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Sammanfattning Syftet med denna studie var att syntetisera vuxna personers erfarenheter av dagliga aktiviteter under tillfrisknande från beroendesjukdom. Metoden var en systematisk litteraturöversikt av kvalitativa forskningsstudier, där sökning i CINAHL, PubMed, Scopus samt Web of Science resulterade i 11 artiklar som granskades och därefter analyserades genom tematisk analys. Resultatet bestod av två tolkande teman; ”Tillfrisknandeprocessen innebär utmaningar ochförluster i de dagliga aktiviteterna, som kan hindra engagemang och leda till återinsjuknande” och ”Dagliga aktiviteter fyller en både stödjande och utvecklande funktion i ett tillfrisknande, där både aktivitetsmönster och engagemang förändras över tid” samt fem beskrivande teman. Konklusion: Det finns flera hinder för aktivitetsengagemang under tillfrisknandet. Svårigheter att hantera vardagen samt avsaknad av meningsfulla aktiviteter riskerar att resultera i försämrad hälsa och återfall. De dagliga aktiviteterna har stor betydelse för tillfrisknande från beroendesjukdom genom att ge struktur, nya sammanhang, mål och meningsfullhet. Vidare forskning rekommenderas för att undersöka erfarenheterna i en svensk kontext ochutifrån resultatet föreslås även att befintliga arbetsterapeutiska gruppinterventioners användbarhet och effekt provas för aktuell målgrupp. / Abstract The aim for this study was to synthesize adults´ experiences of daily activities during recovery from substance use disorder. Method: A systematic literature review was conducted, where a search in CINAHL, PubMed, Scopus and Web of Science resulted in 11 articles that were reviewed and analyzed through thematic analysis. Result consisted of two interpretive themes: “The recovery process involves challenges and losses in daily activities, which can hinder engagement and lead to relapse” and “Daily activities have both a supporting and developing function in recovery, where activity patterns and engagement changes over time” and five descriptive themes. Conclusion: There are several barriers to activity engagement during recovery. Difficulties in managing everyday life as well as a lack of meaningful activities risk resulting in poorer health and relapse. The daily activities are of great importance for recovery from addiction disease by providing structure, new contexts, goals and meaningfulness. Further research is recommended to examine experiences in a Swedish context and based on the results it is also suggested that existing occupational therapy group interventions are tested and developed to fit the needs of people with addiction disease.

Bakgrund Cirka fem procent av alla gravida kvinnor i världen konsumerar en eller flera beroendeframkallande substanser idag. Ett växande bekymmer är den snabba ökningen av opioidmissbruk under graviditet, vilket inte bara har en negativ inverkan på kvinnan utan även kan leda till olika skador på fostret. Individer med substansbrukssyndrom upplever frekvent stigmatisering relaterat till sitt beroende. Kvinnor representerar omkring 30 procent av alla personer som erhåller vård för narkotikarelaterade problem i Sverige, och dödsfallen bland dessa kvinnor ökar betydligt. Personcentrerad vård skall utgå från att se personen bakom diagnosen eller sjukdomen och erbjuda ett empatiskt förhållningssätt. Trots detta utgör den otillräckliga vården ett hinder för kvinnor med substansmissbruk under graviditet. Syfte Beskriva hur gravida kvinnor med substansbrukssyndrom upplever mötet med vården. Metod Detta arbete är en icke-systematisk litteraturöversikt med tio vetenskapliga originalartiklar, som genom en integrerad dataanalys presenteras i resultatet. Databaserna PubMed och CINAHL användes för att få fram artiklar kopplade till det valda ämnet. Klassificering och kvalitetsbedömning gjordes med hjälp av Sophiahemmet Högskolas modifierade bedömningsunderlag. Resultat Resultatet har sammanställts i fem huvudkategorier: Upplevelser av bemötande, Upplevelser av stigmatisering, Upplevelser av behandling, Att söka vård och Identifierade behov: Kunskap och kommunikation. Resultatet påvisar att gravida kvinnor med substansbrukssyndrom upplever att mötet med vården präglas av stigmatisering, otillräcklig behandling och kunskapsbrist. Slutsats Denna litteraturöversikt belyser hur gravida kvinnor med substansbrukssyndrom upplever mötet med vården. Resultatet indikerar att mötet mellan dessa gravida kvinnor och vården ofta är präglat av stigmatisering och diskriminering på grund av deras aktiva bruk av substanser. Många erhåller otillräcklig smärtlindring under förlossning. Resultatet belyser även behovet av ökad kunskap och förbättrad kommunikation inom hälso- och sjukvården. Positiva upplevelser var inte enbart relaterade till vårdpersonalens specialisering, utan snarare till närvarande och fördomsfria vårdgivare som ingav känslan av trygghet. / Background  Approximately five percent of all pregnant women worldwide are currently consuming one or more addictive substances. A growing concern is the rapid increase in opioid abuse during pregnancies, which not only negatively affects the woman but can also lead to various harms to the fetus. Individuals with substance use disorder often experience stigmatization related to their addiction even in the context of healthcare visits. Women constitute about 30 percent of all individuals receiving care for drug-related problems in Sweden, and fatalities among these women are increasing significantly. Person-centered care should recognize the person behind the diagnosis or illness and offer an empathetic approach. Despite this, the inadequate care becomes a barrier for women with substance use during pregnancy.  