Il est possible qu’une personne qui consulte pour un problème d’utilisation de substances souffre également d’un problème associé à un état de stress post-traumatique ( ESPT ). Plusieurs auteurs croient qu’il existe un lien expliquant cette co-morbidité. Voilà pourquoi plusieurs hypothèses ont été formulées pour expliquer le lien entre un trouble tel que celui lié à l’utilisation de substance (TUS) pouvant exister avant l’ESPT, la vulnérabilité suite au TUS, ainsi que l’automédication. Plusieurs recherches proposent deux types d’interventions afin d’aider les personnes aux prises avec cette double problématique. La première consiste à traiter les deux problèmes séparément alors que la seconde, préconise une approche intégrée et simultanée. Puisque les écrits conseillent davantage un traitement intégré, il y aura une présentation d’une de ces formes de traitement nommé « À la recherche de la sécurité ». Le volet académique visait à comprendre le lien existant entre le TUS, les traumas psychologiques et l’ESPT ainsi que les différentes formes d’interventions pour aider les personnes ayant cette co-morbidité. Nous avons utilisé un module du programme « À la recherche de la sécurité » récemment traduit en français afin de vérifier sa mise en application et l’appréciation qu’en ont fait cinq usagers du Centre Dollar-Cormier-Institut universitaire sur les dépendances (CDC-IUD) ayant vécu un traumatisme au cours de leur vie. En conclusion, il sera démontré dans nos résultats que les hypothèses quant au lien de comorbidité sont effectivement présentes dans la réalité des personnes ayant un ESPT et un TUS, et qu’une intervention intégrée offre des points positifs autant pour l’usager que pour l’intervenant. / It is possible that the substance abuse disorder for which a person consults is associated with Posttraumatic Stress Disorder (PTSD). Several authors believe that there is a link explaining this co-morbidity. For this reason, several hypotheses have been formulated to explain this link as the substance abuse disorder (SUD) prior to PTSD, vulnerability following the SUD and selfmedication. Moreover, research shows the various interventions to help people struggling with these twin problems. The first is to separate the two issues while the second includes PTSD and the SUD. Research advice a more integrated treatment, there will be a presentation of one of these forms of treatment called "Seeking Safety". The academic component of our apprenticeship was to understand the link between the SUD, psychological trauma and PTSD and the various forms of interventions to help people with this co-morbidity. We used a module of "Seeking Safety" recently translated in French to ensure its implementation and its assessment from five users of the Centre Dollar-Cormier-Institut universitaire sur les dépendances who experienced trauma in their lives. In conclusion of the study, it is clearly shown that different assumptions are present in the reality of people with PTSD and SUD and an integrated response has positives for both the user and for the speaker.

Made available in DSpace on 2016-01-26T12:51:40Z (GMT). No. of bitstreams: 1 janelisebpazianicosta_dissert.pdf: 2457459 bytes, checksum: 519e9ac156cca4f5016a58719a8b2cb1 (MD5) Previous issue date: 2012-06-15 / Introduction: The use/consumption of psychoactive substances is considered a complex phenomenon, which has biological, psychological and social origins and consequences. Objectives: Describing, analyzing and comparing socio-demographic, psychological and clinical characteristics presented by a population having a Substance Use Disorder. Casuistic and Method: A convenience sample comprising 50 adult male patients who took part in the present study were seen in a Psychosocial Attention Center Alcohol and Drugs (CAPSad) based in a medium-sized city located in São Paulo State countryside. An Identification Form containing personal and socio-demographic features, as well as a Semi-directed Interview Script, were used for people with alcohol and/or drug-related problems. Data were analyzed by means of non-parametric statistic evidences and qualitative analysis of frequency and percentage of answer category having the same semantic meaning. Results: The study group mostly comprised an adult (28-37 and 48-58 years old), negroid (62%), not engaged (72%), evangelic (44%), unemployed (59,18%) population born in areas around the target city (44,68%), with 5 to 8 years of study (42%) and a monthly family income of 3-5 minimum salaries (47,73%). 