INTRODUCTION: In Georgia, criminal justice (CJ) involvement is one of the costliest outcomes experienced by individuals with substance abuse problems. Approximately 8% of individuals in America have needed substance abuse treatment, and in Georgia CJ involvement commonly co-occurs. AIM: To examine the transition into the CJ system for those entering treatment, and, arrests of individuals in treatment. The aim is to determine defining characteristics exist for an individual who switches over into the CJ system, or an individual who has an arrest while in treatment. METHODS: Data from the Treatment Episode Data Set from 2011-2015 was examined. Demographics, drug types, frequency of use, poly drug use, number of treatment episodes, time between treatment episodes, and rural and urban geography are analyzed in relation to the dependent study variables. Analytic techniques used are independent samples t-tests and regression analyses. The dependent variables are any switchover into the criminal justice system upon reentering treatment, and any arrest before discharge from treatment. RESULTS: Factors associated with a switch into the CJ system upon admission are non-completion of high school, ever being unemployed or a student (18 yrs or older), poly drug use, more than one treatment episode, younger at age of first drug use, longer periods of time in treatment, a switch of primary drug to meth, crack-cocaine, opiates, marijuana, or alcohol. Attending self-help programs before entering treatment and living in rural areas also increases a switch to the CJ system. Higher risk of arrest is associated with younger at age of first drug use, being male, black or other non-white race, higher education levels, ever being a student or homeless, attending self-help programs, and living in urban areas. DISCUSSION: The results and interpretation of this study may help inform and direct one part of a criminal justice prevention strategy and evidence-based health policy, for individuals who are undergoing substance abuse treatment.

Experiential avoidance (EA) is a process in which a person attempts to avoid, dismiss, or change experiences such as emotions, behaviors, and thoughts. EA is associated with a number of psychological disorders and is generally harmful to psychological well-being. Various studies have explored the role of EA as a mediator, while others have studied EA as a moderator. The current study aimed to further understand and broaden the knowledge of the role of EA in regard to trauma, substance abuse, aggression, and impulsivity by examining relationships between these variables with EA as a mediator and as a moderator. Experientially avoidant behaviors (i.e., substance abuse, aggression, and impulsivity) were related to higher levels of EA. EA was found to partially mediate the relationship between the number of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms, as well as the relationship between substance abuse and PTSD. EA was also found to moderate the relationship between PTSD symptoms and aggression. Findings from the present study as well as its limitations and future directions for research are discussed.

No description available.

Class of 2007 Abstract / Objectives: To identify differences between patients diagnosed with a serious mental illness who test positive for cocaine and/or methamphetamine compared to patients who test positive or other abused substances. Methods: This retrospective study of clinical data obtained through a community mental health agency that provides outpatient services for patients with a serious mental illness. The study population was divided into two subgroups: positive cocaine and/or methamphetamine drug screen versus other positive drug screens and were compared over a 12- month period for the frequency and types of positive drug screens and blood alcohol levels, days of court-ordered treatment, the number of psychiatric hospitalizations and length of stay, primary psychiatric diagnosis, and the cost of care for services provided. Results: More females were in the “cocaine/methamphetamine” group versus more males in the “other substances of abuse” group, (p < 0.01). A higher proportion of patients diagnosed with psychotic disorders tested positive for “other substances” than for “cocaine and methamphetamine” (p < 0.01) and the “cocaine/methamphetamine” group had significantly more mood and anxiety disorders than the other group (p < 0.05). The frequency of patients testing positive for marijuana, methadone, and other opiates was higher in the “other substance abuse” group (p < 0.001). Patients in the “cocaine/methamphetamine” group had higher rates of polysubstance abuse (p < 0.001). The most commonly abused substance was cocaine (53.8%). Conclusions: Regular drug screening for substances of abuse and utilization of drug treatment programs should be recommended for SMI patients to improve their care and treatment outcomes.

M.A. / Patterns of substance abuse within the family is a widespread phenomenon that occurs through generations. Although various factors can be a symptom of a dysfunctional family, the dynamics that maintain the transgenerational patterns of substance abuse are of great interest. The family in which the abuse of alcohol is repetitive through generations, is seen as a dysfunctional family system. It appears that a circular pattern exists in the family that maintains the alcohol abuse. Although the family as a whole has an influence on individual members, these individual members enter their families with their own preconceived mind maps of past experiences that also have a great influence on the family dynamics. Family dynamics are seen as those factors that impact either positively or negatively on the family and its individual members. The alcoholic parent and adult child of the alcoholic parent are the subjects of concern in this study because it is assumed that parental inputs have been the most influential in the respondent’s lives. A qualitative method of research was implemented to describe this explorative study and was decided on because it describes the phenomenon of transgenerational patterns of alcohol abuse from the viewpoint of the respondent. The aim of this research study was to determine the dynamics that contribute to transgenerational patterns of alcohol abuse, with specific reference to the respondent’s family history of alcohol abuse, their co-dependency (alcohol abuse) and the maintenance of these dynamics throughout generations. These dynamics will be explained in terms of the Living Systems Theory and the Object Relations Theory. These theories form the theoretical foundation from which these dynamics were explained. From these theories a strategy of data-gathering was developed with specific focus on the genogram, family tree and general questions. A focused sampling method was implemented in this research study, and the research units consisted of five respondents with families that have a history of alcohol abuse. Data-gathering was done through phenomenological and semi-structured interviews. The interviews were audiotaped and fieldnotes were made, although limited and only to confirm some of the findings of the research study. The data was analysed according to a specific strategy. Preliminary coding was done by using the audiotapes (transcriptions) and fieldnotes. After the preliminary coding was completed, these categories were used to derive central themes from the findings and all the categories were then divided under one or several of these themes. These central themes were compared with existing literature in order to confirm the findings of this research study and to enhance the trustworthiness. From the study, certain recommendations with regard to methodology and content were made. / Dr. E. Oliphant

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

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.

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.