Substance use disorder is a medical diagnosis who affects approximately one of ten adults in Sweden. Nursing relation on a mutual level is created when the nurse sees the person behind the disease, the care can then be giving from a person-centred approach. The care shall be given from all human’s equal value. Aim: To describe nurses’ treatment against patients with substance use disorder- from the patients’ perspective. Method: A descriptive literature study based on ten scientific articles, of which nine were qualitative and one were quantitative Main result: The patients experienced a fear to tell about their substance use in the meeting with health care. This fear affected patients' care when adequate drug treatment couldn´t be met. In this patient group is comorbidity plain occurring, a holistic view was missed when only one of the diagnoses were treated. The weight of total abstinence of drugs was experienced to be more important than quality of life. What on the other hand made a difference in a positive way in the treatment of this group of patients was the nurse’s education and their personal experiences of relatives with substance use disorder. Conclusion: A big share of the patients experienced the meeting with the health care as condemnatory and disparage which led to the patients avoiding the health care system. That is why it is important that the nurses focus on treating the patients from their symptoms which they seek treatment for initially and minimize withdrawal symptoms. Nurses with higher education tend to have a better treatment. / Bakgrund: Substansbrukssyndrom är en medicinsk diagnos som drabbar ca en av tio vuxna i Sverige. En vårdrelation på en ömsesidig nivå skapas när sjuksköterskan ser personen bakom sjukdomen, omvårdnaden kan då ges utifrån ett personcentrerat förhållningssätt. Vården ska utgå ifrån alla människors lika värde. Syftet: Att beskriva sjuksköterskors bemötande gentemot patienter med substansbrukssyndrom – ur patientens perspektiv. Metod: En beskrivande litteraturstudie baserad på tio vetenskapliga artiklar varav nio kvalitativa och en kvantitativ. Huvudresultat: Patienterna upplevde en rädsla att berätta om sitt substans användande i mötet med sjukvården. Denna rädsla påverkade patienternas vård då lämplig läkemedelsbehandling inte kunde tillgodoses. Inom denna patientgrupp är samsjuklighet vanligt förekommande, ett holistiskt synsätt saknades då endast en av diagnoserna behandlades. Vikten på total avhållsamhet av droger upplevdes vara viktigare än god livskvalitet.  Vad som däremot gjorde skillnad på ett positiv sätt i bemötandet mot denna patientgrupp var sjuksköterskornas utbildning och deras personliga erfarenheter av anhöriga med substansbruk. Slutsats: En stor andel av patienterna upplevde mötet med sjukvården som dömande och nedvärderande vilket tenderade i att patienterna i största mån undvek vården. Det är därför av vikt att sjuksköterskorna fokuserar på att behandla patienterna utifrån symtomen vården söks för och minimera utsättningssymtomen kopplat till substansbrukssyndromet. Sjuksköterskor med högre utbildning tenderar att ha ett bättre bemötande.

Women comprise one of the fastest growing populations of the criminal justice system, yet little research exists concerning the success of these women completing a coed pretrial drug court diversion program. Trauma theory was applied to inform the variables in this quantitative correlational study. The predictive nature of age, educational level, marital status, violent criminal history, and mental health problems for women were examined in relation to completion of a coed pretrial drug court diversion program. A convenience sample from secondary, archival data was obtained from a criminal justice agency in Washington, DC. The dataset included women who participated in the program between January 1, 2009 and December 31, 2014. Logistic regression models were used to predict the likelihood of whether these women completed drug court and determine which independent variables were likely to increase or decrease the probability of program completion. Results of the study failed to yield statistically significant relationships between the variables examined. However, the findings indicate possible relationships between marriage and drug court completion, and postsecondary education and drug court completion, which require additional research. Implications for positive social change are drawn for other criminal justice agencies, drug courts, and administrators for enhancing program delivery and reducing women's recidivism.

Substance use during adolescence is associated with numerous undesirable short term and long term consequences. This study examined rates of substance use, as well as rates of elevated anxiety and depressive symptomalogy, among 138 students attending a predominantly Hispanic, low-SES high school. The current study also examined the complex relationships between adolescent substance use, mental health problems, and involvement in school-based extracurricular activities, among this ethnically diverse sample. Results included that a significant proportion of adolescents in the sample fell in the "at-risk" category for a clinical diagnosis of depression and/or anxiety disorder. Further, those students who reported smoking cigarettes and using marijuana were more likely to endorse feelings/thoughts related to school avoidance. Results also indicated that the more adolescents reported being involved in prosocial/academically oriented school-based extracurricular activities and/or special interest clubs, the less likely they were to report smoking cigarettes. Finally, involvement in athletics protected students with social anxiety from using cigarettes. Implications of these findings for future research as well as practice are also discussed.

