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Mental illness and substance use disorders have been determined to be leading predictors for recidivism among criminal offenders in the United States who are released to community supervision. Women make up an increasing in percentage of this criminal justice population; however, few studies have explored the role that gender plays in determining men and women's recidivism. Offender's education, employment, and peer association have also been reported to be predictors increasing the likelihood of recidivism among criminal offenders. This study was designed to determine if gender, mental illness, substance use disorder, employment, education, and peer association predicted recidivism. Differential association theory and gender pathways theory provided the theoretical framework for this study for examining archival data obtained from the Court Services and Offender Supervision Agency AUTO Screener and Supervision Management Automated Record Tracking System. Multiple logistic regression analysis showed that substance use disorder significantly predicted recidivism, while employment decreased the likelihood of recidivism. This study did not find a significant interaction between mental illness and substance use disorder or mental illness only. Additionally, neither gender, education, nor peer association were found to be associated with recidivism. This study promotes social change by highlighting the increasing need for services for offenders and identifying the complex factors that impact recidivism. The findings from this study will be helpful to criminal justice agencies for developing programs that address the need of SUD and employment for offenders to reduce the likelihood of recidivism and increase public safety.

Background: Whereas the role of externalizing disorders is relatively well established in predicting the onset of cannabis use (CU) or cannabis use disorder (CUD), the status of anxiety and mood disorders in predicting CU and CUD remains controversial. Objective: (1) To examine cross-sectional and prospective associations of CU and CUD with a range of mental disorders and whether anxiety and mood disorders are associated with CU/CUD after adjusting for externalizing disorders. Methods: N = 1395 community subjects aged 14–17 at baseline were followed-up at three waves prospectively over 10 years. Substance use, substance disorders and mental disorders were assessed using the DSM-IV/M-CIDI. Results: (1) The baseline prevalence rates where 19.3% at t0 for CU and 2.6% for CUD. Cumulative incidence rates at t3 were 54.3% for CU and 13.7% for CUD. (2) In cross-sectional and prospective analyses other substance use disorders, mood and anxiety disorders were associated with CU and CUD. (3) Associations of panic-anxiety with CU and of depressive and bipolar disorders with CU and CUD were significant after controlling for externalizing disorders. Conclusion: A range of psychopathological conditions, including depressive, bipolar and less consistently anxiety disorders as well as the degree of their comorbidity are significantly associated with incident CU and progression to CUD, even when controlling for externalising disorders. A better understanding of this complex interplay may result in better aetiological models and intervention strategies.

La schizophrénie est une maladie complexe et a une prévalence approximative de 1% dans la population générale. Au sein des paradigmes neurochimiques, la théorie étiologique de la dopamine est celle qui prévaut alors que sont de plus en plus impliqués d’autres circuits de neurotransmission comme celui du glutamate. En clinique, les patients atteints de schizophrénie ont une grande propension à consommer des substances, particulièrement du cannabis. Nous avons cherché à étayer l’hypothèse d’un désordre du système cannabinoïde endogène, un important neuromodulateur. Ce mémoire propose d’abord dans un premier article une revue exhaustive de la littérature explorant le système endocannabinoïde et ses implications dans la schizophrénie. Puis, nous exposons dans un second article les résultats d’une recherche clinique sur les endocannabinoïdes plasmatiques dans trois groupes de sujets avec schizophrénie et/ou toxicomanie, pendant 12 semaines. Nous avons observé un effet miroir de deux ligands endocannabinoïdes, l’anandamide et l’oleylethanolamide, qui étaient élevés chez les patients avec double diagnostic et abaissés chez les toxicomanes, au début de l’étude. Au terme de l’étude, l’élévation des endocannabinoïdes s’est maintenue et nous avons supposé un marqueur de vulnérabilité psychotique dans un contexte de consommation. Finalement, nous avons analysé les résultats en les intégrant aux connaissances moléculaires et pharmacologiques ainsi qu’aux théories neurochimiques et inflammatoires déjà développées dans la schizophrénie. Nous avons aussi tenu compte des principales comorbidités observées en clinique: la toxicomanie et les troubles métaboliques. Cela nous a permis de proposer un modèle cannabinoïde de la schizophrénie et conséquemment des perspectives de recherche et de traitement. / Schizophrenia is a complex disease that has 1% worldwide prevalence. Dopamine etiological theory leads neurochemical paradigms although glutamate hypothesis is gaining in importance among several neurotransmission circuits involved. Schizophrenia patients are more prone to substance use disorders, particularly to cannabis dependence, than the general population. Therefore, we have aimed to explain the hypothesis of a deregulation in the endogenous cannabinoid system, a very important neurodulator.  First, this thesis proposes in the first article an exhaustive literature review on the endocannabinoid system and its implications in schizophrenia. Then, we present results from our clinical research on plasmatic endocannabinoids in three groups of subjects with schizophrenia and/or substance use disorders, during twelve weeks. We have observed a mirror effect involving two endocannabinoid ligands, anandamide and oleylethanolamide, which were elevated in patients with dual diagnosis and reduced in patients with only substance use disorders. At the end of the study, it seems that endocannabinoid elevation was maintained and we supposed a vulnerability to psychosis in a substance use disorder context.   Finally, we analyzed our results by integrating explanations from molecular biology and neuropharmacology and also from neurochemical and inflammatory theories already well-known in schizophrenia. We also considered the main comorbidities observed in clinic such as substance use and metabolic disorders. Then, we proposed an endogenous cannabinoid model of schizophrenia. Ultimately, this thesis suggested research perspectives and potential treatments.

