremely high concentrations of dissolved HS and this was where the change in U speciation from dissolved to colloidal forms took place. Zone II contained most of the soil cores collected during this study and was characterised by strongly reducing conditions and moderate concentrations of HS. Colloidal U was removed to the solid phase as waters flow through this area. Zone III marks the transition to the saltmarsh. Focusing on Zone II, a conceptual model of U behaviour was developed: upon entering the peaty area, U is weakly held by very large humic-Fe colloids. These colloids are removed to the solid phase and over time the associations of U are transformed; some becomes incorporated into stable humic-bound crystalline oxides as a result of redox cycling of Fe, some becomes strongly complexed to HS and the remainder is weakly held by the HS and/or humic-bound Fe surfaces. The crystalline Fe oxides were transformed to Fe sulfides below 30 cm depth but the associated U was not transferred to these sulfides. Instead the weak associations became more important. In the wider context, since only UVI forms soluble complexes with acetate, UVI does not appear to be reduced even under the strongly reducing conditions encountered within waterlogged organic-rich soils. Initial interactions between UVI and porewater colloids appear to be weak but stronger interactions such as incorporation into Fe phases and complexation by HS occur once the colloids and associated U are removed to the solid phase. Waterlogged organic-rich soils appear to be a long-term sink for U but changing climatic conditions leading to the drying out of such soils may ultimately release U in association with smaller, more mobile organic-rich colloids.

Women with Substance Use Disorders (SUD) have high rates of trauma and PTSD, which is linked to greater physical and mental health problems and poorer SUD treatment outcomes. While research affirms trauma should be addressed during SUD treatment, the majority of addiction programs do not offer such services. One promising intervention is Pennebaker’s expressive writing paradigm, which includes disclosure of traumatic/stressful experiences through 20-minute writing sessions over 3-5 consecutive days. While expressive writing has been linked to improvements in mental and physical health, the intervention has not been studied in persons with SUDs. The present study was a randomized clinical trial comparing expressive writing to control (neutral topic) writing. Conducted in a residential SUD program for women, the study: 1) compared psychological and physical health profiles in SUD women with and without co-morbid PTSD and/or trauma; 2) compared 2-week and 1-month outcomes for the experimental and control groups; and 3) examined immediate and more distal levels of psychological distress following expressive writing. Study participants were N=149 women randomized to either the expressive writing or control writing condition. All women completed 20-minute writing sessions daily for 4 consecutive days. As predicted, SUD women reported high rates of trauma and PTSD, and those with such co-morbidities had more severe psychological and physical health problems. At 2-week follow-up, expressive writing participants showed greater reductions in post-traumatic symptom severity and anxiety scores than control writing participants. While no group differences were found at 1-month follow-up, this was due largely to significant improvements for both groups over the course of residential treatment. Finally, expressive writing participants showed increased negative affect immediately after each writing session, but there were no differences in pre-writing negative affect scores between groups the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect. Study results suggest expressive writing may be a brief, cost effective, adjunct to SUD treatment. Furthermore, expressive writing, when implemented in a residential SUD setting, appears safe, and warrants further study as a strategy for addressing trauma and PTSD in tandem with SUD treatment.

Little research has examined the content of parent-adolescent communication about substance use and variables that may influence it. Using a grounded theory approach for secondary data analysis, qualitative data were drawn from a longitudinal study of coping and substance use in a sample of urban African American adolescents (N=132; M= 13.77 years) and their mothers in Richmond, VA. Transcripts of interviews with participants’ mothers regarding their conversations with their adolescent about alcohol, tobacco or other drugs were microanalyzed by two coders in three sets according to the youth participant’s maternal and familial history of substance abuse. Findings revealed considerable similarity in themes across groups, particularly in providing information, warning about the harms of use, and offering strategies to resist use. Differences in messages were most obvious in the expectations and attitudes conveyed. Future research should further address variables that influence message content and make links from these messages to later youth substance use or abstinence.

