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Bakgrund: Substansbrukssyndrom drabbar människor över hela världen. Tidigare forskning har visat att hälso- och sjukvårdspersonal upplevde att de hade en negativ inställning till patienter med substansbrukssyndrom. Hälso-och sjukvårdspersonal har också rapporterats ha fördomar mot denna patientgrupp. Det har även visats att patienter med substansbrukssyndrom behandlades annorlunda än andra patienter. Patienter med substansbrukssyndrom vårdas på många olika avdelningar, vilket gör att den grundutbildade sjuksköterskan kan möta dessa patienter inom olika vårdinstanser. Syfte: Syftet med litteraturstudien var att belysa vilka erfarenheter patienter med substansbrukssyndrom hade av mötet med hälso- och sjukvårdspersonal. Metod: En litteraturstudie baserad på tolv vetenskapliga artiklar med kvalitativ studiedesign. Artiklarna hämtades från databaserna Cinahl, Pubmed och Psychinfo. Artiklarna analyserades enligt metod beskriven av Friberg (2017). Resultat: Två teman identifierades: Positiva upplevelser samt Negativa upplevelser. Utifrån dessa genererades fyra subteman: Professionellt bemötande, Terapeutisk allians, Oprofessionellt bemötande och Inadekvat vård. Konklusion: Patienterna hade både positiva och negativa erfarenheter av möten med hälso- och sjukvårdspersonal. Vid positiva upplevelser beskrevs ett fördomsfritt och accepterande bemötande samt att hälso- och sjukvårdspersonal skapade en anknytning till patienten och gjorde patienten delaktig i vården. Vid negativa erfarenheter skildrades bemötandet som fördomsfullt, dömande och stigmatiserande. Hälso- och sjukvårdspersonal upplevdes ofta ha bristande kunskaper inom beroendemedicin. Patienter med substansbrukssyndrom upplevde att de fick sämre vård än patienter utan substansbrukssyndrom. Hälso- och sjukvårdspersonal behöver ha kunskap inom beroendemedicin samt ett professionellt och fördomsfritt bemötande för att kunna ge patienter med substansbrukssyndrom en god och likvärdig vård som andra patienter. / Background: Substance use disorder affects people all over the world. Previous research showed that health care professionals had a negative attitude towards patients with substance use disorder. They also had prejudices against this patient group. Patients with substance use disorder were treated differently than other patients. They are cared for in many different wards, which means that the undergraduate nurse can meet these patients in different care institutions. Aim: The purpose of the literature study was to illustrate the experiences of patients with substance use disorder meeting health care professionals. Method: A literature study based on twelve scientific articles with qualitative study design. The articles were retrieved from the databases Cinahl, Pubmed and Psychinfo and were analyzed according to Friberg (2017). Result: Two themes were identified: Positive experiences and Negative experiences. Based on these, four subthemes were generated: Professional attitude, Therapeutic alliance, Unprofessional attitude and Inadequate care. Conclusion: Patients had both positive and negative experiences of meetings with health care professionals. In positive experiences, an open-minded and accepting attitude was described and health care professionals created a connection to the patient and involved patients in the care. In negative experiences, the attitude was portrayed as prejudiced, judgmental and stigmatizing. Healthcare professionals often had a lack of knowledge in addiction medicine. Patients with substance use disorder experienced that they received inferior care than patients without substance use disorder. Healthcare professionals need to have knowledge in addiction medicine as well as a professional and open-minded attitude to be able to give patients with substance use disorder a good and equivalent care as other patients.

Inledning: Sjuksköterskan möter individer med substansbrukssyndrom i många sammanhang i den psykiatriska kontexten. Det finns en önskan hos individerna om en helhetssyn, sjuksköterskans möte kan ha betydelse för en vård där hela patientens hälsa beaktas. Författarna vill därför sammanställa den befintliga kunskapen om mötet utifrån sjuksköterskans perspektiv.  Syfte: Att sammanställa kvalitativ och kvantitativ forskning avseende sjuksköterskans möte med individer som har substansbrukssyndrom.  Metod: Aktuell studie är en integrativ litteraturstudie. Den integrativa metoden är genomförd enligt Whittemore och Knafl (2005).  Resultat: your de meningsbärande enheterna växte en huvudkategori; Sjuksköterskans anpassning av rollen samt fyra underkategorier fram; den auktoritära rollen, den praktiska utföraren, den medmänskliga terapeutiska rollen och den reflekterande vaksamma rollen. Slutsats: De fyra rollerna som framkom your analysen belyser hur flexibel och medveten sjuksköterskan behöver vara i omvårdnaden, både med hänsyn till helhetssynen av individen samt beträffande var i sjukdomsprocessen individen befinner sig. Sjuksköterskan stödjer individen i att återta kontrollen i sitt eget liv.

