Background: Prevalence and characteristics of fetal alcohol syndrome (FAS) and total fetal alcohol spectrum disorders (FASD) were studied in a second sample of three South African rural communities to assess change. Methods: Active case ascertainment focused on children with height, weight and/or head circumference <= 25th centile and randomly-selected children. Final diagnoses were based on dysmorphology, neurobehavioral scores, and maternal risk interviews. Results: Cardinal facial features, head circumference, and total dysmorphology scores differentiated specific FASD diagnostic categories in a somewhat linear fashion but all FASD traits were significantly worse than those of randomly-selected controls. Neurodevelopmental delays were significantly worse for children with FASD than controls. Binge alcohol use was clearly documented as the proximal maternal risk factor for FASD, and significant distal risk factors were: low body mass, education, and income; high gravidity, parity, and age at birth of the index child. FAS rates continue to extremely high in these communities at 89-129 per 1000 children. Total FASD affect 196-276 per 1000 or 20-28% of the children in these communities. Conclusions: Very high rates of FASD persist in these general populations where regular, heavy drinking, often in a binge fashion, co-occurs with low socioeconomic conditions.

The purpose of the study was to create an increased knowledge and understanding of young adults’ experiences from growing up as a child in a family with alcohol abuse, as well as studying long-term consequences of this. In the study five qualitative interviews were conducted, with young adults who grew up with a parent who abused alcohol. The results of the study were analyzed by Bronfenbrenner's developmental ecological model, as well as by the theoretical concepts risk, protective factors and resilience. Results and conclusions showed, that all informants experienced negative consequences during childhood and in adult life, due to the parent’s abuse. The families of the informants were characterized by an abnormal use of alcohol during their childhood, which led to a high level of conflict, lack of relationships, a major responsibility at home for the informants, negative health effects and school difficulties. The young adults stated, that they are living a good life today, but that childhood has made its mark in their minds. The informants narrated experienced health problems, difficulties with feeling trust and expressing how they feel as well as a lack of relation to the parent with addiction. / Studiens syfte var att skapa en ökad kunskap och förståelse för unga vuxnas erfarenheter att som barn växa upp i en familj med alkoholmissbruk, samt att studera långtidskonsekvenser av detta. I studien genomfördes fem kvalitativa intervjuer med unga vuxna, som vuxit upp med en förälder som missbrukat alkohol. Studiens resultat analyserades genom Bronfenbrenners utvecklingsekologiska modell samt begreppen risk- och skyddsfaktorer och resiliens. Resultat och slutsatser visade att samtliga informanter upplevt negativa konsekvenser under barndomen och i det vuxna livet, till följd av förälderns missbruk. Informanternas familjer karaktäriserades under uppväxten av ett onormalt bruk av alkohol, vilket medförde en hög konfliktnivå, bristande relationer, ett stort ansvarstagande hemma för informanterna, negativa hälsoeffekter och skolsvårigheter. De unga vuxna uppgav att de idag lever ett bra liv, men att barndomen har satt sina spår. Informanterna berättade om upplevda hälsoproblem, svårigheter med tillit och att uttrycka känslor samt en bristande relation till föräldern med missbruk.

