Stigma in the healthcare system is widely documented. A significant medium through which stigmatizing thoughts, opinions, and attitudes are propagated is language. Stigmatizing language can create barriers to care, while inclusive non-stigmatizing language has the ability to highlight a patient’s strengths, humanity, and potential for recovery. While several institutions have implemented campaigns and interventions aimed at reducing stigma in healthcare, research examining the impact of these interventions is limited. Specifically, no studies have examined the effects of language-focused campaigns on patient outcomes. This paper reviews the current literature on stigma and stigmatizing language in healthcare and proposes a hypothetical study designed to assess the effects of a clinician-facing training that emphasizes the use of non-stigmatizing language on opioid abstinence in patients newly diagnosed with opioid use disorder. Potential limitations in study design and data analysis, along with possible implications of study results, are discussed. / Urban Bioethics

This non-experimental field study examined the relationship between participant reported experiences of relational depth (RD) with their individual counselors in substance use disorder (SUD) treatment and participant reported motivation to change substance use. Participants in the study were clients enrolled in inpatient and outpatient levels of substance use disorder treatment. A total of 78 clients (aged 18-77, with mean age 35.97, 80.1% Caucasian, 11.5% African-American, 3.8% Hispanic, 1.3% Asian, 1.3% multiracial, 1.3% other) with SUDs participated in the study. Results demonstrated that treatment process variables explained approximately 42% of the variance in participant recognition scores. Specifically, substance abuse community support involvement (β = .598, rs2 = .908, p < .001) and relational depth (β = .184, rs2 = .178, p = .045) were found to be significant predictors of participant recognition of a substance use problem. From these results, one may tentatively conclude that community support and the development of relational depth in SUD treatment are valuable additions to standard SUD treatment. Extended results are described and summarized using text, tables, and figures. The study has practical and clinical implications for counselors working with clients in substance use disorder treatment particularly concerning the length of individual counseling.

Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients. / Doctor of Philosophy / With more than 1,500 active drug court programs throughout the United States, there is a pressing need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. While adult drug treatment court programs have been shown to have positive outcomes in terms of reducing criminal recidivism, the existing literature examining the participants' lived experiences receiving SUD treatment is minimal and disheartening. Due to the nature of the mandated treatment relationship, the confidentiality which has historically bound and secured the therapeutic working alliance is less defined than it is in fully voluntary treatment settings. This shift in understanding what creates a healthy working alliance for mandated clients to work through presenting treatment issues is something that has yet to be explored by current research. The current study sought to explore clients' experiences of the working alliance with counselors during drug court-mandated addictions treatment. Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

Drug use, overdose, and addiction has skyrocketed in the past twenty years (Centers for Disease Control and Prevention, 2020). Negative stigma towards addiction, or otherwise known as substance use disorder (SUD), has only increased since President Nixon declared the "war on drugs" in 1971 (National Public Radio, 2007). Negative public stigma of SUD creates barriers for treatment for those who are suffering, continuing to exacerbate the stigma surrounding SUD. To understand ways to reduce stigma surrounding SUD, this study will look at narrative persuasion through transportation theory to better understand the power of stories and stories of recovery as a method to reduce stigma surrounding SUD among community members. In addition to examining narrative persuasion literature, 21 semi-structured interviews from community stakeholder groups in Virginia's Department of Behavioral Health and Developmental Services region 3, were conducted. To further understand the content in the stakeholder interviews, a qualitative thematic analysis using inductive themes was conducted to determine common themes surrounding substance use disorder, stigma, and ways to reduce stigma surrounding substance use disorder through narrative persuasion. Based on participant interviews, community stakeholders hold negative perceptions of those with SUD based on personal and professional experiences but believe that positive personal narratives of SUD and recovery can reduce public stigma towards those who suffer from the disorder. / Master of Arts / Drug use, overdose, and addiction has skyrocketed in the past twenty years (Centers for Disease Control and Prevention, 2020). Negative stigma towards addiction, or otherwise known as substance use disorder (SUD), has risen since President Nixon declared the "war on drugs" in 1971 (National Public Radio, 2007). Negative public stigma of SUD creates barriers for treatment for those who are suffering, continuing to worsen the stigma surrounding SUD. To understand ways to reduce stigma surrounding SUD, this study will look at persuasive storytelling through transportation theory to better understand the power of stories and stories of recovery as a method to reduce stigma surrounding SUD among community members. In addition to examining narrative persuasion literature, 21 interviews from various community members in region 3 of Virginia were conducted. To further understand the content in the participant interviews, a thematic analysis was conducted to determine common themes and patterns surrounding substance use disorder, stigma, and ways to reduce stigma surrounding substance use disorder through persuasive storytelling. Based on participant interviews, community stakeholders hold negative perceptions of those with SUD through personal and professional experiences but believe that positive personal narratives of SUD and recovery can reduce public stigma towards those who suffer from the disorder.

