Bakgrund: Substansbrukssyndrom är ett allvarligt tillstånd hos en person där det sker en okontrollerad användning av en eller flera substanser. Sjuksköterskor träffar patienter med substansbrukssyndrom i olika situationer och omständigheter inom vården. Sjuksköterskorna har huvudansvaret över omvårdnaden och ska sträva efter att ge optimal vård till alla människor oavsett bakgrund. Resultatet av litteraturöversikten kommer att diskuteras utifrån omvårdnadsteorin omvårdnadens mellanmänskliga aspekter utformad av Travelbee. Syfte: Att sammanställa den senaste forskningsbaserade kunskapen om sjuksköterskors erfarenheter och attityder till patienter med substansbrukssyndrom. Metod: Litteraturöversikt med inslag av en metodologi som används vid systematiska översikter av totalt 16 artiklar av kvalitativ- (n=11), kvantitativ- (n=2) och mixad design (n=3). Resultat: Resultatet har blivit uppdelat i två huvudkategorier och två underkategorier till varje huvudkategori. Den första huvudkategorin är “Professionskompetens är otillräcklig” med dess två underkategorier “Brist på utbildning och kunskap” och “Arbetserfarenhet och livssituation påverkar attityder till patienter”. Denna del fångar upp hur sjuksköterskors attityder påverkas av sjuksköterskornas personliga kompetenser som sjuksköterskorna får genom arbete eller utbildning. Andra huvudkategorin “Attityder påverkar omvårdnadsarbete” och dess underkategorier “Patientmöte bidrar till relationen”och "Varierande känslor och förhållningssätt inför sjukdomen". Denna huvudkategori fångar upp hur sjuksköterskornas attityder påverkas och påverkar det dagliga omvårdnadsarbetet med patienter med substansbrukssyndrom. Slutsats: Sjuksköterskor har delade erfarenheter och attityder till patienter med substansbrukssyndrom. När sjuksköterska-patientrelationen inte är välutvecklad kan det förenas med negativa attityder och tidigare negativa erfarenheter hos sjuksköterskorna. De negativa attityderna hos sjuksköterskorna kan bero på en kunskapsbrist på grund av bristande utbildning inom substansbrukssyndrom. / Background: Substance use disorder is a serious condition for the person where there is uncontrolled use of one or more substances. Nurses meet patients with substance use disorder in different situations and circumstances in health care. The nurse has the main responsibility for nursing and must strive to provide optimal care to all people regardless of background. The results of the literature review will be discussed based on the humanto-human theory designed by Travelbee. Aim: To compile the latest research-based knowledge about nurses' experience and attitudes towards patients with substance use disorder. Method: Literature review with elements of a methodology used in systematic reviews, a total of 16 articles with a qualitative- (n=11), quantitative- (n=2) and mixed methods (n=3). Results: The result has been divided into two main categories and two subcategories for each main category. The first main category is "Professional competence is insufficient" with its two subcategories "Lack of education and knowledge" and "Work experience andlife situation influence attitudes towards patients". This part captures how the nurse's attitudes are influenced by the nurse's personal competence that she acquires through work or education. Second main category “Attitudes affect nursing work” and its subcategories “Patient meeting contributes to relationship” and “Varying feelings and attitudes towards the disease”. This main category captures how the nurse's attitudes are affected and influence the daily nursing work with patients with substance use syndrome. Conclusions: Nurses have shared experiences and attitudes towards patients with substance use disorder. When the nurse-patient relationship is not well developed it can be linked to negative attitudes and previous negative experiences at the nurse. The negative attitudes of the nurses are due to lack of knowledge duo to a lack of training in substance use syndromes.

This single-session feasibility trial aimed to examine the effects of Directed-Imaginal Music Psychotherapy (DIMP) on self-awareness in relation to change in adults being treated for substance use disorder. DIMP is a two-part protocol. The first part is a live music, receptive intervention in which a trained music therapist plays a specified harmony sequence on guitar accompanied by verbal guidance to promote imagery and sensory experiences in participants. The verbal guidance is based on participant-defined “Comforts” in each of their five primary senses. The music and imagery component was followed by group verbal processing to discuss physical, emotional, or cognitive changes participant’s experience and gauge an understanding of insights into treatment gained by the participants. Participants completed the Self-Awareness Outcomes Questionnaire (SAOQ; Sutton, 2016) before and after the intervention to measure possible change in self-awareness in relation to change in their recovery. The Wilcoxon signed rank test indicated statically significant improvements in self-awareness scores from 3.37 pre-test to 3.77 post-test. Fieldnotes and transcripts from audio recordings were also used in thematic analysis. Deductive themes of Insight, Mindfulness, Reflection, and Rumination were taken from Sutton’s (2016) SAOQ study. Inductive themes of Disconnection/Connection, Safety & Comfort, Independence/Isolation, and Goal Orientation emerged from the qualitative data. Feasibility for implementation was considered through the lenses of adoption, reach fidelity, and sustainability (Pearson et al., 2020). The study found that DIMP is feasible for implementation (Bowen et al., 2009). Considerations for future research and clinical practice were identified. / Music Therapy

