Univerzita Karlova v Praze 1. lékařská fakulta Studijní program: Specializace ve zdravotnictví Obor: Adiktologie Bc. et Bc. Kristýna Kopecká Nutriční návyky pacientů léčících se ze závislosti na alkoholu ve vybraných psychiatrických nemocnicích The Nutritional habits of Pacients Recovering From Alcohol Addiction in Selected Psychiatric Hospitals Diplomová práce Vedoucí práce: PhDr. Lenka Čablová PRAHA 2016 Abstract Introduction: Nutritional habits significantly affect the health and quality of life and they are an important part of a healthy lifestyle. Following nutritional recommendations is very important for the general population as well as for people recovering from alcohol dependence. One of the goals of treatment is improving the quality of life and well-balanced diet can actually help. Goals: The main objective of the research is to determine what are the eating habits of people recovering from alcohol dependence during their stay in selected psychiatric hospitals. Another objective is to determine the difference in eating habits of respondents before entering treatment and after entering treatment. The aim is also to describe the relationship between dietary habits and socio-demographic data. It is set as a sub-goal to also map the results of the YFAS questionnaire. Methods and sample: A tool...

Background: The psychology of behavior change and addictive substance users' motivation to get treatment is a topical issue in addictology. The reasons why patients enter treatment vary; they have different goals, and they differ in the degree to which they are able to reflect these goals. To understand addictive behavior, it is necessary to pay attention to all aspects that determine it, i.e. to recognize the abilities, opportunities and motivations of their behavior and their interaction. The topic of patient motivation at the very beginning of the institutional treatment process of addiction, i.e. when entering detox, was not given enough attention in the Czech Republic, despite the fact that detoxification is in many cases the first, indispensable step in starting medium-term and long-term residential treatment of addiction, and work with motivation is a method of direct work with patients. Aims: To map the motivation for treatment of addiction to addictive substances in patients voluntarily hospitalized at the Detox K20department at the Kosmonosy Psychiatric Hospital. To describe the characteristics of these patients, the differences in their motivation and compare their motivation in terms of socio-demographic data, preferential addictive substances, experience with addiction treatment and...

Social workers make decisions about client’s treatment. Problems arise when these assessments are not based on different needs, but rather a result of different biases towards gender. The purpose of this thesis is to study social workers in the addiction treatment field’s reasoning behind their justification concerning gender differences in their work. We used a vignette as a common reference for two group interviews and one individual interview, which were carried out on a social service office and an outpatient clinic. The interviews resulted in three forms of legitimacy: organizational requirements, professionalism and the will to do right. Organizational requirements refer to social workers relying on guidelines and research to justify their actions. Professionalism means that social workers reinforce their reasoning through previous experiences or other profession’s knowledge. The will to do right refers to the determination to live up to the ideals of society. Participants struggle with a complex and sometimes conflicting task, and to act justifiable they use reasoning based on different premises. The social workers are motivated and educated on the subject, and their goal is to make assessments based on individual needs. But it appears to be difficult to fully utilize these skills in practice

Introduction: Community pharmacists in the United States routinely serve as intermediaries in the process of providing (i.e., dispensing) prescription opioids (POs) to patients for whom they are prescribed. Similar to most states, Tennessee (TN) has experienced exponential increases in PO dispensing, abuse and overdose deaths over the past decade. A multifaceted approach has been put forth by the United States National Drug Control Strategy to combat PO abuse, one aspect of which is expanding the extent to which health care professionals detect and address substance use disorders. Despite little exploration of pharmacist provided PO abuse/misuse interventions, our previous research reveals that 26% of TN community pharmacists have provided addiction treatment facility information to one or more patients in the past, and 13% of pharmacists have addiction treatment facility information in their pharmacies. The objective of this study is to investigate the associations between community pharmacist and community pharmacy characteristics and the provision of addiction treatment facility information to pharmacy patients. Methods: A survey was administered to a stratified random sample of licensed TN pharmacists in 2012 using Dillman’s Tailored Design Method. The survey instrument assessed community pharmacists’ attitudes, beliefs and behaviors specific to prescription drug abuse communication. Logistic regression techniques were used to identify correlates of provision of addiction facility information by pharmacists. Results: A response rate of 40% was obtained. Univariate logistic regression analysis indicated the provision of addiction treatment information was associated with being male, increased average number of hours worked per week, having addiction treatment information readily available in the pharmacy, higher self-efficacy beliefs regarding ability to discuss addiction treatment facility options, discuss perceived PO abuse, and discuss perceived PO addiction with patients, participation in PO abuse specific continuing education (CE), and employment in an independent pharmacy setting. Multiple logistic regression analysis indicated that being male (OR = 2.2; 95% CI = 1.4-3.6), having high task-specific self-efficacy beliefs (OR = 4.2; 95% CI = 2.7-6.5), working more hours (OR = 1.00; 95% CI = 1.02-1.05), participating in prescription drug abuse-related CE (OR = 2.9; 95% CI = 1.7-5.0), and having treatment facility information in the practice setting (OR = 8.2; 95% CI = 4.4-15.4) were statistically significant predictors of information provision. Implications: As interventions and models are developed that expand prevention and treatment efforts, factors should be considered that influence health care providers’ prescription drug abuse/misusedeterrent behaviors. Our research has the potential to inform these interventions and thereby expand the extent to which community pharmacists engage in the detection and care of patients with substance use disorders.

