<p>Despite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future. </p>

Magister Artium (Psychology) - MA(Psych) / Western Cape has the highest prevalence rates of Substance Use Disorder (SUD) with prevalence rates of 18.5%, versus the national average of 13.3%. Existing studies have emphasised that SUD is associated with exposure to trauma and Post-traumatic Stress Disorder (PTSD). In addition, demographic factors such as gender, race and socio-economic status have been correlated with SUD. However, limited research exists on the correlates of SUD among inpatients at substance abuse rehabilitation facilities in the Western Cape Province. The study aimed to address this gap in the literature by investigating the correlates of SUD among inpatients at SUD rehabilitation treatment facilities.

Alcohol-related Liver Disease (ALD) represents almost half of all deaths attributable to liver disease (LD) in the US. Despite the large proportion of deaths from ALD, however, only 1.4% of all liver transplants were for patients with ALD. ALD presents a range of medical and ethical concerns for those who drive the policy and practices of liver transplantation (LT). While, historically, stringent eligibility criteria for LT precluded many with ALD from receiving a transplant, more recent research suggests such criteria may be misguided. The following review compares LT outcomes between ALD and non-ALD recipients and finds that LT recipients with ALD have equal, if not better, survival rates than those with non-ALD. The findings of this review suggest a need for revisiting transplant criteria for patients with ALD to ensure parity.

The purpose of this study was to examine staff's experiences of comorbidity between persons with disabilities and substance abuse disorder as well as collaboration between the concerned occupational activities. We used a qualitative method and interviewed six informants from four different municipalities. With organisational theory and stamping theory, we analysed the result and comparing with the earlier research contributed to the reflections in the discussion. The result showed that comorbidity is not unusual and that it can be difficult for staff to handle at times. Furthermore, it emerged that the collaboration situation is an important part of the work of the occupational activities. Other types of collaboration models may be needed for the target group, since collaboration must not become a forum for professionals to distribute the work, unless it focuses on the individual's needs and wishes. / Syftet med studien var att undersöka personalens, boendepersonal och chefer på mellannivå, erfarenheter av samsjuklighet mellan funktionsnedsättningar och substanssyndrom hos brukare/boende samt samverkan mellan berörda verksamheter. Vi använde oss av kvalitativ metod och intervjuade sex personer från fyra olika kommuner för att besvara studiens syfte. Med organisationsteori och stämplingsteori analyserade vi resultatet och jämförande med den tidigare forskningen bidrog till reflektionerna i diskussionen. Resultatet av studien visade att det inte är ovanligt med samsjuklighet i verksamheterna och i perioder kan det vara svårt för verksamheterna att hantera det. Vidare framkom det att samverkan utgör en viktig del av verksamheternas arbete men att det kan behövas andra typer av samverkansmodeller för målgruppen då samverkan inte får bli ett forum för professionella att fördela arbetet utan fokus på den enskildes behov och önskemål.

Providers’ Perspectives on Treating Patients for Substance Use Disorder in Northeast Tennessee Stefan Pienkowski MA, Abbey Mann PhD Department of Family Medicine, Quillen College of Medicine, East Tennessee State University, Johnson CIty, TN ABSTRACT Previous research has shown that people who identify as lesbian, gay, bisexual, transgender, and/or queer/questioning (LGTBQ+) have higher rates of substance use disorder (SUD) compared to the general population.1,2 Additionally, gender and sexual minorities have shown less treatment-seeking intentions than their heterosexual cis-gender counterparts.3 Given these circumstances, increasing approachability to SUD treatment options for people who identify as LGBTQ+ may significantly reduce this health disparity. Through this action research study, we set out to identify barriers to SUD treatment in northeast Tennessee as well as identify SUD treatment providers that make special accommodations for people who identify as LGBTQ+. Through purposive sampling, we identified nine providers of SUD treatment in Washington, Carter, and Sullivan counties. Providers included three physicians, three certified peer support specialists, a licensed counselor, and two facility directors. Providers each participated in a one-on-one semi-structured interview that lasted approximately 45 minutes and was audio recorded without the use of identifying information. Interview data were reviewed, and preliminary analysis was performed in order to identify themes. Themes included barriers to care, general resources, and stigma. LGBTQ+ specific findings revealed that none of the interviewed providers had received formal LGBTQ+ cultural competency training, but most providers expressed interest in receiving LGBTQ+ cultural competency training. Additionally, many providers did not believe that LGBTQ+ patients have specific needs concerning SUD treatment. Only three of the providers interviewed made special accommodations for their LGBTQ+ patients. In addition to identifying themes in the interview data, the results of this project were used to create a LGBTQ+ friendly SUD treatment resource guide for northeast Tennessee. Next steps for this action research project include 1) interviewing people who have experience with SUD treatment in northeast Tennessee and identify as LGBTQ+, 2) developing a community-based LGBTQ+ cultural competency training module informed by those interviews, 3) implementing and evaluating that module with SUD treatment providers in northeast Tennessee. 1. Medley, Grace, et al. “Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration, Oct. 2016, www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. 2. Mereish, Ethan H, and Judith B Bradford. “Intersecting Identities and Substance Use Problems: Sexual Orientation, Gender, Race, and Lifetime Substance Use Problems.” Journal of Studies on Alcohol and Drugs, Rutgers University, Jan. 2014, www.ncbi.nlm.nih.gov/pubmed/24411810.` 3. Benz, Madeline. “Stigma and Help-Seeking: The Interplay of Substance Use and Gender and Sexual Minority Identity.” Addictive Behaviors, Pergamon, 23 May 2019, www.sciencedirect.com/science/article/abs/pii/S0306460318311316.