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations between DD, RF, and remission from SUDs. Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an Adjusting Amount Delay Discounting Task. T-tests were used to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship between DD, RF, and remission status. Remitted individuals (n=82) had significantly lower DD rates (p<0.001) and higher context sensitivity (p<0.001) and coping flexibility (p<0.001). There were significant negative associations between DD and context sensitivity (p=0.008), coping flexibility (p=0.002), and emotion regulation flexibility (p<0.001). Finally, context sensitivity (p=0.023) and coping flexibility (p=0.007) mediated the relationship between DD and SUD remission. Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes. / M.S. / Preference for immediate gratification (also called delay discounting), and self-regulation (the ability to control one’s emotions) are related to addiction outcomes. Regulatory flexibility - a self-regulation process by which individuals select and adapt their coping strategies based on their situation - is related to improved mental health outcomes. However, research studies have yet to examine the relationship between regulatory flexibility and delay discounting in individuals with a history of drug and/or alcohol dependence. Using a sample from an online addiction recovery research and support community called the International Quit and Recovery Registry, the current thesis examined the relationship between delay discounting and regulatory flexibility grouped by substance use disorder clinical diagnoses amongst 148 individuals. Group comparisons suggested that individuals in remission (i.e., no longer meet criteria for clinical diagnosis of addiction) were better able to delay gratification and were better able to flexibly regulate their emotions compared to individuals who relapsed. When examining the relationship between delay discounting and regulatory flexibility, we found that individuals’ who preferred delayed rewards over immediate rewards were better able to flexibly self-regulate, suggesting that being able to delay gratification is an important component of effective coping, together contributing to improved addiction recovery outcomes.

The opioid epidemic in Philadelphia has evolved into a complex polysubstance crisis with the emergence of xylazine alongside fentanyl, reshaping substance use dynamics. Xylazine's rising prevalence introduces unique health risks due to its sedative properties, compounded when combined with fentanyl, leading to heightened potency and toxicity. This combination contributes to severe medical complications, notably injection-related infections driving hospitalizations. Ethical care for individuals with substance use disorder necessitates prioritizing patient autonomy in healthcare decision-making. Critical discussions on care goals with hospitalized drug users are imperative, encompassing pain management, withdrawal mitigation, and medication for opioid use disorder, aligning with patient preferences. Open and transparent communication fosters trust, enabling healthcare providers to effectively support substance use disorder patients and enhance their overall quality of life. / Urban Bioethics

Substance Use Disorders (SUD) continue to be a significant public health concern as drug use reaches a worldwide high. Research has consistently shown that lesbian, gay, and bisexual (LGB) individuals are at a heightened risk of having an SUD than their heterosexual counterparts. While notable work has been done to understand the factors contributing to SUD among LGB populations, there is a substantial gap in research regarding the intersection of race/ethnicity and sexual identity. This study aims to address this gap by investigating the disparities in SUD among sexual minorities across different racial/ethnic and sex groups and the determinants that underlie these disparities. This research involves a statistical analysis of combined data from the 2021-2022 National Survey on Drug Use and Health (NSDUH) to explore prevalence rates and identify demographic and socioeconomic factors associated with disparities in SUD among sexual minority adults (ages 18 and older) in the United States, considering factors such as race/ethnicity, gender, socioeconomic status, religiosity, familism, and language. By understanding the prevalence and determinants of SUD within this population, healthcare providers, policymakers, and advocates can work together to develop prevention and intervention strategies to reduce these disparities and improve the overall well-being of LGB individuals in the United States.