College students have an increased risk for cannabis use, trauma exposure, and posttraumatic stress disorder (PTSD). Cannabis use disorder (CUD) and PTSD comorbidity is high, and given the negative consequences of the comorbidity (e.g., poor academic outcomes), there is a need to understand comorbid CUD-PTSD etiology. Two primary etiologic models exist: self-medication (i.e., PTSD à CUD) and high-risk (i.e., CUD à PTSD) hypotheses. This study 1) examined the prevalence and predictors of cannabis use and interpersonal trauma (IPT) exposure; 2) investigated the relationship between cannabis use and IPT; and 3) examined cannabis use, IPT, and PTSD through mediational self-medication and high-risk hypotheses lenses in a large (n = 9,889) longitudinal study of college students. Aim 1 found the prevalence of lifetime problematic (i.e., use ≥ 6 times) and experimental (i.e., use 1-5 times) cannabis use was 28.3% and 17.4%, respectively. Aim 1 results also estimated that the prevalence of lifetime IPT exposure was 35.9%. Aim 2 results supported the self-medication hypothesis, but not the high-risk hypothesis. Overall model fit from Aim 3 was poor. Nonetheless, Aim 3 results did not support the self-medication or high-risk hypotheses. Given the poor model fit of Aim 3, results should be interpreted with caution. However, as a whole, these findings provide preliminary support for the self-medication hypothesis, indicating that those reporting IPT exposure and probable PTSD may be at risk for cannabis use. Implications of these findings, in light of study limitations, are discussed.

The purpose of this study was to examine staff's experiences of comorbidity between persons with disabilities and substance abuse disorder as well as collaboration between the concerned occupational activities. We used a qualitative method and interviewed six informants from four different municipalities. With organisational theory and stamping theory, we analysed the result and comparing with the earlier research contributed to the reflections in the discussion. The result showed that comorbidity is not unusual and that it can be difficult for staff to handle at times. Furthermore, it emerged that the collaboration situation is an important part of the work of the occupational activities. Other types of collaboration models may be needed for the target group, since collaboration must not become a forum for professionals to distribute the work, unless it focuses on the individual's needs and wishes. / Syftet med studien var att undersöka personalens, boendepersonal och chefer på mellannivå, erfarenheter av samsjuklighet mellan funktionsnedsättningar och substanssyndrom hos brukare/boende samt samverkan mellan berörda verksamheter. Vi använde oss av kvalitativ metod och intervjuade sex personer från fyra olika kommuner för att besvara studiens syfte. Med organisationsteori och stämplingsteori analyserade vi resultatet och jämförande med den tidigare forskningen bidrog till reflektionerna i diskussionen. Resultatet av studien visade att det inte är ovanligt med samsjuklighet i verksamheterna och i perioder kan det vara svårt för verksamheterna att hantera det. Vidare framkom det att samverkan utgör en viktig del av verksamheternas arbete men att det kan behövas andra typer av samverkansmodeller för målgruppen då samverkan inte får bli ett forum för professionella att fördela arbetet utan fokus på den enskildes behov och önskemål.

Adverse Childhood Experiences, also known as ACEs, are a major public health concern. ACEs are defined as stressful or traumatic events in early life that range from parental separation to all forms of abuse and neglect, as well as household dysfunction (e.g., living in a home with substance misuse). The current body of scholarly literature shows that ACEs have long lasting effects on both physical and mental health through a person’s life. Research also illustrates a dose-response relationship between the number of ACEs and the number of risk behaviors, such as substance misuse, that a person may exhibit. Quality of life refers to a person’s self-perceived well-being and includes mental, emotional, physical, and sexual health. Quality of life, synonymous with well-being is associated with numerous health benefits including reduced risk of disease, better immune function, and increased life expectancy. This study seeks to determine if quality of life is a protective factor against substance misuse in adults who report ACEs. In line with the current body of knowledge, we hypothesize that adults within the study sample with a higher number of ACEs will exhibit higher rates of tobacco use, alcohol use, and drug use. We also hypothesize that participants with ACEs who rate a higher quality of life score will be less likely to use alcohol, tobacco, or drugs; as compared to those who rate a lower quality of life. Participants (N=766, age 18-55) were recruited through the REACH (Religion, Emotions, and Current Health) survey study. Data on ACEs will be collected from the Adverse Childhood Experiences (ACEs) Questionnaire which measures the number of traumatic experiences during the first eighteen years of life. Data on substance use will be collected via the Tobacco Questionnaire dichotomously (yes or no), the AUDIT scale on alcohol use which measures the frequency and quantity of consumption, and the Drug Abuse Screening Test (DAST) which measures drug use in the last twelve months. Quality of Life will be measured using the World Health Organization Quality of Life WHOQOL-BREF. Quality of life will also be examined using two subscales, overall quality of life and perceived social support. All data was collected via self-reporting. Bivariate and multivariate analyses will be conducted using SPSS. To examine the potential moderating effect of quality of life, a hierarchical multiple regression will be conducted, specifically the simple moderation from the PROCESS macro for SPSS. We predict that those who perceive a higher quality of life, despite early life adversity, will report less frequency in alcohol, tobacco, and drug consumption. Conversely, we predict that those who perceive a lower quality of life will exhibit higher rates of health-related risk behaviors, specifically substance misuse.