The primary purpose of this study is to determine the occurrence of drug therapy adjustment in people with substance use disorder receiving medication-assisted treatment when admitted to an acute care facility for a comorbid condition. The secondary purpose is to understand the correlation between the presence of adjustment of therapy for substance use disorder and influence on recovery from comorbid conditions. A literature review exploring drug therapy for addicted individuals during hospitalization was performed using various databases, search terms included *substance use disorder or *substance abuse or *illicit drug use or *drug abuse or *MAT or *maintenance therapy, combined with *inpatient or *hospital or *acute care or *admission. The data was conformed into tables that synthesized the relationship between drug therapy adjustment for individuals with substance use disorder during an acute care admission. Initial review of the articles revealed 78 articles relative to the topic, 16 of those articles met inclusion criteria and were selected for a detailed analysis. Studies suggest the need for provider education and guidelines for treating individuals receiving MAT in an acute care facility. While individuals with substance use disorder often use acute care services, their medication-assisted treatment is rarely acknowledged or adjusted. Many studies focus on individuals with substance use disorder, yet, addressing medication-assisted therapy is still inconsistent, and lacks official guidelines.

Drug use is considered in many countries the plague of today's society. Researchers from medical, psychological and sociological fields, as well as lawmakers, are interested in finding more answers to this widespread phenomenon. All over the world there are known conflicts related to drug producing, transportation routes and distribution, that harm the economy and social standing of the involved communities or countries. Policies towards drug use vary from country to country, but this research focuses on how stigma affects the lives of individuals suffering from substance use disorder (SUD) in Albania. Substance use disorder is not often considered a disease, and more often individuals suffering from this disorder are stigmatized and not given the right care from their families, societies, or healthcare providers. Drug usage in Albania is closely linked to the country's geopolitics and its communism and dictatorship past history. This phenomenon has influenced the Albanian societal perceptions. Even though Albania became a democratic country in the 1990s, there are still old mentalities to be changed, with social stigma towards drugs being one of them. The purpose of this pilot research is to understand the connection between social stigma and the treatment that individuals with substance use disorder receive from their families, society, and medical institutions. This pilot study was based on interviews conducted in a small sampling of 18 individuals. The qualitative information collected through interviews falls into four categories: Medical professionals and psychologists, family members or people who have loved ones with substance use disorder, current users of cocaine or synthetic drugs who are in denial regarding their addiction and everything it entails, and heroin users currently in treatment programs. There are also different types of stigma associated with different types of drugs. These types of stigma are herein categorized based on the collected information which supports the premise of how social stigma affects these individuals' lives. This study is the first known research for this subject matter in the country of Albania, therefore, it intends to open the path for further research that is inclusive of more groups/individuals.

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Comorbid PTSD+SUD confers heightened risk of other mental health concerns, suicidality, mortality, and functional impairment. Current treatments for comorbid PTSD+SUD show inconsistent results, highlighting the need for a more comprehensive understanding of the associations between PTSD and SUD symptoms. The current dissertation aimed to characterize the associations between PTSD and SUD using structural equation modelling among three different samples with differing clinical severity and presentation: (1) concurrent disorders sample with a high prevalence of PTSD; (2) an in-patient sample seeking treatment for PTSD; and (3) a subclinical sample of healthcare workers and public safety personnel. Data were extracted from multiple clinical databases across different studies to evaluate the associations between PTSD symptoms and alcohol/cannabis/substance use-related problems. Furthermore, the role of underlying mechanisms such as dissociation and emotion dysregulation, which are associated with both PTSD and SUD, were analyzed. All analyses used a structural equation modelling framework to represent the complex clinical presentation of comorbid PTSD+SUD analytically. A relatively consistent pattern of results was observed across the three samples. Global PTSD symptoms were significantly associated with cannabis-related problems, alcohol-related problems, and other illicit substance-related problems. Among PTSD symptoms, the reactivity symptom cluster (characterized by symptoms of hypervigilance, irritability, reckless behaviour, problems with concentration and sleep disturbances) was significantly associated with alcohol/cannabis/substance-related v problems across among the three samples. Furthermore, underlying mechanisms such as dissociation and emotion dysregulation significantly mediated the relations between PTSD symptoms and alcohol/cannabis/substance-related problems. Overall, the current results contribute to the limited literature examining the associations between PTSD and SUD symptoms. Lastly, the current results have important clinical implications for identifying efficacious treatment targets for comorbid PTSD+SUD. / Dissertation / Doctor of Philosophy (PhD) / Psychological distress following a traumatic event, known as traumatic stress, is often associated with problematic alcohol and/or substance use. The co-occurrence of these two confers a heightened risk of other mental health problems. As such, studying how these phenomena are associated with one another and what about each thing is more important to the association is important to understand. The purpose was to examine the connection between these phenomena among three different groups of people: two treatment-seeking groups and non-treatment seeking group one group. Traumatic stress was associated with problematic substance use in all three groups. In addition, other factors like mentally escaping from your body and having difficulties with regulating your emotions explained how traumatic stress and problematic substance use were connected to each other. These findings can help clinicians hone their treatment programs to better help individuals struggling with traumatic stress and problematic substance use.

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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