Bakgrund: Antalet dödsfall relaterat till narkotikarelaterat substansbruk ökar. Personer med narkotikarelaterat substansbrukssyndrom utgör en marginaliserad och stigmatiserad grupp i samhället. Dessa personer löper förhöjd risk för ohälsa, inte minst till följd av deras substansbruk. Stigmatisering inom hälso- och sjukvården är särskilt allvarligt, då det drabbar människor i ett särdeles sårbart tillstånd. Mot bakgrund av detta föreligger ett behov av att sammanställa tidigare forskning som studerat erfarenheter hos personer med narkotikarelaterat substansbrukssyndrom av att vårdas på sjukhus.   Syfte: Syftet var att undersöka de erfarenheter personer med narkotikarelaterat substansbrukssyndrom har av att vårdas på sjukhus. Metod: En icke-systematisk litteraturöversikt med integrerad dataanalys genomfördes baserat på 16 vetenskapliga originalartiklar. Litteratursökningarna utfördes i databaserna PubMed och CINAHL utifrån MeSH-termer och CINAHL Subject Headings, samt ytterligare relevanta sökord. Samtliga artiklar som inkluderades i studien har genomgått en kvalitetsgranskning enligt Sophiahemmet Högskolas bedömningsmall.   Resultat: Tre huvudkategorier identifierades, vilka var Erfarenheter av ojämlik vård, Erfarenheter av bemötande och Erfarenheter av utebliven vård. Resultatet visade att personer med narkotikarelaterat substansbrukssyndrom hade erfarit bristande bemötande av vårdpersonal till följd av stigmatisering och diskriminering, vilket ledde till konsekvenser som fördröjd eller nekad vård. Det framkom att vårdpersonal saknade kunskap om substansbrukssyndrom och hur substansbruksrelaterade tillstånd behandlas. Vidare visade resultatet att substansbruk utgjorde ett hinder för att erhålla adekvat smärtlindring, då vårdpersonalen antog att denna patientgrupp enbart sökte vård för att få tillgång till narkotikaklassade substanser. Personer med substansbrukssyndrom avbröt inte sällan sin sjukhusvistelse mot medicinsk inrådan, främst till följd av abstinensbesvär och inadekvat smärtlindring. Slutsats: Denna litteraturöversikt kan bidra till att hos vårdpersonal medvetandegöra patientgruppens erfarenheter och användas till grund för vidareutbildning inom området. Då flera stigmatiserade grupper kan tänkas uppleva liknande bemötande när de söker vård, kan föreliggande litteraturöversikt också användas för att förstå de erfarenheter stigmatiserade grupper generellt kan antas ha av att söka vård. / Background: The number of deaths related to narcotics related substance use is increasing. People with narcotics related substance use syndrome constitute a marginalized and stigmatized group in society. These people run an increased risk of ill health, especially as a result of their substance use. Stigmatization in health care is particularly serious, as it affects people in a particularly vulnerable state. In light of this, there is a need to compile previous research that has studied experiences of people with narcotics related substance use disorder being cared for in hospital settings.   Aim: The aim of this study was to examine experiences of people with narcotics related substance use disorder who have received hospital care.   Method: A non-systematic literature review with integrated data analysis was conducted based on 16 original scientific articles. The literature searches were carried out in the databases PubMed and CINAHL based on MeSH terms and CINAHL Subject Headings as well as additional relevant keywords. All articles that were included in the study have undergone a quality review according to Sophiahemmet University's assessment template.  Results: Three main categories were identified, as follows: Experiences of unequal care, Experiences of encounters and Experiences of missed care. The results showed that people with narcotics related substance use disorder had experienced a lack of treatment by healthcare professionals as a result of stigmatization and discrimination, which led to consequences such as delayed or denied care. It emerged that healthcare staff lacked knowledge about substance use disorder and how substance use related conditions are treated. Furthermore, the results showed that substance use constituted an obstacle to obtaining adequate pain relief as the healthcare staff assumed that this patient group only sought care to gain access to narcotic-classified substances. People with substance use syndrome often terminated their hospital stay against medical advice, mainly as a result of withdrawal symptoms and inadequate pain relief.  Conclusions: This literature review can contribute to raising awareness of the patient group's experiences among health care professionals and be used as a basis for further education in the field. As several stigmatized groups can conceivably experience similar treatment when they seek care, the present literature review can also be used to understand the experiences stigmatized groups can generally be assumed to have from seeking care.