African Americans have been disproportionately affected by HIV since the beginning of the epidemic and the disparities have worsened over time (CDC, 2013a). African Americans comprise about 12% of the U.S. population but represented about 44% of all new HIV infections in 2010 (CDC, 2014a). Young people (age 13–24) accounted for 26% of all new HIV infections in 2010, despite persons in this age range comprising just 17% of the population (CDC, 2014c). Young African Americans (age 13-24) are affected in particular. In 2010, they comprised 57% of infections in this age range (CDC, 2014c). Substance use is a major factor in the sexual risk taking of young people. Substance use has been associated with risky behaviors such as unprotected sex and having multiple partners, which may put one at risk for contracting sexually transmitted infections (STIs) (Kaiser Family Foundation, 2002). This may help to explain why STIs are more prevalent among 18 to 24 year olds than any other age group. Prevalence estimates suggest that young people (age 15–24) acquire half of all new STIs (Satterwhite et al., 2008). Program evaluation is a social science activity that entails “collecting, analyzing, interpreting, and communicating information about the workings and effectiveness of social programs” (p. 2) (Rossi, Lipsey, & Freeman, 2004). This dissertation is an evaluation of the Raise 5 Project, which aimed to provide HIV and substance abuse prevention services to the African American students attending Virginia Commonwealth University (VCU). The project utilized four strategies: 1) evidence based interventions, 2) peer education and awareness, 3) HIV testing and counseling, and 4) a social marketing campaign. Two forms of evaluation, process and outcome, were utilized to assess the Raise 5 Project. Process evaluation assesses service utilization (i.e., program engagement) and program organization. This process evaluation sought to determine if the project’s four strategies operated as intended. Outcome evaluation assesses the intended outcomes of a program. This outcome evaluation examined if participants in the project’s evidence based interventions had reduced substance use and risky sexual behaviors.

The objective of this study was to investigate the relationship between stressful events in adolescents and negative outcomes of substance use, depressive symptoms, and anxiety symptoms. Parental support and unsupportive parental responses were examined as moderators of this relationship. The research design was cross-sectional, and self-report data were collected from 100 adolescents in the 8th and 9th grades. As hypothesized, significant positive associations were found between perceived stressors and each of the three negative outcomes, as well as between unsupportive parental responses and the outcomes. Also consistent with hypotheses, and previous literature, was the finding of a significant inverse association between parental support and negative outcomes. Multiple linear regression analyses supported one of the moderator hypotheses, showing that parental support buffered the association between stressful events and adolescent substance use, such that adolescents with high stress and high perceived parental support engaged in significantly less substance use than adolescents with high stress and low perceived parental support. However, no significant evidence was found for parental support as a buffer of the associations between adolescent stressful events and either depressive symptoms or anxiety symptoms. Contrary to hypotheses, no significant moderation effects of unsupportive parental responses were found for the associations between stressful events and adolescent substance use, depressive symptoms, or anxiety symptoms. A major contribution of the present study is the evidence for unsupportive parental responses as a significant predictor of negative outcomes in adolescence. The present findings further suggest that unsupportive parental responses are a distinct construct from parental support, rather than simply opposite ends of the same continuum.

