No description available.

Opioid drug misuse and dependence are a social and public health problem in the United States. Prescription opioid abuse and misuse have been associated with substantial morbidity and mortality rates as well as social and economic costs. The purpose of this project was to provide a systematic review of literature on the effectiveness of medication-assisted therapy interventions in addressing the problem of prescription opioid misuse in health care settings. The systematic review was completed through a literature search conducted across five electronic databases. The review was guided by the health belief model and eligible studies were rated using Johns Hopkins hierarchy of evidence. Fifteen peer-reviewed journal articles published from 2011 met the inclusion criteria and were reviewed in full. Of these, 14 were randomized controlled trials and 1 was a quasi-experimental study. The most commonly explored interventions were psychosocial interventions in conjunction with medications for opioid addiction. Review findings provided moderate evidence to support the effectiveness of psychosocial interventions in conjunction with medications in the treatment of opioid dependence, although the strength of the efficacy varied depending on the intervention provided. This project may advance nursing field by promoting provision of care to opioid dependent patients based on the best available evidence. Evidence-based care to patients with prescription opioid dependence will positively impact social change by improving the quality of life of patients, relieving caregivers of the burden of monitoring the addicted patients and saving millions of dollars spent in the criminal justice and health care systems.

A lack of available data exists regarding environmental factors related to prescription drug abuse (PDA), which could explain the ineffectiveness of efforts to reduce PDA in Florida. Prescription drug abuse among adults older than age 18 varies with the level of education achieved, and these metrics potentially reflect socioeconomic differences. The purpose of this quantitative study was to examine the connections between contextual aspects of prescription opioid abuse among Florida's middle and high school students to understand youth PDA in relation to their environments. This study consisted of a secondary analysis of existing PDA data (dependent variable) in relation to a number of independent variables, including the incidence of female-headed households, the nature of residential environment, adherence to religious precepts, and students' ability to achieve educational goals. Incidence of female-headed households, the nature of residential environment, and adherence to religious precepts were not found to predict youth PDA. The only finding of significance was that PDA predicted lowered students' ability to achieve educational goals (p = .015). Data collected from this study might be used by school counselors and administrators when developing drug abuse prevention, intervention, and educational programs, thereby leading to positive social change in helping to reduce PDA among youth.

Ce travail présente le développement d’une nouvelle approche pharmacoépidémiologique, reposant sur les bases de données de l'assurance maladie, permettant de caractériser et d’estimer le détournement d’usage de médicaments psychoactifs. Cette approche utilisant la méthode de classification, regroupe, a posteriori, les sujets en différents sous-groupes, menant à l’identification, la caractérisation et la quantification de différents profils de comportement dont le comportement déviant. Nous avons appliqué cette méthode sur plusieurs médicaments. Pour chaque médicament, nous avons inclus l'ensemble des sujets affiliés au régime général des régions PACA et Corse ayant eu un remboursement. Leurs délivrances ont été suivies sur 9 mois. Après une analyse descriptive, une méthode de classification est appliquée, suivie d’une analyse des différents sous-groupes.Un premier travail a permis de confirmer l'importance du détournement d'usage d'une molécule émergente, le clonazépam (publication n°1). Ensuite nous avons adapté notre méthode afin de pouvoir suivre l'évolution sur plusieurs années de ce détournement (publication n°2). Nous avons appliqué cette méthode pour souligner l’existence, sur plusieurs années, du détournement d'usage du méthylphénidate (publication n°3). Notre équipe avait également développé une autre méthode pour estimer la polyprescription (publication n°4). Enfin, nous avons appliqué de façon conjointe ces deux méthodes (publication n°5). La méthode de classification est de plus en plus utilisée afin de surveiller l'évolution du détournement d'usage de médicaments et commencent à être intégrés au système français de surveillance de l’abus de médicament.aux cotés des autres outils pharmacoépidémiologiques plus traditionnels (OSIAP, OPPIDUM, OPEMA, ASOS, DRAMES). / This work presents the development of a new pharmacoepidemiologic method. This methodallows to estimate abuse of psychoactive prescription drugs in real life using prescriptiondatabase. The method is based on a cluster analysis which is a statistical method used todetermine, a posteriori, different subgroups of subjects. According the subgroups’characteristics, we can determine and estimate different behaviours whose subjects with adeviant behaviour. It assesses the rate of subjects with a deviant behaviour among all thesubjects that obtain the drug from a pharmacy.We used this method on several prescription drugs. For each prescription drug, we includedall individuals, affiliated to the French health reimbursement system of two southern Franceareas (Provence-Alpes-Côte-d’Azur and Corsica), who have had a prescription drugreimbursed during the first weeks of the year. Their deliveries have been monitored over a 9month-period. After a descriptive analysis, a clustering method has been used. The fourquantitative variables used to establish profiles of consumers were : number of differentprescribers, number of different pharmacies, number of dispensings and quantity dispensed(DDD). Finally, the characteristics of different subgroups have been presented, especiallythose with a deviant behavior.The first study using this method allows to confirm and assess the magnitude of the abuseliability of an emerging prescription drug as clonazepam (publication n°1). Then we adapt thismethod in order to follow the abuse evolution during several years. In the second publicationon clonazepam, we identified that the proportion of deviant subjects has increased between2001 and 2006 (from 0.86% to 1.38%). We also applied this method to estimatemethylphenidate abuse during several years (from 2005 to 2008) (publication n°3).Methylphenidate abuse is already describe in other countries whereas few data are available inFrance. This study estimates the proportion of subjects with a deviant behaviour (from 0.5%9in 2005 and in 2006 to 2.0% in 2007 and 1.2% in 2008) and assesses its evolution since theapplication of a specific regulation.Our research team has also developed an other method using prescription database : thedoctor shopping indicator which measures the quantity obtained by doctor shopping amongthe overall quantity reimbursed (publication n°4). The objective of the last publication is toanalyze and compare results from those two methods applied to High Dosage Buprenorphine,a product well-known to be diverted in France.Actually, clustering method is more and more used on prescription drugs in order to assesstheir abuse. The results obtained by this method begin to be included in the other postmarketing surveillance of CNS drugs (OSIAP, OPPIDUM, OPEAM, ASOS, DRAMES)which are used by French public health authorities.