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Många människor går in och ut ur olika missbruksprogram utan att bli fria från sitt missbruk på sikt. Frivilligsektorn har alternativa hjälpinsatser att erbjuda men frågan är vad dessa hjälpinstanser, som AA och frikyrkan, gör som individerna själva upplever vara till hjälp. Tidigare forskning har inte svarat på frågan varför individer väljer att söka sig till hjälpinstanser som dessa när det finns missbruksvård inom offentlig sektor att tillgå. Syftet med denna studie var att undersöka människor med bakomliggande missbruksproblematiks upplevelser av hjälp från Anonyma Alkoholister (AA), frikyrkan eller missbruksvården inom offentlig sektor, för att få en uppfattning om vad som faktiskt har fungerat för dessa människor. Studien är kvalitativ, hermeneutisk och bygger på semistrukturerade intervjuer med sju informanter. Studien visar att faktorer som gemenskap, ökad självkänsla, nya identiteter och andlighet varit betydelsefulla för informanternas varaktiga drogfrihet. Studiens slutsats är att informanterna från AA och frikyrkan upplever en högre grad av dessa faktorer i den hjälp de fått än informanterna som fått hjälp från offentlig sektor, faktorer som i studien kopplats till teorier rörande identitet, empowerment och trygghet i strukturer och fostran eller i att lägga sitt liv i Guds händer. Denna studie kan bidra med nya perspektiv som missbruksvården inom offentlig sektor kan ha nytta av för att bättre anpassa missbruksarbetet till individernas behov. / Many people go in and out of addiction programs without any long lasting results. The voluntary sector provides an alternate help to this group. If we look from the perspective of the individual, the question is what the organizations in the voluntary sector do provide that is helping the individual to become free from abuse? Existing research does not answer the question of why individuals choose to turn to organizations in the voluntary sector, like AA and the Free Church, when there is addiction treatment to be received through the public sector. This study aims to examine the experiences of people with substance abuse when receiving help from Alcoholics Anonymous, the Swedish Free Church and the traditional addiction treatments of the public sector, to gain an understanding of what has been working for these people. This is a qualitative, hermeneutic study based upon semi-structured interviews with seven interviewees. The study displays that factors such as fellowship, enhanced self-esteem, new identities and spirituality are important for them to be continuously abstinent. The result of the study shows that the interviewees from AA and the Free Church experiences that the help they received provide them with a stronger sense of these factors than the interviewees from traditional addiction treatment experiences. These factors are in this study connected with theories involving identity, empowerment and sense of security in ruling, frames and fosterage or relying on God. This study can contribute with new perspectives that the traditional addiction treatment can find useful to adjust the treatment to the needs of the individuals.

Bakgrund: Bakgrunden beskriver hur sjuksköterskor bemöter patienter med missbruk och beroende. Den beskriver även vikten av en främjande vårdrelation samt hur patienter med missbruk och beroende önskar bli bemötta av sjuksköterskor inom beroendevård. Syfte: Syftet var att beskriva sjuksköterskors uppfattningar av att vårda patienter med missbruk eller beroende med fokus på bemötandet i vårdrelationen. Metod: Fem sjuksköterskor, yrkesverksamma inom beroendevård, intervjuades. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Resultatet läggs fram genom två kategorier, Sjuksköterskors beskrivningar av hur de förhåller sig till patienter med missbruk eller beroende.  Denna kategori har fem subkategorier. Den andra kategorin är Sjuksköterskors önskan att göra gott för patienter med missbruk eller beroende.  Denna kategori har två subkategorier. Resultatet visar att sjuksköterskor ibland kan bidra till stigmatisering av patienterna. Resultatet visar även att sjuksköterskorna önskar bekräftelse, både yrkesmässig och personlig. Diskussion: Resultatet diskuteras utifrån Ida Jean Orlandos interaktionsteori samt övrig relevant litteratur. Diskussionen kretsar kring hur sjuksköterskornas förhållningssätt på olika sätt får konsekvenser för vårdrelationen. / Background: The background describes how nurses treat patients with substance abuse and addiction. It also describes the importance of promoting caring relationship and how patients with substance abuse and addiction wish to be treated by nurses in addiction care. Aim: The aim was to describe nurses' perceptions of caring for patients with substance abuse or addiction, with a focus on the hospitality of the caring relationship. Method: Five nurses, professionals in addiction care, were interviewed. The material was analyzed using qualitative content analysis. Results: The results are presented in two categories, Nurses' descriptions of how they relate to patients with substance abuse or dependence. This category has five subcategories. The second category is the Nurses' desire to do good for patients with substance abuse or dependence. This category has two subcategories. The results show that nurses sometimes may contribute to the stigmatization of patients. The result also shows that the nurses want confirmation, both professional and personal. Discussions: The results are discussed from Ida Jean Orlando interaction theory and other relevant literature. The discussion revolves around how nurses´ approach in different ways has implications on the caring relation.