Eating disorders and substance use disorders both exhibit a clear sex-difference in prevalence. Eating disorders are more common in females while substance use disorders are more common in males. Previous research has also established a strong association between these two disorders, especially within females. Much less research has examined comorbity in males. The etiology and reasons for these sex-differences and for the comorbidity of eating and substance use disorders remain unclear. The present report aimed to examine disordered eating (DE), substance use (SU), and their comorbidity further, in both sexes, using disorder eating attitudes and behaviors and substance use rather than diagnoses. DE was examined with the Drive for Thinness, Bulimia, and Body Dissatisfaction subscales of the Eating Disorder Inventory-II. Nicotine, alcohol, and illicit drug use was also assessed. Male and female twin pairs from The Swedish Twin study of CHild and Adolescent Development will be used which includes 1,480 twin pairs assessed at three age points; 13-14, 16-17, and 19-20. A twin design was utilized to examine important aspects of the genetic and environmental risk factors for DE, SU, and their comorbidity within three distinct studies. In Study I multivariate twin designs were used and revealed that an underlying common factor was responsible for the three facets of DE in both sexes at age 16-17. Sex-differences were exhibited within these genetic influences such that only 50% of the genetic risk for the DE factor is shared between the sexes. Total heritabilities for the three subscales were higher for females. In Study II a longitudinal, multivariate twin design was used and revealed that an underlying common factor was responsible for SU at all three assessment ages. In general, genetic effects became more substance specific, and common shared environmental effects decreased across the age groups. In Study III, the genetic and environmental covariance between the DE and SU common factors at age 16-17 was examined. The covariance between DE and SU was partly mediated through familial factors, and these factors impacted covariance similarly in the sexes. Genetic and shared environmental factors each accounted for approximately 50% of covariance.

The aim of this thesis is to expand our understanding of the etiology of alcohol misuse and related disorders in African Americans using genetically informative study designs. Specifically, we take advantage of the candidate-gene approach and polygenic score analysis to extend the literature specific to African American populations. Chapter 2 explores gene x environment (GxE) interactions through the candidate gene approach to explore the relationship between two genes chosen on their potential relevance to stress response and adolescent alcohol use and misuse, among African American youth living in highly impoverished neighborhoods, as moderated by stressful life events. Chapter 3 implements polygenic score analyses to examine the effect of an aggregate of markers. We explore whether polygenic risk for alcohol dependence – derived from GWAS estimates in one discovery sample – predict alcohol use and broader externalizing behaviors and interact with stressful life events to predict alcohol use/misuse among high-risk African American youth.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

Magister Artium (Social Work) - MA(SW) / Substance abuse has become a serious global problem affecting individuals, families and communities. The effects of substance abuse devastate both the user and their families. This study aimed to describe the adverse effects that substance abuse has on the levels of care giving and well-being of families. The study explored family members perceptions of the ways in which an adolescent’s substance abuse affects family care giving and well-being. The study was conducted within a qualitative approach in order to gather an in depth understanding of the family’s experiences. Furthermore, the study was aligned with Family Systems and Bowens Family Theories, which served as reference points to allow the researcher to discern how substance abuse influences family roles, dynamics and functioning. The researcher used the case study design which focused on an issue of concern (such as adolescent substance abuse) and thus selected one case to elucidate the issue i.e. a single case study. The case would be the family members of substance abusing adolescents in Mitchells Plain. The population of interest were the parents and siblings of adolescents who abused substances. Purposive sampling was used to select families with participants who had the specific qualities and experiences needed for the study. The study sample consisted of 12 participants, seven parents (mothers) and five siblings. The participants were female which corresponds with literature, as females are perceived as more willing to share and speak about their experiences. Individual semi-structured interviews were used for data collection through the use of interview schedules. Data verification methods ensured credibility (member checking), transferability (using thick, rich descriptions), dependability (an inquiry audit), and confirmability (using researcher reflexivity). The data was analysed in the form of qualitative thematic analysis achieving data reduction by seeking themes, sub-themes and categories of data. Four themes emerged from the findings, namely, (1) parents/sibling reactions to discovering the substance abuse, (2) the effects of substance abuse on the parents/siblings living with a substance abuser, (3) effects on family communication, and (4) measures used to assist the substance abuser. Each theme was further delineated into 12 sub-themes and 23 categories which were based on both predefined and emergent codes. Permission to conduct this study was obtained from the university’s Faculty of Community and Health Sciences Ethics Committee by its Humanities and Social Sciences Research Ethics Committee (HSSREC); and by the Department of Social Development’s Research Ethics Committee. Ethics compliance was assured through confidentiality and privacy, securing and handling of confidential information, and debriefing opportunities to ensure that emotional harm is minimised together with sensitive interviewing techniques.