Background Substance use disorder [SUD] is a global problem and opioids is a growing partof the overdoses worldwide. Sweden has a high mortality rate related to narcotics compared tothe rest of the EU. Nurses meet people with SUD when people with SUD are seeking care. People with SUD are usually met with stigma and have a risk of getting worse care in a healthcare setting. Aim The aim with this study is to describe nurses’ experiences of meeting people with SUD. Method This study is a literature study. Seven qualitative articles were analyzed with acontent analysis approach. Results The results show that nurses had a sense of insecurity being present in the meetingwith people with SUD. The presence of insecurity comes from a more demanding care, afeeling of being vigilant, lack of information and that nurses’ integrity is under threat. Conclusions People with SUD are a vulnerable group with a risk of being exposed for carepanding and in many cases nurses experience a kind of insecurity while caring for them. / Bakgrund Beroendeproblematik är ett problem globalt där opiater står för en stor och ökadmängd överdoser. Sverige har en hög dödlighet kopplat till narkotika preparat i jämförelsemed resten av EU. Sjuksköterskor möter personer med beroendeproblematik när de sökervård. Personer med beroende möts av både stigma och riskerar sämre vård inom hälsosjukvården. Syfte Syftet var att beskriva sjuksköterskors upplevelser av att möta personer medberoendeproblematik. Metod Studien är en allmän litteraturstudie. Sju kvalitativa artiklarna inkluderades ochinnehållsanalys valdes med en induktiv ansats. Resultat Resultatet visar på hur en upplevd osäkerhet är närvarande hos sjuksköterskor imötet med personer som har en beroendeproblematik. Upplevelserna innefattar att vården ärkrävande, ett ökat behov att vara vaksam, informationsbrist och att sjuksköterskor integritet ärhotad. Slutsats Personer med beroendeproblematik är en sårbar grupp som riskerar att utsättas förvårdlidande och som sjuksköterskor i flera fall upplever en osäkerhet i att vårda.

Addiction has been a global health crisis over recent decades and worsened substantially during COVID-19 lockdowns. We report on the development, validation, and findings from an instrument developed to assess the readiness of churches in the Appalachian Highlands to address addiction. The Church Addiction Response Scale (CARS) is a 41-item, three section measure assessing “What are your views about addiction?” (14 items), “What are your views about interacting with people who are addicted to drugs?” (11 items), and “What do you think the church’s role is in addressing addiction?” (16 items). The CARS was found to be unidimensional with strong internal consistency and initial evidence of construct validity was positive. Most respondents reported willingness to assist people living with addiction, but many reported that they felt underprepared, thus were not ready. Areas of preparation were largely those that could be addressed through training, such as understanding the physiology and psychology of addiction, available treatment options, and how to avoid doing harm. Thus, with adequate training, the likelihood of equipping a church-based workforce to provide support for people living with addiction seems attainable.