Överkonsumtion av alkohol är ett globalt problem som ökar risken för insjuknandet i flera sjukdomar, därmed kommer personer med substansbrukssyndrom i kontakt med många delar av hälso- och sjukvården. Patienter med substansbrukssyndrom upplever att de inte erhåller vård på samma villkor som andra. Syftet med litteraturstudien var att utforska sjuksköterskors inställningar vid vårdandet av personer med substansbrukssyndrom utanför specialiserad beroendevård. En systematisk litteraturstudie med beskrivande design användes som metod för att besvara syftet.  Resultatet består av två kategorier: “Sjuksköterskors inställningar till att vårda patienter med substansbrukssyndrom” och “Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom”. Kategorin ”Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom” bygger på fyra subkategorier: negativa aspekter, positiva aspekter, bristande kunskap och samtal om alkohol. Inställningen till att vårda patienter med substansbrukssyndrom var övervägande negativ. En förbättring av sjuksköterskors kunskaper om omvårdnad vid substansbrukssyndrom skulle kunna bidra till en bättre vårdupplevelse för både sjuksköterska och patient. / Overconsumption of alcohol is a global health issue that increases the risk for several physical and mental health conditions. People who suffer from alcohol dependence will therefore often come in contact with different instances within the health care system. Patients suffering from substance dependence might experience that they don’t receive equal care compared with other patients. The aim of the study was therefore to explore how nurses in general healthcare experience caring for patients suffering from substance dependence in general healthcare, outside of specialized care. A systematic literature review was used to answer the aim of the study. The result consists of two categories: "Nurses' experiences of caring for patients with substance use disorder" and "Nurses' emotional reactions of caring for patients with substance use disorder". The category "Nurses' emotional reactions of caring for patients with substance use disorder" is based on four subcategories: negative aspects, positive aspects, lack of knowledge and discussion about alcohol. Attitudes of caring for patients with substance dependence were predominantly negative. An improvement in nurses' knowledge could contribute to a better care experience for both nurse and patient.

Bakgrund: Sjuksköterskor möter personer med substansberoende inom alla vårdformer. Detta är en stigmatiserad patientgrupp som inte alltid upplever att de får vård på lika villkor som andra. En negativ inställning till denna patientgrupp är inte i enlighet med sjuksköterskans etiska kod och utgör ett hinder för god omvårdnad. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors upplevelser av att i sin professionella roll möta personer med substansberoende. Metod: En systematisk litteraturstudie av 10 studier med kvalitativ ansats. Sökningen genomfördes i databaserna PubMed, Cinahl samt PsycINFO. De kvalitetsgranskades och sammanställdes med inspiration av en modell för syntesprocess. Resultat: Fyra huvudteman framkom: a) misstro och negativ inställning till personer med substansberoende, b) kunskapsbrist och organisatoriska brister, c) hinder för god omvårdnad samt d) sympati och vilja att upprätta en god relation. Konklusion: Litteraturstudien visar att sjuksköterskor upplever flera brister och hinder inom omvårdnaden av personer med substansberoende. Det bidrar till att vård inte kan utföras i enlighet med etiska riktlinjer. Det finns behov av mer utbildning, kunskap och stöd i sjuksköterskornas yrkesroll samt vidare forskning för att kunna hitta förbättringsåtgärder som stödjer sjuksköterskan och kan förbättra vården för personer med substansberoende. Nyckelord: substansberoende, sjuköterskor, upplevelse, attityder, stigmatisering / Background: Nurses meet patients with substance use disorders in all forms of care settings. This is a stigmatized group that does not always receive care on equal terms as others. Negative attitudes towards this group are not in accordance with nurses ethical code and is a barrier for good nursing care. Aim: The aim of this systematic review was to illuminate nurses’ experiences of in their professional role encountering patients with substance use disorders. Method: A systematic review of 10 qualitative studies was performed. The search was made in the databases PubMed, Cinahl and PsycINFO. The studies were scrutinized for quality and compiled with inspiration of a model for synthesis. Results: Four major themes emerged; a) distrust and negative attitudes towards patients with substance use disorders, b) lack of knowledge and organizational deficiency, c) barriers for good nursing care, and d) sympathy and will to establish a good relationship. Conclusion: The systematic review shows that nurses experience many barriers in caring for patients with substance use disorders. This leads to inability to provide care according to the ethical guidelines. There is a need for more education, knowledge and role-support as well as further research to find improvements that support nurses’ and could improve the care for patients with substance use disorders. Keywords: substance use disorder, nurses, experience, attitudes, stigma