Hintergrund: Die Psychotherapierichtlinien ermöglichen erst seit 2011 unter bestimmten Bedingungen eine ambulante psychotherapeutische Behandlung bei Substanzstörungen. Empirische Ergebnisse zu diagnostischen Charakteristika der auf dieser Grundlage behandelten Patienten und zu Erfolgsraten fehlen weitgehend. Methoden: Wir untersuchten N = 59 konsekutive Patienten einer Spezialambulanz, von denen n = 34 eine Behandlung begannen (Intent-to-Treat(ITT)-Stichprobe) und n = 28 sie abschlossen (Completer), mit standardisierten diagnostischen Interviews und ermittelten die Erfolgsraten nach ambulanter Kognitiver Verhaltenstherapie (Einzeltherapie) auf der Basis von Symptomskalen (Brief Symptom Inventory (BSI); Beck Depression Inventory (BDI)) sowie Patienten- und Therapeuten-Ratings, einschließlich einer klinischen Beurteilung der Abstinenz. Ergebnisse: 40% aller anfragenden Patienten nahmen keine Psychotherapie auf. Bei den behandelten Patienten kam es zu signifikanten Veränderungen (ITTAnalysen: d = 0,8 (BSI) bis d = 1,2 (BDI)). Mehr als zwei Drittel der Patienten erreichten eine klinisch relevante Verbesserung der Symptomatik gemäß Patienten- oder Therapeutenbeurteilungen (zwischen 68 und 76%, ITTStichprobe). Alle Completer mit Abhängigkeitssyndrom (n = 11) sowie 86% der diesbezüglichen ITT-Stichprobe erreichten zumindest unter der Behandlung eine Abstinenz. Schlussfolgerungen: Die Erfolgsraten bei Patienten, die die Therapie abschließen, sind gut. Sie sprechen für den Nutzen des ambulanten Settings. / Effectiveness of Outpatient Cognitive-Behavioral Therapy for Substance Use Disorders – Evaluation of a Specialized Outpatient Clinic Background/Aim: Given a number of conditions, the revision of the German psychotherapy guidelines in 2011 facilitates treating substance use disorders in outpatient psychotherapy. Empirical results on the diagnostic characteristics of the patients treated within this setting and about the effectiveness of the treatment are lacking. Material and Methods: We examined N = 59 consecutive patients, diagnosed with standardized diagnostic interviews, of a specialized outpatient clinic for cognitivebehavioral therapy. Of these, n = 34 started the treatment (intent-to-treat (ITT) sample) and n = 28 completed it. The outcome (including clinical judgement of abstinence) was assessed with established symptom scales (Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI)) as well as therapist and patient ratings. Results: About 40% of the patients who contacted the clinic did not start the therapy. In therapy completers, clinically relevant improvement was reached. Based on ITT analyses, effect sizes ranged from d = 0.8 (BSI) to d = 1.2 (BDI). Based on therapist and patient ratings, the percentage of successful therapies was high (between 68 and 76%, ITT analyses). All therapy completers diagnosed with a dependence syndrome reached abstinence at least temporarily. Conclusion: Effectiveness rates are high in completers. These results show that treatment can be efficient in an outpatient setting.

MPM / Oliver Tambo Institute of Governance and Policy Studies / See the attached abstract below

The aim of this study is to examine how active participants in Alcoholics Anonymous experience the importance of social support and motivation within the group to maintain sobriety, and how this was affected by the covid-19 pandemic. The purpose is answered based on two questions: What significance does social support and motivation have for individual participants in Alcoholics Anonymous for maintaining sobriety? What opportunities have existed to provide continued social support during the pandemic and has the pandemic affected the motivation of the individual participants? The study uses a qualitative method consisting of semi-structured interviews with two active participants in Alcoholics Anonymous and six active participants who hold a position of trust as group service representatives in Alcoholics Anonymous. Theories we have used in our analysis of the collected material are Randall Collins' theory of social support, Interaction Rituals and Richard Ryan and Edward L. Deci´'s motivation theory, Self-Determination Theory. The results depict varying experiences about the importance of social support and motivation and to what extent the covid-19 pandemic has affected the individuals and groups. All respondents describe how the community was experienced more strongly during the pandemic as cooperation between participants was required to a greater extent. The contact between participants outside of meetings is described as significant, to enable continued social support. Common to all respondents is the importance of community and participants during meetings to maintain motivation for sobriety. The respondents describe how the social support and motivation did not affect the community as a whole during the pandemic. Furthermore, a majority of the respondents feel that the pandemic had an impact on individual participants who for various reasons did not have the opportunity, or chose not to attend meetings as a result of the pandemic. / Syftet med studien är att undersöka hur aktiva deltagare inom Anonyma alkoholister upplever betydelsen av socialt stöd och motivation inom gruppen för att bibehålla nykterhet, samt hur detta påverkats av covid-19 pandemin. Syftet besvaras utifrån två frågeställningar: Vilken betydelse har socialt stöd och motivation för enskilda deltagare inom Anonyma alkoholister för bibehållen nykterhet? Vilka möjligheter har funnits att tillhandahålla ett fortsatt socialt stöd under pandemin och har pandemin påverkat motivationen hos de enskilda deltagarna? I studien anläggs en kvalitativ metod beståendes av semistrukturerade intervjuer med två aktiva deltagare inom Anonyma alkoholister och sex aktiva deltagare som innehar ett förtroendeuppdrag som gruppservicerepresentanter inom Anonyma alkoholister. Teorier vi har utgått från i vår analys av det insamlade materialet är Randall Collins teori kring socialt stöd, Interaktionsritualer samt Richard Ryan och Edward L. Deci´s motivationsteori, Self-Determination Theory. Resultatet skildrar varierande upplevelser kring betydelsen av socialt stöd och motivation samt till vilken mån covid-19 pandemin påverkat de enskilda individerna och grupperna. Samtliga respondenter beskriver hur gemenskapen upplevts starkare under pandemin då det till högre mån krävts ett samarbete mellan deltagare. Kontakten mellan deltagare utanför möten beskrivs som betydande, för att möjliggöra ett fortsatt socialt stöd. Gemensamt för samtliga respondenter är betydelsen av gemenskap och deltagande under möten för att bibehålla motivation till nykterhet. Respondenterna beskriver hur det sociala stödet och motivationen inte påverkat gemenskapen som helhet under pandemin. Vidare upplever en majoritet av respondenterna att pandemin haft en påverkan på enskilda deltagare som av skilda anledningar inte haft möjlighet, eller valt att inte delta på möten till följd av pandemin.