I denna uppsats beskrivs situationen för mångbesökarna inom missbruks- och beroendevården. Kvalitativt intervjumaterial belyser upplevelser och erfarenheter som rör deras beroendeproblematik. De bär alla på någon form av samsjuklighet och återkommer till psykiatriska intensiv- och akutmottagningen för avgiftning på sjukhus. Att hitta sätt att avlasta den mentala smärtan är ledande genom berättelserna tillsammans med uttalade behov av att bli lyssnade på och av att bli tagna på allvar. Genom makt att påverka sin situation och kraft att förändra den i gemenskap med andra kan de lindra sin ohälsa. Pendlingen mellan nedbrytning och uppbyggnad tär på både kropp och själ, samtidigt som vården de erhåller gör att de känner sig fångade i ett ekorrhjul. Att fokusera på självuppfattning kan leda till banbrytande förändringsmöjligheter och återuppbyggnad genom att ta hänsyn till hela människans potential. Teorier kring emotionell energi, skam och stolthet förklarar hur detta är möjligt. / In this study the situation for frequent attenders at substance abuse and addiction carefacilities is described. Qualitative interview data illustrates their experiences related to substance abuse. They all carry some form of co-morbidity and recurrence of psychiatric intensive care with detoxification in hospital. Finding ways to relieve mental illness is ever present in their narratives, along with the expressed needs to be listened to and to be taken seriously. The power to influence their situation and the power to change it in community with others, can relieve their illness. Commuting between formation and degradation depletes body and soul, while the care they receive makes them feel like they are caught in a ratrace. Focusing on selfperception could lead to groundbreaking opportunities for change and reconstruction by taking into account their full human potential. Theories of emotional energy, shame and pride explains how this is possible.

The work points to the possible causes of drug addiction, and how from drug addiction can be cured. What are the centers for drug addicts and what offering.Practical part is formed by using case studies with individuals who are addicted to marijuana and methamphetamine.

Peniston and Kulkosky (1989, 1990) demonstrated the effectiveness of alpha-theta EEG-Biofeedback (EEG-BFB) in treating inpatient alcoholics noting significant improvements in depression, psychopathology, serum β-endorphin levels, and abstinence rates. The present study is an extension of a previously unpublished replication of the Peniston EEG-BFB protocol with 20 chemically dependent outpatients (Bodenhamer-Davis, Callaway, & DeBeus, 2002). Fifteen subjects were "high risk for re-arrest" probationers. Data for the EEG-BFB group was collected from archival records. Subjects completed an average of 39 sessions (SD = 6.096), with 33 of those being EEG-BFB. Pre/post-treatment MMPI-2s™ (University of Minnesota) were collected and follow-up (4-11 years) data obtained (abstinence rates, re-arrests in some cases). Treatment effects were evaluated by comparing assessment data (pre/post) and documenting abstinence rates. Post-treatment MMPI-2 results were within normal limits, with several scales significantly reduced from baseline suggesting less psychopathology. Results were then compared to 20 subjects receiving standard addiction treatment (OT-CD group), but not EEG-BFB. OT-CD subjects completed a 2-week inpatient program followed by 18 outpatient sessions. Pre/post assessment and follow-up data was collected on the OT-CD group. The OT-CD group's post-assessment results showed three elevations (MMPI-2 scales 4/6/8), suggestive of characteriological problems. Post-MMPI-2 results of the two groups were compared via ANCOVAs. Findings indicated no significant differences between groups on targeted scales; however, there was a trend for the EEG-BFB group to have lower scores. Follow-up data was obtained on 13 EEG-BFB subjects. Results indicated 92% (n = 12) were sober, with 8% (n = 1) claiming significantly reduced alcohol intake. Probationer re-arrest and revocation rates were collected on the subset of probationers (n = 14 out of 15). The majority of the probationers (79%, n = 11) had not been re-arrested nor had their probation been revoked. Short-term follow-up information (35-131 days post-assessment), available at the time of writing, for the OT-CD group (N = 13) showed 85% (n = 11) were sober, with 15% (n = 2) relapsed. Limitations and implications of the study are discussed.