Department of Psychology. Bibliography : leaves 72-76.

In the 21st century drug and alcohol abuse presents one of the most serious problems worldwide. Of particular concern is the strong relationship between drug use and crime. While law enforcement strategies, including incarceration, have been revealed to contribute little to break the vicious cycle of drug use and crime, substance abuse treatment has been shown to represent an effective form of intervention. Substantial research on the effectiveness of drug treatment has demonstrated the importance of motivation in predicting treatment retention and success. However, substance users are frequently coerced into therapy by external sources, including the criminal justice system, therefore, typically exhibiting little motivation to enter and remain in treatment long enough to overcome their substance addiction. Although past research investigating the effects of treatment-entry coercion indicates positive treatment results, the vast majority of these studies are seriously impeded by extensive conceptual and methodological problems, questioning the postulated value of coercion in substance abuse treatment. Following the call for a shift in the methodological focus of future studies made by some researchers, the author of the present study tested three models that were based on well-established theories. The first model was based on Self Determination Theory (SDT), a motivational theory, while the second model was based on the Theory of Planned Behaviour (TPB), an expectancy-value theory. The third model consisted of a combination of the two theories, which was argued to provide a more complete and comprehensive model than each theory on its own. The testing of the models allowed the exploration of the dynamic interplay and relationships between a number of variables including perceptions of coercion, motivation, perceived autonomy support, and behavioural intentions in an effort to explain and predict retention and treatment outcomes amongst drug and alcohol abusers. The study was conducted in two phases. Phase 1 involved the development of a 29-item instrument called the Perceived Coercion Questionnaire, which was designed to assess participants' perceptions of coercion to enter drug and alcohol treatment originating from six different sources. The scale was shown to be a valid and reliable measure of the coercion construct. Phase 2 involved the testing of the three models longitudinally by using a sample of 350 substance abusers from six therapeutic communities across Australia. Participants were asked to complete a battery of standardised measures within the first two weeks of treatment admission (Time 1), two months into treatment (Time 2), and at completion of the treatment program (Time 3). The models were tested cross-sectionally and longitudinally employing hierarchical multiple regression analysis. In addition, change scores were calculated to test whether changes in predictor variables would predict outcomes and changes in outcomes cross-sectionally and longitudinally. Analyses of Time 1 and Time 2 cross-sectional data revealed that the SDT model, compared to the TPB and the combined model, provided a better and more parsimonious account of the factors that influence outcomes in therapeutic community treatment. Given the complexity of the study, it was decided to resume the analysis by focusing on the investigation of the SDT model alone. To highlight some of the most important findings, results demonstrated that motivation was a key factor in the treatment and rehabilitation of substance users. As anticipated, intrinsic motivation was consistently predictive of retention and more positive treatment outcomes, while external motivation and amotivation were associated with more negative outcomes. Results also revealed that clients who entered treatment as the result of a legal mandate experienced substantially higher levels of legal coercion compared to clients who entered treatment voluntarily. Legal coercion, in turn, was found to exert a negative impact on substance users' motivation for treatment, thereby indirectly resulting in more negative treatment outcomes. In contrast, self coercion (i.e., feelings of pain and suffering) and health-related pressures seemed to facilitate the development of a more intrinsic motivational attitude towards treatment. Besides, perceptions of competence and control in relation to the therapeutic regime emerged as consistent and important predictors of motivation and treatment outcomes. Finally, findings suggested that treatment staff who employed more autonomous and non-coercive strategies that guided substance users through the change process directly influenced individuals' treatment motivation and thereby facilitated more positive treatment outcomes. In sum, findings provided support for the usefulness of the SDT model in predicting dropout as well as processes and outcomes in therapeutic community drug and alcohol treatment. Implications for residential substance abuse treatment were discussed, as well as the strengths and limitations of the study. The discussion concludes with implications for practice and suggestions for future research.