Bakgrund: Personer som brukar droger är en särskilt utsatt patientgrupp inom hälso- och sjukvården, bland annat på grund av stigmatisering och dåligt bemötande. Ett dåligt bemötande kan ge negativa konsekvenser för patientens behandling. Syfte: Att utforska faktorer som påverkar hur patienter med substansbrukssyndrom upplever bemötandet av hälso- och sjukvårdspersonal. Metod: Litteraturstudie med kvalitativa originalartiklar. Vid litteratursökning användes PubMed, PsycInfo, Scopus, ScienceDirect och CINAHL. Resultat: Ett personcentrerat förhållningssätt ger patienter en god upplevelse av bemötande, stigmatisering samt en brist på formell kompetens hos hälso- och sjukvårdspersonal ger en sämre upplevelse av bemötande. Slutsats: De faktorer som påverkar upplevelsen av bemötande är hur väl ett personcentrerat förhållningssätt utövades, om det förekommer stigmatiserande attityder och beteenden, samt sjuksköterskors formella kompetens inom substansbrukssyndrom. Personer med substansbrukssyndrom kan uppleva att hälso- och sjukvårdspersonals bemötande påverkar deras benägenhet att söka vård. Förbättring och utökning av utbildning inom substansbrukssyndrom och bemötande bör prioriteras inom hälso- och sjukvårdsutbildningar. / Introduction: People who use drugs are particularly vulnerable patients within health care, due to stigmatization and poor attitudes from healthcare professionals. Poor treatment can cause negative consequences for the patient’s overall health. Aim: To explore factors affecting how patients with substance use disorder experience treatment from healthcare professionals. Method: Literature review of qualitative studies. Data is collected from databases PubMed, PsycInfo, Scopus, ScienceDirect and CINAHL. Result: A person centered approach has a positive effect on the experience of treatment. Stigmatization and lack of formal competence are factors contributing to a negative experience of treatment from healthcare professionals. Conclusion: The factors contributing to the experience of treatment from healthcare professionals are if person centered care is applied, if stigmatizing behaviors and attitudes are present, and the formal nursing education levels related to substance use disorders. Individuals with substance use disorders may experience that treatment received by healthcare professionals affect their decision to seek care. Improvement and extension of nurse’s education related to substance use disorder and treatment within health care should be a priority.