Aim To describe how pregnant women with substance use disorder experience encounters with healthcare.  Method  This is a non-systematic literature review with ten scientific original articles, which were selected and presented in the results, through an integrated data analysis. The databases PubMed and CINAHL were used to retrieve articles related to the chosen topic. Classification and quality assessment were performed using Sophiahemmet University’s modified assessment criteria model.  Results  The results obtained after the analysis of the ten scientific articles have been compiled into five main categories: Experiences of reception, Experiences of stigmatization, Experiences of treatment, Seeking care, and Identified needs: Knowledge and communication. The results indicate that pregnant women with substance use disorders perceive encounters with healthcare characterized by stigmatization, inadequate treatment and lack of knowledge.  Conclusions  This literature review emphasizes how pregnant women with substance use disorders experience encounters with healthcare. The results indicate that the interaction between these pregnant women and healthcare is often characterized by stigma and discrimination due to their active substance use. A significant number of these women do not receive sufficient pain relief during childbirth. The findings underscore the necessity for increased knowledge and improved communication within healthcare. Positive experiences were not solely related to the specialization of healthcare professionals but rather to the presence of a nonjudgmental healthcare provider who instilled a sense of security.

Stigmatization remains a significant barrier to the initiation and maintenance of treatment in patients with substance use disorders, with higher levels of stigma being associated with lower levels of treatment initiation and adherence. While societal stigma is frequently discussed, less discussed are the inherent biases expressed by healthcare providers. Healthcare providers often hold comparable or even higher levels of stigma against patients with substance use disorders compared to the general population, and this can have quite a significant impact on patient care. From improper treatment decisions stemming from fear and stigmatization of the medications used for opioid use disorders, to the development of mistrust and poor/worsening self-esteem secondary to poor patient-provider interactions. The effects of stigma on the substance use disorder patient cannot be understated and must be alleviated in the coming years to ensure that patients with SUDs receive the high-quality treatment that they deserve. Several interventions have been validated to help reduce stigma within healthcare providers, subsequently improving treatment outcomes. Words matter. Patient-first language is crucial; verbiage can strongly impact how not only the provider sees the patient, but how the patient views themselves (and as we know, poor self-esteem also hinders treatment outcomes). Education and normalization of SUD medications should be done at the healthcare provider level to ensure that all providers are comfortable with these medications. As higher frequency of interactions with substance use disorders has been shown to reduce levels of stigma seen within healthcare providers, it’s also crucial that trainees receive adequate exposure to this patient population. While these suggestions may take time to show effect, it’s imperative that we get the ball rolling on training future generations of healthcare providers that do not hold inherent biases and who will provide high-quality, care utilizing validated treatments. / Urban Bioethics