The present study examined cross-sectional and longitudinal developmental characteristics of the association between mental health and substance use. N=1182 adolescents aged between 11 and 20 years were recruited from schools in Australia. Participants completed the Youth Self Report (YSR) (Achenbach, 1991a) and reported on their use of alcohol, tobacco, and marijuana, their social ability, their motivation for using substances, their ability to regulate emotion, and the influences of their parents and peers on their substance use. N=561 of time one participants were retained for testing one year later to assess the potential to predict substance use at time two from mental health at time one. Results indicated a clear and consistent cross-sectional association between externalising scores on the YSR and use of the three substances, regardless of gender. The relation between internalising scores and substance use was non-significant. When the relation between externalising scores and substance use was assessed for mediation, only the influence of parents and peers was found to be significant. A cross-sectional structural model developed to account for this association was demonstrated to be invariant across the three substances of interest, and across gender, but not age category. There was no evidence that social skills, emotion regulation, or substance use motives, had roles in mediating the relationship between mental health and substance use. A model was developed to assess the potential to predict substance use at time two from externalising scores at time one. Results showed that externalising scores predicted increases in alcohol use via parent and peer attitudes. Thus, externalising disposition, in the context of a facilitative social environment, was predictive of an increase in alcohol use over time. Structural models developed to account for the predictive relation between externalising scores and use of cigarettes and marijuana proved unstable and could not be tested. Substance use at time one was not predictive of externalising scores at time two. The results of the present research are discussed in relation to their potential to inform the developmental substance use literature, and efforts directed against the development of substance use problems. Limitations of the present research are noted.

Drug use and misuse among young people in Australia has caused concern throughout the community and has prompted nationwide action to address the problem. One component of intervention strategies with young people is drug education. Drug education in Australia represents an international philosophy of prevention and takes a harm minimisation approach to intervention. One strategy that has had international success in the area of drug education with young people, and that has been used effectively in health education in Australia since the 1970s, is peer education. Peer drug education involves young people conducting drug education sessions with their peers. An example of peer drug education in Australia is the Teenagers Teaching Teenagers' (Triple T) program, conducted in the Australian Capital Territory (ACT). Evaluations and descriptions of peer drug education programs tend to focus more on outcomes pertaining to program recipients and fail to explore in detail the specific experience of peer leaders. Existing research on the experience of peer leadership does not explore in detail the personal experience of leaders, that being the effect of peer leadership training and duties on leaders' personal perceptions of drugs, their behaviour with drugs and their own feelings and skills. This thesis explores the personal experience of a group of peer leaders who participated in the Triple T program in 1994. It considers their perceptions of the program at the time of training and then goes on to explore the impact of this experience on their formulation of ideas about drugs to the present day. The thesis is a qualitative project which utilises in-depth interviewing and focus groups to gather data and then presents a thematic analysis of participant response. The thesis asks two research questions, 1. What do young men and women involved in the Triple T program take from the experience of peer leadership training and duties? 2. In what way does the Triple T' experience appear to contribute to the development of drug related ideas of these young people in the two years following involvement in the program? The findings suggest that the participants gained information, skills and personal development from the training and generally found it to be a positive experience. However, participants distanced themselves personally from a substantial amount of the training content and did not personally reflect on the training content to any great extent at the time of training. Training processes and some aspects of leadership duties more personally affected them, although again there was personal distancing from this part of the program. In exploring the findings there was difficulty determining the influence of the training experience due to participant reluctance to attribute influence to any one source on the formulation of ideas. Instead, participants describe a complex interaction of influences on the formulation of ideas about drugs and a process which involves maintaining control, upholding the notion of informed choice and incorporating ideas about drugs into the formation of an adult identity. Influences on these ideas include the training, actual experiences with drugs and observations of others. The thesis exploration suggests that being involved in peer drug education does impact on peer leaders but this experience was not personalised to any great degree at the time of training. However, in the following two years, participants called on the training information as well as other influences as they formed their ideas about drugs. The thesis raises some issues of how to maximise leaders' personal connection to the peer drug education process, if this is in fact a desired outcome of peer education. It also suggests the need for further research into the experience of peer leaders who seem to have remained the least considered party in the peer education movement.

Thesis (D. Min.)--Logos Evangelical Seminary, 2004. / Vita. Includes bibliographical references (leaves 1-14 at end).

<p>Research about social support and social networks has mostly concerned the impact on a person’s wellbeing and health. However an aspect largely neglected is how social support within the social networks can affect the process of giving up a drug abuse. The purpose of this paper is to contribute to a better understanding of what role the social support within different relationships can have on the process of giving up drug abuse. Furthermore the aim is to examine how a self-help group can provide social support in the transitional period after leaving a drug abuse. The study is based on qualitative interviews with staff and participant from a self-help group. System theory and social network theory has been used to interpret the empirical results. The main result shows that the social support from the social networks are viewed as important by all women. However the social support given to the women from close relationships is not necessarily constructive in the process of rehabilitating from a drug abuse. In addition the result has shown that distrust and inequality in power relationships can lead to lack of support within the professional network. In accordance to earlier tudies, a self-help group can be seen as complementary in the rehabilitation of a drug abuse.</p>