Background: Under-reporting of alcohol consumption is a widespread and persistent problem in surveys worldwide. For Great Britain in 2010, 56% of alcohol sold was reported consumed. Under-reporting occurs for reasons, including, but not limited to: selective reporting, mode effects, recall bias, and under-estimation. Methods: Secondary analyses of Health Survey for England (HSE) 2008 (n=9,608) and General Lifestyle Survey (GLF) 2008 data (n=12,490) to estimate population level alcohol consumption with under-reporting taken into account. Secondary analyses of the HSE 2011 (n=3,774) to highlight possible risk factors for under-reporting of alcohol consumption in retrospective interview compared with prospective drinking diary. Qualitative semi-structured interviews (n=10) with HSE 2011 drinking diary participants to identify further potential risk factors. Self-completion questionnaire and pouring task with a convenience sample (n=283) to explore under-estimation of home drinking. Results: After accounting for under-reporting, 40% men and 30% women drank above weekly guidelines, an increase of over 10% points (GLF 2008). On the heaviest drinking day in the last week 75% men and 80% women drank above daily limits, compared with around half in the original survey (HSE 2008). Risk factors for prospective diary measures exceeding those of the retrospective interview were: weekly alcohol intake, number of drinking days, drinking a combination of drink types, and drinking exclusively in licensed premises (HSE 2011). Qualitative interviews identified having a non-routine drinking pattern and not using alcohol units to track consumption as linked to drinking more in the prospective diary than expected. The pouring task did not identify systematic under-estimation of a usual glass; however under-estimation was associated with increasing volume poured. Conclusions: Under-reporting of alcohol consumption has implications for public health research and policy. In three studies, alcohol-related factors were associated with under-reporting of alcohol consumption whereas demographic and social factors were not. Targeted interventions and policies may reduce under-reporting.

The clinical data for the studies was collected at The PROMIS Recovery Centre, a Minnesota Model treatmentc entre for addictions,w hich encouragesth e membership and use of the 12 step Anonymous Fellowships, and is abstinence based. The area of addiction is contextualised in a review chapter which focuses on research relating to the phenomenon of cross addiction. A study examining the concept of "addictive orientations" in male and female addicts is described, which develops a study conductedb y StephensonM, aggi, Lefever, & Morojele (1995). This presents tudy found a four factor solution which appeared to be subdivisions of the previously found Hedonism and Nurturance factors. Self orientated nurturance (both food dimensions, shopping and caffeine), Other orientated nurturance (both compulsive helping dimensions and work), Sensation seeking hedonism (Drugs, prescription drugs, nicotine and marginally alcohol), and Power related hedonism (Both relationship dimensions, sex and gambling. This concept of "addictive orientations" is further explored in a non-clinical population, where again a four factor solution was found, very similar to that in the clinical population. This was thought to indicate that in terms of addictive orientation a pattern already exists in this non-clinical population, and that consideration should be given to why this is the case. These orientations are examined in terms of gender differences. It is suggested that the differences between genders reflect power-related role relationships between the sexes. In order to further elaborate the significance and meaning behind these orientations the next two chapters look at the contribution of personality variables and how addictive orientations relate to psychiatric symptomatology. Personality variables were differentially, and to a considerable extent predictably involved with the four factors for both males and females.C onscientiousnesws as positively associatedw ith "Other orientated Nurturance" and negatively associated with "Sensation seeking hedonism" (particularly for men). Neuroticism had a particularly strong association with the "Self orientated Nurturance" factor in the female population. More than twice the symptomatology variance was explained by the factor scores for females than it was for males. The most important factorial predictors for psychiatric symptomatology were the "Power related hedonism" factor for males, and "Self oriented nurturance" for females. The results are discussed from theoretical and treatment perspectives.