Intimate partner violence (IPV), substance use, and HIV are syndemic and have compounding risks that contribute to the collective physical and mental health burden among women in the United States. These syndemic factors may contribute to the significant gender-related disparities in substance use disorder (SUD) treatment. IPV is a source of stress and trauma for women, with known interactions with SUD; however, SUD services generally lack trauma-informed treatment modalities to address IPV-related health impacts. The goal of this dissertation was to improve the understanding of the associations between IPV, substance use behaviors, and SUD treatment utilization, and to inform the response to women’s needs related to IPV experiences and substance use within healthcare settings. We employed a mixed-methods approach to understand the interplay of IPV with subsequent substance use behaviors and utilization of SUD services, along with identifying differences by HIV status. We used quantitative methods to evaluate the association of specific forms of IPV (psychological, physical, and sexual) with subsequent substance use (Chapter 2) and SUD service utilization (Chapter 3), and qualitative methods to explore women’s perspectives on how IPV experiences influenced their substance use behaviors and SUD treatment and recovery (Chapter 4). The study in Chapter 2 found that incident IPV experiences were associated with increased risk of subsequent substance use, with physical IPV being more consistently associated than other IPV forms. The study in Chapter 3 found recent IPV experiences to be associated with increased SUD service utilization, whereas lifetime IPV experiences were associated with decreased utilization. Both quantitative studies highlight the complex relationship between IPV and substance use and SUD service utilization. This relationship varies by IPV form, with the syndemic interaction of IPV and HIV exacerbating adverse outcomes. In Chapter 4, qualitative findings explained mechanisms of IPV’s contribution to substance use behaviors and impediment of SUD service engagement and recovery. The interviews also highlighted the value of mental health and IPV supportive services, along with SUD treatment, for a successful SUD recovery. Overall, the findings of this dissertation emphasize the importance of using a trauma-informed approach to address IPV to facilitate women’s SUD recovery. / 2026-05-16T00:00:00Z

Bakgrund: Sjuksköterskor som vårdar patienter med en beroendediagnos upplever att det är en balansgång mellan frustration och förståelse över patientens situation. Sjuksköterskor upplever även att de behövde en ökad förståelse för sina egna reaktioner. Syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av att vårda personer med beroendediagnos inom specialiserad beroendevård. Metod: En kvalitativ studie där nio sjuksköterskor intervjuades under december 2015 och januari 2016. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Det framkommer två huvudkategorier i denna studie, relationen mellan sjuksköterskan och patienten samt rollen som sjuksköterska. Deltagarna i studien berättar om att en individanpassad vård är det bästa för patienten. Det framkommer att drogen enbart är en del av patientens problem och att dessa patienter blir felbehandlade i icke specialiserad beroendevård. De tar även upp att det pågår en ständig diskussion kring mediciner samt att det finns en maktutövning inom vården. Deltagarna i studien berättar även om hot och våld samt påfrestningar. Deltagarna framhåller att det är viktigt att vara trygg i sin profession samt att kunna samarbeta med andra Slutsats: En individanpassas vård ger bäst resultat av den omvårdnad som ges. En annan slutsats är att tydliga rutiner och riktlinjer gör att man känner sig trygg i sitt arbete. Vidare slutsatser är att det skulle vara av intresse att forska vidare på samma frågeställning men ur ett genusperspektiv. / Background: Earlier studies regarding nurses experiences shows that nurses fell that there is a balance between frustration and understanding of the patient's situation when they care for patients whit a substance use disorder. Nurses also experience that they needed a better understanding regarding their own reactions. Aim: The aim of this study was to describe nurses' experiences when caring of persons with a substance use disorders in specialized addiction care units. Method: A qualitative study was performed during December 2015 and January 2016, nine nurses were interviewed. The interviews were subjected to qualitative content analysis. Results: Two main categories appeared in this study, the relationship between the nurse and the patient, as well as the role of the nurse. Participants in the study tells us that individualized care is the best for the patient. It appears that the drug is only a part of the patient's problem, and that these patients are mistreated in nonspecialized care. The participants also talk about the fact that there is a continual discussion of medications between the patient and the nurse. It further shows that the power over the care is divided. Participants in this study also mentions threats, violence and stress. Participants emphasize that it is important to be confident in their own profession and to be able to cooperate with others. Conclusion: An individualized care gives the best results for the patient. It is important that the nurse is confident in their professional capacity and has support from their colleagues. Another conclusion is that guidelines makes the nurse feel safer during work. Further conclusions are that it would be of interest to further research in the same issue but from a gender perspective.