According to the regulations contained in the Social Services Act (SFS 2001:453), Swedish social services have a legal responsibility to provide support, care, and treatment for individuals with substance use problems.  This law mandate those who are responsible to provide treatment to motivate drug users to actively seek treatment on a voluntary basis, ensuring an end to their dependence on drugs. Studies have shown that although the treatment system largely focuses on promoting abstinence, about two-thirds of client’s relapse into substance use within one year after completing treatment. This dissertation focuses broadly on clients who repeatedly enter and use treatment for substance use disorders in the Swedish addiction treatment system. The aim of this thesis is to examine and identify the population groups who are repeated treatment users of the Swedish treatment system for substance use disorder, including both the voluntary treatment and compulsory care. This thesis was based on three national level databases. The results showed that clients with a higher degree of problems and problems in different areas of life also had an increased risk of having treatment for substance use disorder repeatedly. Clients who were older, men, reported more years of polydrug and alcohol use to intoxication, reported more compulsory care episodes for substance use, had ever been charged with crime, had ever been in inpatient mental health treatment, and had a higher ASI mental health symptom composite score, were significantly more likely to report more voluntary addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and drugs. Individuals who experienced prior compulsory care including mandatory treatment through LVU (law (1990:52)), been in prison, and had children mandated to out-of-home care, were more likely to have two or more entries in the compulsory care system for substance use disorder. In addition, this analysis showed that 59% of clients mandated to compulsory care dropped-out during their compulsory care episode, and that younger clients were significantly more likely to drop-out. Those who drop-out were significantly more likely to experience negative outcomes, i.e. additional sentence to compulsory care and higher risk of mortality.  A hierarchal logistic regression model also identified that individuals with riskier childhood conditions were more likely to have had repeated entries to compulsory care for substance use disorder. The indirect effects showed that a family history of substance use disorder and psychiatric problems are both associated with higher probability of institutional care as a child i.e. LVU, and that in turn, mandated childhood institutional care is related to repeated compulsory care intakes as an adult. Individuals who use treatment for substance use disorder repeatedly have a higher degree of problems i.e. an exposed and problematic group of individuals characterized by problem in several different areas of life. Growing up in a home environment with unfavorable conditions, mandated care before the age of 18 (LVU), compulsory care for substance use disorder as an adult, children taken into out-of-home care, and crime are the factors that are primarily associated with repeated treatment for substance use. A change in the view of treatment for clients in need of repeated use of treatment seems important, and access to adapted continuous care efforts are crucial to counteract the risk of relapse after a treatment episode of voluntary or compulsory care. Further, it seems important to motivate the client to complete the compulsory care without any deviation, since this seems to have positive effects on their substance use disorder.

Dr. Robert Pack is Professor of Community and Behavioral Health, Associate Dean for Academic Affairs in the College of Public Health at East Tennessee State University, and Director of the new ETSU Center for Prescription Drug Abuse Prevention and Treatment. The Center grew out of a university and community collaborative that was started in 2012 to address the regional problem of prescription opioid abuse. At least five funded projects and dozens of other academic products have grown out of the Working Group. Dr. Pack is currently PI of the NIH/NIDA-funded Diversity Promoting Institutions Drug Abuse Research Program at ETSU, the research component of which is the five-year set of three studies titled Inter-professional Communication to Prevent Prescription Drug Abuse and Misuse. He was trained in health education/health promotion at the UAB Royals School of Public Health and is experienced in designing, running and disseminating theory-based intervention studies. In 2014, he was trained at the NIH-funded Training Institute for Dissemination and Implementation Research in Health (TIDIRH, Boston, 2014).

Det finns flera kopplingar mellan försämrad hälsa och missbruk åt båda hållen. Personer med missbruksproblematik är en särskilt utsatt grupp på flera sätt för Covid-19. Hur pandemin påverkat dessa människor i Sverige är en lucka som behöver fyllas. Syftet med denna studie är att beskriva hur missbruksbehandlare uppfattar att samhällsläget under Covid-19 pandemin påverkat behandling och förekomst av missbruk. Studien behandlar substansmissbruk gällande alkohol- och/eller narkotika. Denna studie bygger på tematisk analys utifrån fem enskilda kvalitativa intervjuer med arbetsverksamma behandlare inom öppenvårds- och slutenvårdsbehandling för missbruksproblem. Intervjuerna var semistrukturerade och studiens resultat analyserades tematiskt med hjälp av sociokognitiv teori. Studiens resultat talar för att det skett förändringar i relationer, psykisk hälsa, arbetsmiljö och förekomst av missbruk. Den ökande psykiska ohälsan kopplad till restriktioner för att minska smittspridningen av Covid- 19 med minskade sociala kontakter och ändrade vanor som följd ökar risken för att hamna i eller för att återfalla i missbruk. Restriktioner och ändrade arbetsformer har påverkat missbruksbehandlingen negativt. / There are multiple correlations between reduction in health and substance use disorder in both directions. People suffering from substance use disorder are an especially vulnerable group in many regards to Covid-19. How the pandemic has affected these persons in Sweden is a gap that needs to be filled. The purpose of this study is to describe how addiction counsellors perceive that the state of society during the Covid-19 pandemic has impacted the therapy and prevalence of substance abuse. This study deals with substance abuse of alcohol and/or drugs. This study is founded on a thematic analysis from five individual qualitative interviews with addiction counsellors, working in either in- or outpatient care mental and behavioural disorders due to psychoactive substance use. The interviews were semi-structured, and the results were scrutinized through thematic analysis with a social cognitive theory lens. The results point towards changes in both private and professional relations, mental health, the work environment, and an increased prevalence of substance abuse. Decreased mental health related to restrictions to decrease the spread of Covid-19 with changes in habits and less social contacts increases the risk of starting or relapsing a substance abuse. Restrictions and change in work conditions has had a negative impact on substance abuse treatment.