68% of these patients had been under treatment for at most a month, especially the youngest interviewed ones (18-37 years old). There has been balance between the participants directed to CAPSad and the ones who have searched for help on their own. Some of the main reasons for this search were: willingness to quit consuming, psychological and emotional problems, as well as chemical addiction. 43,18% of the patient sample were abused (esp. physically) in childhood and/or adolescence, and 74% reported having family problems involving alcohol and/or others drugs. Psychoactive substances use was a contributing factor to damages in the quality of relationship with family of origin, spouse and children. Participants reported significant changes and social repertoire and part of leisure activities was associated to the very use of substances or related activities. 76,60% declared having friends who made use of alcohol and/or other drugs. Alcohol (98%), nicotine (84%), cocaine (72%) and cannabis (72%) derivates, inhalants (48%), hallucinogens (22%) and psychotropic medicine (12%) were the most commonly consumed drugs in a lifetime found among patients. Marijuana, cocaine and crack were statistically associated to research youngest population. 64% started using substances in adolescence, mainly due to friendship, party attendance and curiosity and 38% of these youngsters already made continuous use of them in this very life stage. 66% indicated ‗group, friendship circle, friends as usage partners, 72,92% declared uninterrupted use of drugs for some days and 86% of them reported having had periods without any drug contact. The main factors encountered to relapse were loneliness, family distance, belief of being able to drink with no negative consequences, as well as of feeling fine, use willingness and pleasure and individual psychological characteristics. The most common treatments for problems with alcohol and/or other drugs were CAPSad, Hospitalization, Emergency Room, ―Alcoólicos Anônimos‖, ―Narcóticos Anônimos‖, ―Amor Exigente‖ and religion. Participants reported psychological (96%), physical (90%) and cognitive (71,92%) damages related to substance use. Conclusions: It has been observed that a great percentage of the total number of adult participants in the present study presented significant damages related to alcohol and other drugs abuse/dependence, compromising all individual s functioning areas. Although the results are not conclusive to predicting factors in childhood to drug use, considering sample characteristics varied from worse to better socioeconomics and life conditions. In adolescence, individuals with significant damages, changes and sufferings, in touch with user friends and presenting common features for abuse maintenance were predominant. We may conclude that efficient health promoting and prevention programs and more effective treatments and rehabilitation programs must take into consideration users population heterogeneity. / Introdução: Considera-se o uso de substâncias psicoativas um fenômeno complexo, com origens e consequências biológicas, psicológicas e sociais. Objetivos: Descrever, analisar e comparar características sociodemográficas, psicossociais e clínicas apresentadas por uma população com Transtornos por Uso de Substâncias. Casuística e Método: Participou da pesquisa uma amostra de conveniência com 50 pacientes adultos, sexo masculino, atendida no Centro de Atenção Psicossocial Álcool e Drogas (CAPSad) de uma cidade de médio porte do interior do Estado de São Paulo. Foram utilizados: Ficha de Identificação, contendo características pessoais e sociodemográficas e Roteiro de Entrevista Semidirigida para pessoas com problemas relacionados ao álcool e/ou outras drogas. Os dados foram analisados por meio de provas da estatística não paramétrica e por análise qualitativa a partir de frequências e porcentagens de categorias de respostas com mesma semântica de enunciados. Resultados: Pode-se destacar uma população adulta (28-37 e 48-58 anos), negróide (62%), sem companheiro(a) (72%), com 5 a 8 anos de estudos (42%), evangélica (44%), natural da região administrativa da cidade alvo do estudo (44,68%), com renda mensal familiar de 3 a 5 salários mínimos (47,73%) e desempregada (59,18%). 