Thesis (M.S.)--Boston University

This study represents the first phenomenological investigation of problem gambling. The subjective experiences of six problem gamblers are explored. Heideggerian, hermeneutic phenomenology provides the constructs and framework that underpin this research. Four themes, each reflecting the participants' experiences, emerged from conversations conducted. These themes were: being alone, buying time, magical thinking and critical voices - themes are independent and have no ranking. The study articulates the needs of problem gamblers, as well as providing an opportunity for them to be heard. It allows health professionals to gain insight into underlying problems. The implications of the findings for the participants, health professionals and government are discussed / Doctor of Philosophy (PhD)

A literature review revealed the strong evidence that youth aged 16 to 25 years (World Health Organisation, 1989) in many jurisdictions world-wide report experiencing significant harmful impacts arising from gambling. The exact nature and prevalence of these impacts and the processes that underlie their origins remain obscure in part because of the common assumption that measures and criteria developed with adult populations may be applied to youth. Therefore, the approach adopted in this doctoral sequence of empirical studies was to focus on the core addictive construct of self-control (Heather, Miller and Greeley, 1991) using in the first instance a qualitative data analysis of 34 youth who gambled regularly at least once per week. The main cognitive themes from the interviews were used to develop a Limit Maintenance Model which outlined five qualitatively different approaches to the control of gambling. With certain aims in mind, three empirical studies provided a mixed-methods approach to identifying the cognitive, emotional and developmental barriers to self-control of gambling. In so doing, they emphasized the imperative for youth to embark on a learning process to ensure their self-regulatory skills are sufficiently developed to manage the temptation to gamble to excess, and instead, maintain self-controlled and safe gambling behaviours. / Doctor of Philosophy (PhD)

Gambling availability has increased as well as the number of people gambling. Within gambling, addiction has become a growing problem, affecting both the gambling business as well as the individuals. This situation forces companies to balance their profit with responsible action in order to prevent gambling addiction. This thesis examines why and how gambling companies differ in their methods to help players avoid addiction in order to establish a sustainable society. A multiple case-study has been carried out, where three gambling companies have been examined and analyzed. The companies are Svenska Spel, Norsk Tipping and Unibet. The survey is based on interviews with representatives from the companies working in the departments of Responsible gambling or CSR. The conclusions of this study show that gambling companies can profit both economically and establish good will, if they show responsibility. Gambling companies differ in how they handle addiction, mainly because of diffuse concepts as CSR and Responsible Gambling. If gambling companies cooperate actively between themselves as well as with research of addiction, a balanced, sustainable society may be reached. Discussions of solving the problem of gambling addiction can preferably continue in order to reach a sustainable society.