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

<p>Marijuana use has been shown to increase and peak during young adulthood (i.e., ages 18-35). However, it appears that Black individuals do not decline in use at rates similar to other race groups. Marijuana use among Black adults has been linked to more problems such as increased arrests, greater mental health disorder diagnoses, and substance dependence. The biopsychosocial model of racism and race-based theoretical framework aims to understand how factors such as racial discrimination as a traumatic event could be associated with marijuana behaviors, particularly among Black adults. The present study aims to examine the association between racial discrimination and marijuana use and problem use above and beyond trauma exposure. Further, I aimed to explore whether gender or vocation (college, community, and military) moderated the relationships. 391 Black adults (57.5% female; mean age 24.9) completed measures on marijuana use and problems, trauma exposure, and racial discrimination distress. Hierarchical linear regression and Hayes PROCESS macro were used to evaluate the study aims. Racial discrimination distress was associated with marijuana use above and beyond trauma exposure (DR2=.016, <em>p</em>=.004). However, racial discrimination distress did not add significant variance within the model for problem marijuana use (DR2=.001, <em>p</em>=.419). Additionally, moderation by gender and vocation were not supported in either model. Taken together, the present results support that examining psychological and health outcomes among Black young adults should include an evaluation of racial discrimination distress. Further, future studies should continue to evaluate sociodemographic factors in larger more representative community-based studies to better understand potential variation in risk among Black young adults.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / Marijuana use has been shown to increase and peak during young adulthood (i.e., ages 18-35). However, it appears that Black individuals do not decline in use at rates similar to other race groups. Marijuana use among Black adults has been linked to more problems such as increased arrests, greater mental health disorder diagnoses, and substance dependence. The biopsychosocial model of racism and race-based theoretical framework aims to understand how factors such as racial discrimination as a traumatic event could be associated with marijuana behaviors, particularly among Black adults. The present study aims to examine the association between racial discrimination and marijuana use and problem use above and beyond trauma exposure. Further, I aimed to explore whether gender or vocation (college, community, and military) moderated the relationships. 391 Black adults (57.5% female; mean age 24.9) completed measures on marijuana use and problems, trauma exposure, and racial discrimination distress. Hierarchical linear regression and Hayes PROCESS macro were used to evaluate the study aims. Racial discrimination distress was associated with marijuana use above and beyond trauma exposure (R2=.016, p=.004). However, racial discrimination distress did not add significant variance within the model for problem marijuana use (R2=.001, p=.419). Additionally, moderation by gender and vocation were not supported in either model. Taken together, the present results support that examining psychological and health outcomes among Black young adults should include an evaluation of racial discrimination distress. Further, future studies should continue to evaluate sociodemographic factors in larger more representative community-based studies to better understand potential variation in risk among Black young adults.

Substance use disorders (SUDs) among community-based offenders are a significant challenge for criminal justice agencies. SUDs are linked with both adverse health risks and increased risk of recidivism. Given the consequences of SUDs, mandated substance use treatment is often required in community supervision. Unfortunately, relapse is extremely common regardless of whether treatment is a condition of supervision. Previous research has identified some factors that can influence treatment outcomes among offender populations, including demographic differences, substance use history, mental health conditions, and criminal history. This dissertation will argue that a more nuanced understanding of the role of health and well-being among community-based offenders is a necessary component in understanding treatment engagement. Health Related Quality of Life (HRQOL), a construct to gauge health and well-being, is often used among medical communities to better understand health impacts on a given population as well as decision-making in treatment compliance studies. However, HRQOL is rarely studied in criminal justice, and has almost never been examined in community offender populations. A robust understanding of health is needed for this population of vulnerable offenders, an understanding that includes multiple dimensions of health including HRQOL. This study sampled a total of 103 offenders from drug court and probation settings, who were mandated to participate in substance use treatment. The health and treatment experiences of this sample of offenders were examined using mixed methods, beginning with quantitative analyses including descriptive, bivariate, multivariate statistical models and structural equation models. The multivariate models and structural equation models examined two main treatment engagement outcomes: whether offenders stayed in treatment and the proportion of treatment sessions attended. These quantitative findings were followed by qualitative analysis of 10 interviews with a subsample of the survey participants who had experienced some level of health difficulty at their baseline survey. Qualitative analyses sought to elaborate on the quantitative findings to provide context for how and why participants were or were not engaging with their mandatory treatment. Results from the quantitative analysis indicate that although criminal history is the most consistent factor influencing treatment engagement, various aspects of health appear to influence treatment success to some extent. HRQOL may influence whether participants stay in treatment. Treatment experiences and health also appear to differ substantially depending on the offenders’ primary drug of use. Offenders who exclusively used marijuana were substantially healthier than their harder drug using peers, and they appear to stay in treatment more easily. Furthermore, both mental and physical health conditions appear to influence treatment attendance among participants who used drugs other than exclusively marijuana. Finally, there were differences in treatment retention depending on whether participants were supervised by drug court or probation, such that drug court participants were more likely to stay in treatment; however, supervision type did not influence proportion of treatment sessions attended. Qualitative findings both provided support for some of the quantitative findings and also illuminated the nuances of the treatment engagement experience of offenders with health difficulties. Interviewees who primarily used marijuana tended to have less severe health difficulties and many did not perceive their use as problematic. Treatment engagement among participants was influenced by their motivation for treatment, whether they had mental health and/or physical health difficulties and the severity of those health difficulties. Logistical factors also influenced treatment engagement, particularly conflicts between treatment requirements and employment and familial relationships. Many of the results presented herein are exploratory and thus require replication; however, some clear directions for future research arise. There is a need to examine the role of health among community based offenders and their ability to comply with mandated treatment with a larger sample. In particular, studies are needed, which include more participants who use ‘harder’ illicit drugs such as opioids and cocaine, as they appear to have more difficulties both with their health and with treatment engagement. Further research is needed on models for Treatment Engagement that include multiple dimensions of health and allow for recursive relationships between health dimensions. Regarding policy and practice implications, the correctional agencies involved should consider re-evaluating the means by which offenders are assigned to supervision and SUD treatment. In particular methods for screening and assessment of SUDs should be re-evaluated, with particular consideration given to the role of offenders’ primary drug of use. / Criminal Justice