68% estavam em tratamento no período de ‗até um mês , principalmente os entrevistados mais jovens da pesquisa (18-37 anos). Houve equilíbrio entre participantes que foram encaminhados ao CAPSad e os que buscaram ajuda por conta própria, sendo os principais motivos: cessar o consumo, problemas psicológicos, emocionais e dependência química. 43,18% sofreram abusos (principalmente físicos) na infância e/ou na adolescência e 74% relataram possuir familiares com problemas de álcool e/ou outras drogas. Uso de substâncias psicoativas foi um fator contribuinte para prejuízos na qualidade dos relacionamentos com família de origem, cônjuge e filhos. Os participantes referiram significativa mudança e redução do repertório social e parte das fontes de lazer esteve relacionada ao próprio uso de substâncias ou atividades afins. 76,60% relataram possuir amigos que faziam uso de álcool e/ou outras drogas. Álcool (98%), nicotina (84%), derivados de coca (72%) e de canabinóides (72%), inalantes (48%), alucinógenos (22%), medicamentos psicotrópicos (12%) foram os tipos de drogas mais consumidas durante a vida. Maconha, cocaína e crack foram associadas estatisticamente à população mais jovem da pesquisa. 64% iniciaram o uso de substâncias na adolescência, sendo os principais motivos amizades, frequência em festas e curiosidade e 38% já faziam uso contínuo nessa mesma fase da vida. 66% relataram ‗turma, amigos, colegas como companheiros de uso, 72,92% uso ininterrupto de drogas por alguns dias e 86%, períodos sem o consumo. Principais fatores relacionados à recaída foram solidão, distância dos familiares, impressão de poder beber sem consequências negativas ou de estar bem, vontade e prazer no uso e características psicológicas próprias dos entrevistados. Tratamentos mais utilizados para problemas com álcool e/ou outras drogas foram CAPSad, Internação, Pronto Socorro, Alcoólicos Anônimos, Narcóticos Anônimos, Amor exigente e Religioso. 96% dos participantes relataram prejuízos psicológicos, 90% físicos, e 71,92% cognitivos, relacionados ao consumo de substâncias. Conclusões: Na vida adulta foram evidenciados, para quase a totalidade dos participantes do presente estudo, significativos prejuízos relacionados ao abuso/dependência de álcool e/ou outras drogas, em todas as áreas de funcionamento dos indivíduos. Embora os resultados não permitem evidenciar fatores considerados como preditores na infância para o início do uso de substâncias, uma vez que características da amostra foram variadas entre piores e melhores condições socioeconômicas e de vida, para a adolescência, houve predomínio de sujeitos com prejuízos relevantes, mudanças e sofrimentos, em contato com amigos usuários, demonstrando características comuns para a manutenção do abuso. Há a necessidade de programas eficazes de promoção e prevenção de saúde, tratamentos e reabilitações mais efetivos que levem em consideração a heterogeneidade da população usuária.

Background: Rates of accidental overdose mortality from substance use disorder (SUD) have risen dramatically in the United States since 1990. Between 1999 and 2004 alone rates increased 62% nationwide, with rural overdose mortality increasing at a rate 3 times that seen in urban populations. Cultural differences between rural and urban populations (e.g., educational attainment, unemployment rates, social characteristics, etc.) affect the nature of SUD, leading to disparate risk of overdose across these communities. Methods: Multiple-groups latent class analysis with covariates was applied to data from the 2011 and 2012 National Survey on Drug Use and Health (n=12.140) to examine potential differences in latent classifications of SUD between rural and urban adult (aged 18 years and older) populations. Nine drug categories were used to identify latent classes of SUD defined by probability of diagnosis within these categories. Once the class structures were established for rural and urban samples, posterior membership probabilities were entered into a multinomial regression analysis of socio-demographic predictors' association with the likelihood of SUD latent class membership. Results: Latent class structures differed across the sub-groups, with the rural sample fitting a 3-class structure (Bootstrap Likelihood Ratio Test P value=0.03) and the urban fitting a 6-class model (Bootstrap Likelihood Ratio Test P valueThis result supports the hypothesis that different underlying elements exist in the two populations that affect SUD patterns, and thus can inform the development of surveillance instruments, clinical services, and prevention programming tailored to specific communities.