Background: When a person has a pattern of psychoactive substance and/or alcohol use that is causing damage to health family members are affected. The quality of life of parents, siblings, children, partners and other relatives may be severely impaired. When young adults transition from child/youth to adult care it involves changes for the patients as well as for relatives. To be able to support relatives, deeper knowledge is needed about the way nurses perceive the situation of relatives. Aim: The aim is to investigate how nurses perceive the situation for relatives when a person is being treated in addiction care, as well as the consequences for relatives when patients are being transferred from children/youth care to adult care.  Method: This is a qualitative study with an inductive approach. Eight semi-structured interviews have been carried out with nurses working within addiction care. The collected data was analysed according to qualitative content analysis. Result: Data analysis resulted in the formulation of two categories, with two sub-categories in each. The first category describes relatives’ situation at transition from child/youth care to adult care with two sub-categories are lack of transparency and changed life situation. The second category describes relatives’ situation with constant worry when having a relative with pattern of psychoactive substance and/or alcohol use. This category formulated with sub-categories psychological burden and social burden. Discussions: The result is discussed in relation to Afaf Ibrahim Meleis’ transition theory and other relevant research. Transition theory provides support for changed life situation of relatives within addiction care, which may be important to know in order to develop nursing care. / Bakgrund: I samband med att en person har ett skadligt bruk av alkohol eller droger påverkas anhöriga. Livskvaliteten kan försämras allvarligt för såväl föräldrar, syskon, barn, partner som andra anhöriga. När unga vuxna byter vårdform och övergår till vuxenlivet sker förändringar för patienten men även deras anhöriga. För att stödja anhöriga till närstående som har ett skadligt bruk av alkohol eller droger behövs fördjupade kunskaper om hur sjuksköterskor uppfattar anhörigas situation. Syfte: Syftet är att undersöka hur sjuksköterskor beskriver anhörigas situation när närstående vårdas i beroendevården samt vad som händer med anhöriga när närstående övergår från barn och ungdomsvård till vuxenvård. Metod: Studien är en kvalitativ studie med induktiv ansats där semistrukturerade intervjuer genomfördes med åtta sjuksköterskor verksamma inom beroendevården. Det insamlade datamaterialet analyserades enligt kvalitativ innehållsanalys. Resultat: Dataanalysen resulterade i två kategorier med två underkategorier vardera. Den första kategorin är den som beskriver anhörigas situation vid övergång från barn och ungdomsvård till vuxenvård med underkategorier: bristande insyn och förändrad livssituation. Den andra kategorin beskriver anhörigas situation med ständig oro när man har en närstående med skadligt bruk av alkohol eller droger. Denna kategori formuleras i två underkategorier vilka var psykisk merbelastning och social merbelastning. Diskussion: Resultatet diskuteras utifrån Afaf Ibrahim Meleis transitionsteori samt annan relevant forskning. Transitionsteorin ger stöd för den förändrade livssituationen för anhöriga inom beroendevården, vilket kan vara viktigt att känna till för att utveckla omvårdnaden.

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.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-08-08T12:13:43Z No. of bitstreams: 1 Louise Halla Reydams.pdf: 1479930 bytes, checksum: dbeb9959b561b6b01f81682d8d0dd3b9 (MD5) / Made available in DSpace on 2018-08-08T12:13:43Z (GMT). No. of bitstreams: 1 Louise Halla Reydams.pdf: 1479930 bytes, checksum: dbeb9959b561b6b01f81682d8d0dd3b9 (MD5) Previous issue date: 2018-04-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES# / #2075167498588264571# / #600 / Substance use disorder is related to numerous mental and physical health problems, associated with several functional impairments that affect several aspects of the life of the individual with the disorder. The objective of this study was to evaluate the relationship between psychoactive substances and biological rhythm in a community sample of young people. It is a cross-sectional population-based study with adults aged 24 to 30 years living in the urban area of the city of Pelotas, RS. The sample selection was performed by multi-stage conglomerates. Socio-demographic data were collected from the sample and substance abuse or dependence was assessed through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), as well as the biological rhythm was evaluated through the Biological Rhythm Interview of Assessment Neuropsychiatry (BRIAN). A total of 1241 subjects were evaluated. The prevalence of substance use disorders in the sample was as follows: alcohol 14.1% (n=175), tobacco 30.8% (n=382), cannabis 10.5% (n=130), cocaine/crack 8.4% (n=104) and other psychoactive substance use disorder 9.2% (n=114). In the model of linear regression adjustment, alcohol use disorder was able to predict change in sleep/social pattern (p<0.001), activity (p=0.024), eating pattern (p=0.049) and overall rhythm (p<0.001). Other psychoactive substance use disorder was also predictive of changes in the sleep/social pattern (p <0.001), activity (p<0.001), eating pattern (p<0.001) and overall rhythm (p<0.001). Our findings suggest that individuals with alcohol and other psychoactive use disorders presented greater changes in sleep/social patterns, activity and food patterns, as well as greater disruptions in maintaining the overall biological rhythm. / O transtorno por uso de substâncias está relacionado a inúmeros problemas de saúde mental e física, associado a diversos prejuízos funcionais que afetam diversos aspectos da vida do indivíduo portador do transtorno. O objetivo deste estudo foi avaliar a relação entre substâncias psicoativas e ritmo biológico em uma amostra comunitária de jovens. Trata-se de um estudo transversal de base populacional com adultos de 24 a 30 anos de idade residentes da zona urbana da cidade de Pelotas-RS. A seleção amostral foi realizada por conglomerados com múltiplos estágios. Foram coletados dados sócio-demográfico da amostra e o abuso ou dependência de substâncias foi avaliado através do Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), bem como o ritmo biológico foi avaliado através da Biological Rhythm Interview of Assessment Neuropsychiatry (BRIAN). Foram avaliados 1241 sujeitos. As prevalências de transtornos por uso de substâncias na amostra foram as seguintes: álcool 14,1% (n=175), tabaco 30,8% (n=382), cannabis 10,5% (n=130), cocaína/crack 8,4% (n=104) e uso de outra substância psicoativas 9,2% (n=114). No modelo de ajuste por Regressão Linear, transtorno por uso de álcool foi capaz de predizer mudança no padrão de sono/social (p<0,001), atividade (p=0,024), alimentação (p=0,049) e ritmo global (p<0,001). Além disso, o transtorno por uso de outras substâncias psicoativas também foi capaz de predizer mudanças no padrão de sono/social (p<0,001), atividade (p<0,001), alimentação (p<0,001) e ritmo global (p<0,001). Nossos sugerem que os indivíduos com transtorno por uso de álcool e outras substâncias psicoativas apresentaram maiores alterações no padrão de sono/social, na atividade e no padrão alimentar, bem como, apresentaram maiores disrupturas na manutenção do ritmo biológico global.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-06-23T13:33:01Z No. of bitstreams: 1 Jéssica Limberger_.pdf: 820645 bytes, checksum: 3d2e4ab40a254364d4c40b732fa2537c (MD5) / Made available in DSpace on 2016-06-23T13:33:02Z (GMT). No. of bitstreams: 1 Jéssica Limberger_.pdf: 820645 bytes, checksum: 3d2e4ab40a254364d4c40b732fa2537c (MD5) Previous issue date: 2016-01-14 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O uso de crack em mulheres requer a identificação de especificidades, como suas interações sociais. Esta dissertação compõe-se de dois estudos empíricos acerca das habilidades sociais (HS) de mulheres em internação hospitalar pelo uso do crack. O primeiro artigo objetivou descrever os fatores de HS em tais mulheres, identificando associações entre as HS e suas características. Utilizou-se um questionário de dados sociodemográficos, MINI (Mini International Neuropsychiatric Interview), Inventário de Habilidades Sociais, Screening Cognitivo do Wais-III e SCID-II (Structured Clinical Interview for DSM Disorders). Participaram 62 mulheres, sendo identificados déficits na conversação e desenvoltura social; autoexposição a desconhecidos e situações novas e autocontrole da agressividade. A idade apresentou correlação com o escore total, e possuir amigos que usam drogas e o tráfico de drogas associou-se com déficits nas HS. O segundo estudo, qualitativo e de casos múltiplos, objetivou compreender o desenvolvimento das HS na trajetória de vida de tais mulheres. Além dos instrumentos referidos no item anterior, utilizou-se uma entrevista clínica sobre trajetória de vida e HS. Nos casos, houve dificuldades na utilização das habilidades sociais desde a infância, sendo que as comorbidades podem ter dificultado o uso das habilidades sociais. Conclui-se que são necessárias intervenções na internação hospitalar, desenvolvendo as habilidades sociais desta população. / The use of crack in women requires the identification of specific characteristics, such as their social interactions. This dissertation consists of two empirical studies on social skills (HS) in hospitalized women for the use of crack. The first article aimed to describe the HS factors in such women, identifying associations between HS and its features. The instruments used for this research were: sociodemographic questionnaire, MINI (Mini International Neuropsychiatric Interview), Social Skills Inventory, Cognitive Screening by Wais-III and SCID-II (Structured Clinical Interview for DSM Disorders). The sample consisted of 62 women, identified with deficits in: conversation and social resourcefulness; self-exposure to strangers and new situations; and aggressiveness self-control. The age presented a correlation with the total score. Having friends who use drugs and drug trafficking was associated with deficits in HS. The second study, qualitative and of multiple cases aimed to understand the development of HS in the trajectory of life of these women. In addition to the instruments referred to in the previous section, we used a clinical interview about life trajectory and HS. These cases have indicated difficulties in the use of social skills since childhood, where comorbidities may have hampered the use of social skills. We conclude that interventions are needed in the hospitalizations in order to develop social skills of this population.