Bakgrund: Substansberoende är ett samhällsproblem som leder till både psykisk och fysisk skada hos den som är beroende, detta leder i sin tur till sjukhusinläggningar orsakade av beroendet. Studier visar att personer med ett substansberoende känner sig stigmatiserade och dåligt bemötta av vårdpersonal. Syfte: Syftet var att beskriva sjuksköterskors upplevelser i vårdmötet med personer som har ett substansberoende. Metod: En beskrivande litteraturstudie. Tio vetenskapliga artiklar användes, dessa hittades i databaserna PubMed och Cinahl. Huvudresultat: Resultatet visar att sjuksköterskor känner sig osäkra att tillhandahålla vård till patienter med ett substansberoende och att de upplever känslor av misstro och manipulation, frustration, hot och våld i vårdmötet. Vårdmötet påverkades av attityder och bristande kunskap om patienternas problematik. Det visade sig att personliga erfarenheter ledde till bättre förståelse men att det fanns ett behov av mer utbildning. Slutsats: I denna litteraturstudie visar resultatet att sjuksköterskorna känner en osäkerhet i att vårda patienter med ett substansberoende, de upplever känslor såsom misstro, manipulation, stigmatisering och rädsla för hot och våld som gör att de tar avstånd från patienterna. På grund av dessa känslor och den bristande kunskapen blir vårdmötet med denna patientgrupp lidande. En ökad kunskap hos sjuksköterskan gav en bättre förståelse för individen och underlättade vårdmötet. / Background: Substance use disorder is a societal problem that leads to both mental and physical harm to the addict, this in turn leads to hospitalizations. Studies show that people who are addicted to substances have felt stigmatized and that they have been treated badly in healthcare. Aim: The aim was to describe the nurse´s experiences in the care meeting of people with a substance use disorder. Method: A descriptive literature study. Ten scientific articles were used, these were found in the databases PubMed and Cinahl. Result: The results showed that nurses feel insecure in providing care to patients with a substance addiction and that they experience feelings of mistrust and manipulation, frustration and threats and violence in the care meeting. The care meeting is affected by attitudes and a lack of knowledge about the patients´ problems. They found that personal experiences led to a better understanding but that there was a need for more education. Conclusion: In this literature study, the results show that the nurses feel insecure in caring for patients with a substance use disorder, they experience emotions such as mistrust, manipulation, stigmatization and fear of threats and violence that make them distance themselves from the patients. Due to these feelings and the lack of knowledge, the care encounter with this patient group suffers. An increased knowledge of the nurse gave a better understanding of the individuals and facilitated the care meeting.

Bakgrund: Sjuksköterskor upplever det som problematiskt att vårda personer med beroendesjukdom. Sjuksköterskor beskriver svårigheter att leva upp till sin professionella yrkesroll. Brist på förståelse och kunskap hos sjuksköterskorna bidrog till frustration och osäkerhet samt framkallade negativa attityder. Sjuksköterskor har i tidigare studier upplevt patienter med beroendesjukdom som manipulativa och med avsaknad vilja att ta eget ansvar. Tidigare studier tyder på att personer med beroendesjukdom har blivit bemötta på ett fördomsfullt sätt samt att sjuksköterskor hade låg motivation till att vårda dessa patienter. Syfte: Syftet med intervjustudien var att beskriva sjuksköterskors erfarenheter av att vårda personer med beroendesjukdom. Metod: Tio sjuksköterskor inom öppen- och slutenvården intervjuades med semi-strukturerade intervjuer. Intervjuerna spelades in och transkriberades ordagrant. En kvalitativ innehållsanalys användes vid analysering av materialet. Resultat: I analysen av sjuksköterskors erfarenheter av att vårda personer med beroendesjukdom framkom tre kategorier och åtta subkategorier som handlade om sjuksköterskans yrkesroll, relationen mellan sjuksköterska och patient samt att möta brister. Slutsats: Sjuksköterskor upplevde arbetet som utmanande och att personer med beroendesjukdom var komplicerade och svåra att vårda. Viktigt i mötet var gränssättning och tydliga ramar. Sjuksköterskorna beskrev att starka känslor väcktes. Bemötandet var av stor betydelse för en god relation mellan patient och sjuksköterska. Fördomar gentemot personer med beroendesjukdom upplevdes av samtliga sjuksköterskor. Det fanns en önskan hos sjuksköterskorna att bidra till att dessa fördomar mot patientgruppen minskade. / Background: Nurses found it problematic to care for people with substance use disorder (s.u.d.). A lack of understanding and knowledge among nurses has contributed to frustration and uncertainty as well as induced negative attitudes. Nurses described difficulties in living up to their professional and occupational role. Previous research has shown that patients with s.u.d. were perceived as manipulative and unwilling to take their own responsibility. Previous studies indicate that people with s.u.d. have been treated in a prejudicial manner and that nurses had low motivation to care for these patients. Objective: The purpose of the interview study was to describe nurses' experiences of caring for people with s.u.d. Method: Ten nurses in open and closed wards were interviewed with semi-structured interviews. The interviews were recorded and transcribed word for word. A qualitative content analysis was used in analyzing the material. Results: In the analysis from the nurses' experience of caring for people with s.u.d. three categories and eight subcategories emerged, the nurse's professional role, the relationship between the nurse and the patient and how to overcome obstacles with shortcomings. Conclusion: Nurses perceived their work as challenging and that people with s.u.d. were complicated and difficult to care for. Important in the meeting were boundaries and clear frameworks. The nurses described that strong feelings were aroused. The response was of great importance for a good relationship between the patient and the nurse. Prejudice towards people with addictive illness was experienced by all nurses. There was a desire on the part of the nurses to help reduce these prejudices against the patient group. / <p>Godkännandedatum: 2020-01-15</p>

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