Bakgrund   Personer som har problem orsakade av användandet av opioider kan påträffas inom vården i direkt koppling till deras användande av substansen eller vid uppsökande av vård av andra anledningar. Som sjuksköterska finns möjligheten att identifiera ett beroende eller riskbruk och stötta personen till en förändring i livsstilen eller till egenvård (Skärsäter & Wiklund, 2019). Genom att ge omvårdnad på den egna individens villkor respekteras individens värdighet och integritet vilket är avgörande för individens uppfattning av bemötandet (Svensk Sjuksköterskeförening, 2016).   Syfte   Syftet var att beskriva hur personer som använder opioider upplever mötet med hälso- och sjukvårdspersonal.   Metod   En icke-systematiskt litteraturöversikt utfördes och baserades på 17 vetenskapliga artiklar av kvalitativ design. Artiklarna eftersöktes i databaserna CINAHL och PubMed med hjälp av lämpliga sökord samt så genomfördes även en manuell sökning. Kvalitén på artiklarna granskades utefter Sophiahemmet Högskolas bedömningsunderlag och vidare användes en integrerad analys vilket resulterade i tre huvudkategorier och sex subkategorier.   Resultat  Resultatet bestod av tre huvudkategorier och sex subkategorier. Huvudkategorierna var Patienters upplevelser av vårdpersonalens kompetens, Patienters upplevelser av vårdpersonalens attityder och Patienters upplevelser av samarbetet med vårdpersonal. Subkategorierna var kunskap, kommunikation, stigmatisering, tillit, delaktighet och relationen mellan vårdpersonal och patient. Resultatet visade att majoriteten av patienter upplevt stigmatisering relaterat till deras bruk av opioider. Patienter upplevde även att de inte var delaktiga i sin vård samt förbisedda i sin behandling.   Slutsats  Resultatet från litteraturöversikten påvisade upplevd stigmatisering kring patienter som använder opioider. En stor del av stigmatiseringen kring patientgruppen grundade sig i okunskap hos hälso- och sjukvårdspersonal om “substance use disorder” (SUD). Ett starkt samband mellan vårdpersonalens kunskap om SUD och deras attityder till dessa personer uppmärksammades och det är därför viktigt att kunskapen hos vårdpersonalen ökar när det kommer till denna patientgrupp. Vidare har vårdpersonalens okunskap och stigmatiseringen kring SUD bidragit till att patienter inte tillåtits vara delaktiga i sin egen vård. / Background  People with problems caused by the use of opioids may be found in healthcare, either directly related to their use of the substance or when outreaching for other reasons. As a nurse, you have the opportunity to identify an addiction or risk use, and support the person to a change in lifestyle or to self-care (Skärsäter & Wiklund, 2019). By providing care on the individual's terms, the dignity and integrity of the individual are respected, which is crucial to the individual's perception of the treatment (Svensk Sjuksköterskeförening, 2016).   Aim  The aim was to describe how people who use opioids experience the encounter with health care professionals  Method  A non-systematic literature review was performed and based on 17 scientific articles of qualitative design. The articles were searched in the CINAHL and PubMed databases using the applicable keywords. A manual search was performed. Subsequently, the quality of the articles was examined according to Sophiahemmet University's assessment data and an integrated analysis was further used, resulting in three main categories and six subcategories.   Results  The result consisted of three main categories and six subcategories. The main categories were: Patients’ experiences of Healthcare Professionals competence, Patients’ experiences of Healthcare Professionals’ attitudes and Patients’ experiences of collaboration with Healthcare Professionals. The subcategories were knowledge, communication, stigma, trust, participation and the relationship between healthcare professionals and patients. The results showed that the majority of patients experienced stigma related to their use of opioids.   Conclusions  The results of the literature review show perceived stigma around patients using opioids. Much of the stigma surrounding the patient group has been based on ignorance among health professionals about substance use disorder (SUD). A strong link between healthcare professionals' knowledge of SUD and their attitudes towards these people was recognised and it is therefore important that the knowledge of healthcare professionals increases when it comes to this patient group. Furthermore, the ignorance of healthcare professionals and the stigma surrounding SUD have contributed to patients not being allowed to participate in their own care.

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