BACKGROUND: Historically, the addiction field used total abstinence as the primary marker of recovery. Although harm reduction is increasingly accepted, abstinence remains a primary treatment outcome and central goal of mutual aid groups. Recovery research often measures success primarily in terms of abstinence. This focus limits knowledge about recovery progress and outcomes for non-abstinent individuals and the field’s ability to support this population. This dissertation advances research in the field because it studies a community, rather than a treatment sample; it focuses on early recovery, which is a crucial period in the recovery trajectory; and studies a rarely researched population – individuals who identify as having resolved an addiction and are non-abstinent. AIMS: This three-paper dissertation explores insights into the perceptions of individuals in a community sample about their experiences in early recovery. The first two papers used data from a survey to achieve the following aims: (1) Recruit a sample of abstinent and non-abstinent individuals with diverse substance use and treatment histories; (2) Compare abstinent and non-abstinent participants’ responses to the pre-screen questionnaire; (3) Compare participants’ addiction and treatment history and mental health and wellness (e.g., depression and difficulty regulating emotions) by abstinence-status. The third paper used interview data to achieve the following aims: (1) Explore motives for cannabis substitution; (2) Describe the experience of using cannabis; and (3) Examine whether cannabis use supported or harmed recovery. METHODS: The Socioecological Framework and Harm Reduction principles provided the theoretical and philosophical underpinnings for this dissertation. Participants completed online surveys about substance use, mental health, and life experiences known to impact recovery (e.g., addiction-stigma, racial and ethnic discrimination). Individuals were eligible for the study if they self-identified as having “resolved an addiction” evidenced by (1) reduced use, OR (2) reduced negative consequences, OR (3) improved social or occupational experiences. I recruited interview participants by posting advertisements on Facebook and Reddit in groups specifically related to addiction and recovery. Participants were eligible who reported that they had resolved an addiction to opioids or stimulants and subsequently increased their cannabis use (i.e., cannabis substitution). I analyzed the pre-screen questionnaire data via content analysis. Descriptive statistics and regression models were computed in SAS. I took a grounded theory approach to analyzing the interview data. First, I coded the data deductively for motivations in the Motivational Model and characterization of substitution effects. Then I coded inductively for emergent themes including additional motives (e.g., to manage withdrawal). RESULTS & DISCUSSION: Criteria for self-identification of resolving an addiction successfully enrolled abstinent and non-abstinent adults (N=267). Forty-five percent reported abstinence; the most common primary substances were alcohol (46%), opioids (23%), and stimulants (17%). Surprisingly, pre-screen responses about resolving an addiction did not differ according to abstinence-status. In bivariate analysis, abstinent participants had more often been to treatment and mutual aid groups, however there was no difference in past use severity. In regression modeling, abstinence-status was not associated with depression, though it was associated with difficulty regulating emotions. These results suggest that abstinence-status affects distinct mental health outcomes differently, and that positive recovery experiences may be achievable in some domains for non-abstinent adults. In paper three, interview participants (N=14) revealed a series of motives for cannabis use, including those identified in the Motivational Model and those that emerged from the data. Participants viewed cannabis use as compatible with their recovery. Though many participants reported negative side effects, for example increased social anxiety, they did not believe these outweighed the benefits of cannabis use. CONCLUSIONS: Counter to common assumptions in the addiction field about the necessity of abstinence in recovery, survey responses from both abstinent and non-abstinent participants proved to be more similar than different. Insight into how these groups perceive the process of resolving an addiction (1) enhance our understanding of recovery, including non-abstinent recovery, and (2) can facilitate engagement with individuals resolving addictions, even when abstinence is not one of their identified goals. The interview data offered additional insights into the role of cannabis in non-abstinent recovery, demonstrating its potential to support individuals during cravings. Clinicians in addiction treatment settings and other medical and mental health settings who see clients who are working on recovery can benefit from the findings reported here by supporting their clients regardless of the client’s abstinence goals. / 2025-10-24T00:00:00Z

No description available.