The aim of this study was to understand what meaning the discretion of swedish social workers has for how support is given to pregnant women with alcohol or substance abuse. Initially in the work with this study we searched for previous research about social workers professional experiences in contact with pregnant women with alcohol and/or substance abuse. The previous research that we present in this study describe the subject from different point of views such as custodial care, working methods, cooperation and discretion. We also learned the theoretical meaning of discretion. To achieve the aim we also did our own research on how professional social workers work with these women by completing qualitative interviews with seven different social workers with varied professional roles. Our choice of interviewing seven professionals within social work was based on the aim to understand the meaning of their discretion in cases with the defined target group. Based on the answer of our respondents we identified four themes; pregnancy as a motivation factor, impact of the pregnancy on professional work, cooperation and interpretation of laws. We analyzed these themes against previous research, our theoretical take-off and our aim and issues. The main conclusion of our research was that social workers discretion while working with support for substance abusing pregnant women can be defined as wide, and with that comes both advantages and disadvantages. A wide discretion leaves room for individual-based judgements and support, but it also brings high demands for social workers to make fair and valid decisions.

Abstract in English / The overall aim of this study was to construct and describe a conceptual framework that can serve as a frame of reference for organisational stakeholders to sustain a community coalition to manage alcohol misuse as a risk factor of HIV infection in a specific community in the North West Province, South Africa. A Participatory Action Research (PAR) design that was qualitative and theory generative in nature was followed in this study. A phased approach with specific objectives aligned to the PAR cycle, namely observe (Phase One), reflect (Phase Two), plan (Phase Three) and act (Phase Four), was followed. These phases were actualised through an exploratory, descriptive and contextual research design, guided and theoretically influenced by critical theory. Data in Phase One were collected through 10 key informant interviews. Data were collected in Phases Two to Four through 10 dialogue meetings. Data collected in the four phases were used to construct and describe the conceptual framework that was evaluated by five experts in the field of mental health and substance misuse for refinement (Phase Five). Thematic data analyses was done to identify emerging themes. Key issues identified were that the community is characterised by fragile community coalitions that hamper the management of alcohol misuse as a risk factor of HIV infection. Factors to be considered to sustain the coalition were identified as sharing a common vision, promoting a trusting relationship, formalising the coalition, transformational leadership, strengthening organisational unity, and access to financial resources. This research adds knowledge in the field of mental health and substance misuse by providing a sustainable community coalition conceptual framework for organisational stakeholders to manage alcohol misuse as a risk factor of HIV infection. The conceptual framework could be used to inform policy, further research, education and improve practice in the field of mental health and substance misuse. Although the study was limited to a specific geographical area of a community in the North West Province, South Africa, the findings can be adapted to fit a specific setting. / Health Studies / D Litt et Phil. (Health Studies)

The purpose of this study was to examine and to contribute with knowledge about exposed women with substance abuse problems and alcohol abuse problems. Further, our study seeks to examine and understand different dimensions of vulnerability of being a woman with abuse problems, and also to understand the stigma and shame connected to the studied group and the found dimensions. Therefore, our study is based on six different autobiographies containing experiences and interpretations of the Swedish societies, from the women in this field.  The main result of our study shows that the studied women are vulnerable in different dimensions, connected to physical and sexual abuse, authorities, economy and family. Other results show that the exposed women with abuse problems are a stigmatized group, ascribed with negative characteristics, by the norms and values in the Swedish societies. These results reflect our society's lack of knowledge, and normalizes the stereotypes about these women. Due to the norms and values of our societies, a lot of the women in this field have untold stories because of the perceived stigma that we illustrate, which is negative since the subject needs even more attention. They tend not to ask for help, since there is an unwritten rule about this field being shameful and taboo. Goffman’s theory about stigma is a part of our study, which is strongly connected to shame, used to analyze the result of our collected data.

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

No description available.