Cocaine is a plant-based illicit drug commonly involved in substance use disorder. Although cocaine overdose and cocaine use disorders cause adverse health consequences to individuals and the economic burden on their family and society, there are no FDA (Food and Drug Administration) approved medications for treatment. Recently, it has been recognized that delivery of cocaine hydrolase (CocH) is a promising therapeutic strategy. Human butyrylcholinesterase (hBChE), the primary enzyme involved in cocaine metabolism in human, have advantages over other candidates for the development of CocH. Previous studies in our laboratory have designed and characterized hBChE mutants that have ~4,000-fold improved catalytic efficiency against naturally occurring (-)-cocaine as compared to the wild-type hBChE. Besides the catalytic efficiency, the biological half-life is another essential factor that influences the desired therapeutic value in the long-term treatment of cocaine use disorder. In order to provide prolonged effects to reduce administration frequency in clinical use, efforts have been made to increase the retention time of CocHs in blood circulation by fusing CocHs with other thermostable proteins or their mutants, including human serum albumin (Albu) or the Fc region of the human IgG (Fc). In this dissertation, we demonstrated the clinical potential and the benefits of long-lasting CocHs for cocaine overdose treatment. We used rodent models to show the ability of AlbuCocH1 to block or reverse manifestations of toxic effects of cocaine. In addition, a concomitant LC-MS/MS-based analysis was conducted to investigate the pharmacokinetic profile of a lethal dose of cocaine with the presence of AlbuCocH1. These experimental data demonstrated AlbuCocH1 as an effective cocaine detoxification agent by accelerating the metabolism of cocaine. In order to examine the potential therapeutic value of Fc-fused CocHs in the treatment of cocaine use disorder, we conducted a series of behavioral experiments in rats to evaluate the effectiveness and duration of Fc-fused CocHs in blocking or attenuating cocaine-induced psychostimulant and discriminative stimulus effects. In addition, the intravenous self-administration model was used to investigate the long-term effectiveness of Fc-fused CocHs in blocking or attenuating the reinforcing effects of cocaine. It has been shown that a single dose of E30-6-Fc (3 mg/kg) was able to effectively alter the cocaine dose-response curve and attenuate the reinforcing efficacy of cocaine for at least a month in both male and female rats. In summary, AlbuCocH1 (TV-1380), which failed to meet the primary efficacy endpoint in clinical trials for facilitating abstinence in cocaine-dependent subjects with a weekly dosing schedule (due to the short biological half-life), is more suitable to be developed as a cocaine detoxification agent. On the contrary, the newly designed Fc-fused CocH (e.g. CocH3-Fc, E30-6-Fc) with higher catalytic efficiency and longer biological half-life will be beneficial for long-term abstinence management in cocaine-dependent individuals.

Il est possible qu’une personne qui consulte pour un problème d’utilisation de substances souffre également d’un problème associé à un état de stress post-traumatique ( ESPT ). Plusieurs auteurs croient qu’il existe un lien expliquant cette co-morbidité. Voilà pourquoi plusieurs hypothèses ont été formulées pour expliquer le lien entre un trouble tel que celui lié à l’utilisation de substance (TUS) pouvant exister avant l’ESPT, la vulnérabilité suite au TUS, ainsi que l’automédication. Plusieurs recherches proposent deux types d’interventions afin d’aider les personnes aux prises avec cette double problématique. La première consiste à traiter les deux problèmes séparément alors que la seconde, préconise une approche intégrée et simultanée. Puisque les écrits conseillent davantage un traitement intégré, il y aura une présentation d’une de ces formes de traitement nommé « À la recherche de la sécurité ». Le volet académique visait à comprendre le lien existant entre le TUS, les traumas psychologiques et l’ESPT ainsi que les différentes formes d’interventions pour aider les personnes ayant cette co-morbidité. Nous avons utilisé un module du programme « À la recherche de la sécurité » récemment traduit en français afin de vérifier sa mise en application et l’appréciation qu’en ont fait cinq usagers du Centre Dollar-Cormier-Institut universitaire sur les dépendances (CDC-IUD) ayant vécu un traumatisme au cours de leur vie. En conclusion, il sera démontré dans nos résultats que les hypothèses quant au lien de comorbidité sont effectivement présentes dans la réalité des personnes ayant un ESPT et un TUS, et qu’une intervention intégrée offre des points positifs autant pour l’usager que pour l’intervenant. / It is possible that the substance abuse disorder for which a person consults is associated with Posttraumatic Stress Disorder (PTSD). Several authors believe that there is a link explaining this co-morbidity. For this reason, several hypotheses have been formulated to explain this link as the substance abuse disorder (SUD) prior to PTSD, vulnerability following the SUD and selfmedication. Moreover, research shows the various interventions to help people struggling with these twin problems. The first is to separate the two issues while the second includes PTSD and the SUD. Research advice a more integrated treatment, there will be a presentation of one of these forms of treatment called "Seeking Safety". The academic component of our apprenticeship was to understand the link between the SUD, psychological trauma and PTSD and the various forms of interventions to help people with this co-morbidity. We used a module of "Seeking Safety" recently translated in French to ensure its implementation and its assessment from five users of the Centre Dollar-Cormier-Institut universitaire sur les dépendances who experienced trauma in their lives. In conclusion of the study, it is clearly shown that different assumptions are present in the reality of people with PTSD and SUD and an integrated response has positives for both the user and for the speaker.