L’objectif de ce travail de thèse était d’évaluer la faisabilité, l’acceptabilité et de fournir des résultats préliminaires du programme MBRP (Mindfulness Based relapse prevention) pour le traitement des addictions. Dans un premier lieu ce travail nous a permis de démontrer que ce programme représentait un type de prise en charge thérapeutique acceptable et faisable pour le traitement du trouble de l’usage de l’alcool. La participation au programme augmentait le niveau de pleine conscience et de flexibilité psychologique et réduisait le craving. Ensuite, nous avons pu identifier que la pratique à domicile, occupant une place centrale dans les traitements basés sur la pleine conscience, était facilitée par la motivation initiale des participants et de leur sentiment d’auto-efficacité quant à la capacité de mettre en place une pratique, à l’inverse, l’impression de « mal faire » ou l’absence d’effets immédiats de la pratique présentait un frein à la pratique autonome. Nous avons également pu rendre compte de l’intérêt de ce programme pour le traitement du trouble lié à la pratique de jeu d’argent et de hasard. A travers nos résultats descriptifs, nous avons pu montrer que la méditation de pleine conscience était un outil dont la majorité des patients joueurs se saisissaient volontiers pour gérer les envies de jeu et l’impulsivité. Nous avons trouvé que la participation au programme a permis de réduire la pratique de jeu, les symptômes de jeu, le craving, ainsi que les symptômes dépressifs et anxieux et augmenter le niveau de pleine conscience. Par ailleurs nous avons pu montrer à travers un cas clinique, que l’association de la pratique de pleine conscience et de training cognitif, pouvait représenter une prise en charge complémentaire et augmenter le contrôle de soi, chez une patiente résistante aux TCC classiques. Nous avons également montré que l’initiation à la pleine conscience chez des soignants travaillant dans le domaine de l’addictologie a été très bien accueillie, qu’en moyenne ils ont participés à 4 séances sur 5 et qu’ils ont tous mis en place une pratique autonome après l’initiation en groupe. Pour finir nous avons validé le Transdiagnostic Craving Trigger Questionnaire (TCTQ) visant à évaluer les déclencheurs de craving, dans une population présentant un trouble de l’usage de l’alcool. Nos analyses ont montré une solution à trois facteurs, les émotions désagréables, les émotions agréables et les déclencheurs externes et pensées associées aux consommations. Finalement ce travail de thèse nous a permis de conclure que le programme MBRP est un programme qui a tout son intérêt pour le traitement des addictions avec ou sans substances. Nous avons pu montrer qu’il agissait sur des processus sous-jacents de cette pathologie tels que les affectes dépressifs et l’anxiété, qu’il permettait de réduire le craving et qu’il mobilisait des ressources telles que la flexibilité psychologique. Nous avons l’objectif de conduire des travaux supplémentaires afin de pouvoir statuer sur son efficacité en comparaison à une condition contrôle. / The purpose of this work was to investigate feasibility, acceptability and preliminary outcomes of the MBRP (Mindfulness Based relapse prevention) program as a treatment of addictions. First, this work allowed us to establish that this program represented an acceptable and feasible therapeutic approach as a treatment for alcohol use disorders and that it increased the level of mindfulness and psychological flexibility and reduced craving. Secondly, we were able to identify that home practice, which is central to mindfulness-based treatments, was facilitated by the participants' initial motivation and their feeling of self-efficacy in terms of their ability to set up a practice, while the impression of "doing wrong" or the absence of immediate effects of the practice was a barrier to it. We have also been able to highlight the interest of this program as a treatment for gambling disorder. Through our descriptive results, we showed that mindfulness meditation was a tool that most gamblers readily used to manage craving and impulsive behavior. In addition, we found that participating in the program reduced gambling, gambling symptoms, craving, as well as depression and anxiety and increased mindfulness levels. In addition, we were able to show by examining a case report that the combination of the MBRP program and cognitive training could increase self-control in a patient who was resistant to conventional CBTs. We have also shown that the initiation to mindfulness among caregivers working in an addiction facility has been very well received. On average they participated in 4 out of 5 sessions and, all set up a personal home practice after the group initiation. Finally, we validated the Transdiagnostic Craving Trigger Questionnaire (TCTQ) to assess craving triggers in a population with an alcohol use disorder. Our analyses showed a three-factor solution, composed of unpleasant emotions, pleasant emotions and external triggers and associated thoughts. This thesis work allowed us to conclude that the MBRP program has a strong interest in the treatment of addictive disorders, with or without substances. We were able to show that it worked on underlying processes of this disorder, such as depression and anxiety, that it reduced craving and that it was a way of mobilizing resources, such as psychological flexibility. Our objective is to carry out further research which would allow us to state on its efficacy as compared to a control condition.