Providers’ Perspectives on Treating Patients for Substance Use Disorder in Northeast Tennessee Stefan Pienkowski MA, Abbey Mann PhD Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson CIty, TN ABSTRACT Previous research has shown that people who identify as lesbian, gay, bisexual, transgender, and/or queer/questioning (LGTBQ+) have higher rates of substance use disorder (SUD) compared to the general population.1,2 Additionally, gender and sexual minorities have shown less treatment-seeking intentions than their heterosexual cis-gender counterparts.3 Given these circumstances, increasing approachability to SUD treatment options for people who identify as LGBTQ+ may significantly reduce this health disparity. Through this action research study, we set out to identify barriers to SUD treatment in northeast Tennessee as well as identify SUD treatment providers that make special accommodations for people who identify as LGBTQ+. Through purposive sampling, we identified nine providers of SUD treatment in Washington, Carter, and Sullivan counties. Providers included three physicians, three certified peer support specialists, a licensed counselor, and two facility directors. Providers each participated in a one-on-one semi-structured interview that lasted approximately 45 minutes and was audio recorded without the use of identifying information. Interview data were reviewed, and preliminary analysis was performed in order to identify themes. Themes included barriers to care, general resources, and stigma. LGBTQ+ specific findings revealed that none of the interviewed providers had received formal LGBTQ+ cultural competency training, but most providers expressed interest in receiving LGBTQ+ cultural competency training. Additionally, many providers did not believe that LGBTQ+ patients have specific needs concerning SUD treatment. Only three of the providers interviewed made special accommodations for their LGBTQ+ patients. In addition to identifying themes in the interview data, the results of this project were used to create a LGBTQ+ friendly SUD treatment resource guide for northeast Tennessee. Next steps for this action research project include 1) interviewing people who have experience with SUD treatment in northeast Tennessee and identify as LGBTQ+, 2) developing a community-based LGBTQ+ cultural competency training module informed by those interviews, 3) implementing and evaluating that module with SUD treatment providers in northeast Tennessee. 1. Medley, Grace, et al. “Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration, Oct. 2016, www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. 2. Mereish, Ethan H, and Judith B Bradford. “Intersecting Identities and Substance Use Problems: Sexual Orientation, Gender, Race, and Lifetime Substance Use Problems.” Journal of Studies on Alcohol and Drugs, Rutgers University, Jan. 2014, www.ncbi.nlm.nih.gov/pubmed/24411810.` 3. Benz, Madeline. “Stigma and Help-Seeking: The Interplay of Substance Use and Gender and Sexual Minority Identity.” Addictive Behaviors, Pergamon, 23 May 2019, www.sciencedirect.com/science/article/abs/pii/S0306460318311316.

Background Substance use disorder [SUD] is a global problem and opioids is a growing partof the overdoses worldwide. Sweden has a high mortality rate related to narcotics compared tothe rest of the EU. Nurses meet people with SUD when people with SUD are seeking care. People with SUD are usually met with stigma and have a risk of getting worse care in a healthcare setting. Aim The aim with this study is to describe nurses’ experiences of meeting people with SUD. Method This study is a literature study. Seven qualitative articles were analyzed with acontent analysis approach. Results The results show that nurses had a sense of insecurity being present in the meetingwith people with SUD. The presence of insecurity comes from a more demanding care, afeeling of being vigilant, lack of information and that nurses’ integrity is under threat. Conclusions People with SUD are a vulnerable group with a risk of being exposed for carepanding and in many cases nurses experience a kind of insecurity while caring for them. / Bakgrund Beroendeproblematik är ett problem globalt där opiater står för en stor och ökadmängd överdoser. Sverige har en hög dödlighet kopplat till narkotika preparat i jämförelsemed resten av EU. Sjuksköterskor möter personer med beroendeproblematik när de sökervård. Personer med beroende möts av både stigma och riskerar sämre vård inom hälsosjukvården. Syfte Syftet var att beskriva sjuksköterskors upplevelser av att möta personer medberoendeproblematik. Metod Studien är en allmän litteraturstudie. Sju kvalitativa artiklarna inkluderades ochinnehållsanalys valdes med en induktiv ansats. Resultat Resultatet visar på hur en upplevd osäkerhet är närvarande hos sjuksköterskor imötet med personer som har en beroendeproblematik. Upplevelserna innefattar att vården ärkrävande, ett ökat behov att vara vaksam, informationsbrist och att sjuksköterskor integritet ärhotad. Slutsats Personer med beroendeproblematik är en sårbar grupp som riskerar att utsättas förvårdlidande och som sjuksköterskor i flera fall upplever en osäkerhet i att vårda.

Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing “What are your views about addiction?” (14 items), “What are your views about interacting with people who are addicted to drugs?” (11 items), and “What do you think the church’s role is in addressing addiction?” (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable.

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