Peer support groups (PSGs) for addiction recovery are the most common source for aftercare services once professional treatment has ended (Cloud, Rowan, Wulff, & Golder, 2007), and a significant number of individuals who seek help for a substance-related problem only seek that help from peer support organizations, such as Alcoholics Anonymous (White, 2010). In the last two decades, a different, more secular culture of “recovery” from self-defined problematic substance has led to the emergence of new PSGs (White, 2009). However, very few research studies to date have examined how more recent, typically secular, PSGs work, what aspects of them attract participants, and what participants find helpful about the group. Further, very little is known whether theories that have been applied to clinical treatment, such as the Stages of Change model, relate to the peer support environment. LifeRing is a secular PSG that views substance misuse as a learned habit that can be changed through taking responsibility for one’s actions and actively engaging with peers (Nicolaus, 2009). A particularly relevant model to LifeRing is Stages of Change, because LifeRing encourages personal responsibility and choice, does not prescribe any specific steps, and encourages individuals to build their own recovery plan that can help them stay motivated in recovery (Nicolaus, 2009). The current study examined data from 50 participants that attend LifeRing meetings on Vancouver Island. The results were not consistent with the Stages of Change framework. 4 Specifically, readiness to change and active group participation did not predict group engagement outcomes. Analysis of open-ended follow-up questions indicate that group cohesion and match in beliefs were significantly associated with greater active group participation and convenor alliance was significantly associated with group satisfaction, paralleling findings on the topic in the psychotherapy literature. Information from qualitative follow-up questions regarding helpful and unhelpful aspects of LifeRing are also discussed. / Graduate / avsotskova@gmail.com

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Substance Use Disorder (SUD) has plagued families of rural Appalachia for many years, perpetuating involvement in the criminal justice system as well as generational trauma for people diagnosed with SUD and their children. This points to the necessity of a trauma-informed, restorative-justice based framework for rehabilitative services to most effectively heal families, address trauma, and re-integrate people diagnosed with SUD into society. A restorative justice-based program would provide health care services for addiction and any comorbid mental health disorders as well as teach parents how to properly provide for themselves and their families, manage finances, obtain employment, and further education. Current rehabilitative program structures were evaluated in the literature, and it was found that typically, rehabilitative programs provide either strictly addiction services or mental health services, but not both. It was also found that the criminal justice system tends to sentence to 28-day inpatient rehabilitative services, which provides people diagnosed with SUD an opportunity to achieve sobriety and establish some stability; however, with little or no follow up, these people are significantly more likely to relapse. These findings were compared with the structure of Ballad Health STRONG Futures, an outpatient addiction services and behavioral health clinic located in Greeneville, TN; Red Legacy Recovery, a recovery initiative serving incarcerated women in Elizabethton, TN; and Families Free, a 501(c)3 organization providing outpatient services to Northeast Tennessee through the Tennessee Department of Mental Health and Substance Abuse Services. It was found that rehabilitative care structures that addresses trauma, addiction, and aspects of daily living such as parenting, finances, education, and employment provides clients with the tools and stability needed to be successful in their respective recovery journeys. This work will provide significant insight for the creation and implementation of other substance use clinics and initiatives across the country and encourage them to address mental health and aspects of daily living to promote clients' success and break cycles of generational trauma.

Introductions: The research deals with the attachment theory at women and min with substance use disorder in an aftercare programme. It is divided into theoretical and practical part. The theoretical part explains the concept of attachment, describes its theoretical foundations, the connections between attachment and addiction, the possibilities of therapeutic work with attachment, its application in work with people with addiction, gender differences and the specifications of aftercare programmes. The practical part is base on qualitatively oriented research. The research was conducted on interviews with ten respondents, five women (set A) and five men (set B). All respondents are people with SUD, currently abstinents, after addiction treatment, participating in an aftercare programme. Aim: The aim of the research was to compare the differences and similarities at men and women with addiction disorder in their attachment, partnerships and family relationships and the subsequent implications of the results for practical use. Methods: Two semi-structured clinical interviews, the Adult Attachment Interview (AAI) and the Current Relationship Interview (CRI), were used for the data generation. AAI is focused on childhood and early relationships between the respondent and his parents, CRI is focused on...