A relação entre drogas e psicanálise tem um entrelaçamento desde o início do projeto freudiano. A criação da psicanálise se deu logo após o envolvimento de Freud com a polêmica da cocaína e seus decorrentes embates políticos. Nessa época, questões ligadas à moralidade e ao papel da ciência em nossa sociedade começavam a entrar em xeque, por consequência do avanço tecnológico e da preocupação com a gestão dos hábitos de populações que viviam em um mundo imerso em novas possibilidades de satisfação, comercializadas enquanto soluções para o enfrentamento do mal-estar da civilização. Nossa pesquisa busca apresentar quais fatores presentes na constituição do sujeito moderno contribuem para a formação do problema das adicções, assim como mostrar que a abordagem da psicanálise sobre o assunto pode ter ignorado aspectos fundamentais para o enfretamento do problema. Por meio da teoria pulsional de Freud e da teoria de sujeito desenvolvida por Jacques Lacan, realizamos uma leitura crítica das proposições fundamentais da psicanálise sobre as drogas, a saber, a noção de autoerotismo e também a droga como elemento antissocial. Como fundamentação desta crítica, propomos uma leitura do superego presente nas adicções enquanto mecanismo integrante do que Marshall Berman cunhou de desenvolvimento fáustico. A leitura de Berman nos proporciona uma visão na qual os efeitos colaterais do desenvolvimento capitalista repercutem nas adicções enquanto problema social, possibilitando identificar como o papel das drogas em nossa sociedade possui aspectos ignorados pela formulação da teoria psicanalítica até então. Dentre esses aspectos, identificamos os lugares do trabalho e das condições sociais como fatores fundamentais no entendimento das adicções. Como resposta às teorias existentes e como proposição clínica, recorremos à formulação teórica de Nathalie Zaltzman sobre o que a mesma denominou de pulsão anarquista, constructo o qual a psicanalista direciona à clínica de situações limite. Por fim, apresentamos algumas vinhetas clínicas que servem de suporte para as reflexões e rearranjos teóricos na abordagem psicanalítica sobre o tema. Passagens que foram extraídas de experiências de trabalho no âmbito da saúde pública e em atendimentos em consultório particular compõem as modulações transferenciais, categorias que utilizamos para compreender as diferentes configurações de demandas clínicas em torno da questão das drogas e seus possíveis direcionamentos. Com o suporte das vinhetas clínicas, pudemos apontar os limites que se situam entre as drogas e os profissionais que acolhem os pacientes com essa demanda, estabelecendo uma interpretação do fenômeno da fissura, no qual a satisfação tóxica pode até ser imprescindível, mas não é suficiente / The relationship between drugs and psychoanalysis has an interlacing since the beginning of the Freudian project. The creation of psychoanalysis occurred right after the involvement of Freud with the controversy of cocaine and its resulting political clashes. At that time, issues of morality and the role of science in our society began to come into question, as a result of technological advancement and the concern for the management of habits of populations that lived in a world steeped in new possibilities of satisfaction, sold as solutions to face the malaise of civilization. Our research aims to show which factors present in the constitution of modern subject contribute to the formation of the addictions problem, as well as show that the approach of psychoanalysis on the subject may have ignored key aspects to face the problem. Through the drive theory of Freud and the theory of subject developed by Jacques Lacan, we conducted a critical reading of the fundamental propositions of psychoanalysis on drugs, namely, the notion of self eroticism and also the drug as an anti-social element. In support to this criticism, we propose a reading of the superego present in addictions as an integral mechanism that Marshall Berman coined the Faustian development. The Berman reading gives us a vision in which the side effects of capitalist development have repercussions on addictions as a social problem, making it possible to identify that the role of drugs in our society has aspects that were overlooked by the formulation of psychoanalytic theory so far. Among these aspects, we have identified the places of work and social conditions as key factors in the understanding of addictions. In response to existing theories and as a clinical proposition, we used the theoretical formulation of Nathalie Zaltzman about what she called the anarchist drive, construct which the psychoanalyst directs to the limit situations clinic. Finally, we present some clinical vignettes that support the reflections and theoretical rearrangements in the psychoanalytic approach to the subject. Passages that were extracted from work experience in the field of public health and in private practice care compose the modulations transference, categories that we use to understand the different settings of clinical demands on the issue of drugs and their possible directions. With the support of clinical vignettes, we could point out the limits that are among the drugs and the professionals who receive patients with this demand, establishing an interpretation of the phenomenon of craving, in which the toxic satisfaction may even be essential, but is not enough