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Prescription drug abuse is a public health problem of epidemic proportions in the United States. Provider-patient communication underpins many initiatives aimed at preventing and reducing the public health burden of prescription drug abuse. The characteristics of and factors contributing to this interpersonal process, however, have not been fully explored. The purpose of this research was to examine: 1) the overall problem of prescription drug abuse and provider-patient communication about prescription drug abuse from the patient perspective; and 2) provider-patient communication about prescription drug abuse from the prescriber perspective. In 2014-2015, semi-structured interviews were conducted with 20 patients from primary care and addiction medicine and 10 prescribers from multiple health professions and medical fields in Central and South Central Appalachia. The interviews were audio-recorded and transcribed verbatim. Thematic analysis, facilitated by qualitative data analysis software, was used to generate themes. Patients perceived prescription drug abuse as a problem, both in terms of its prevalence and contribution to negative consequences. Patients connected abuse to accessibility, identifying routes of access, routine practices, and rationales involved in the acquisition and distribution of prescription drugs for abuse. With regard to provider-patient communication, patients reported different levels of engagement in prescription drug abuse-related communication with healthcare providers—active, passive, and no/limited. Prescribers likewise reported different patterns of prescription drug abuse-related communication with patients—informative, counteractive, and supportive. Collectively, patients and prescribers described a range of factors—personal and environmental—that positively and negatively influence provider-patient communication and, by association, prescriber delivery and patient receipt of healthcare related to prescription drug abuse. When comparing the perspectives of patients and prescribers, multiple similarities in their prescription drug abuse-related communication perceptions and behaviors were identified. The findings of this research have implications for: 1) clinical practice to mitigate prescription drug abuse and improve patient prescription drug abuse-related communication behaviors; 2) patient- and prescriber-targeted interventions to improve provider-patient communication about prescription drug abuse; and 3) future research to continue to advance understanding of provider-patient communication about prescription drug abuse.

The purpose of this study is to estimate the association between sibling drug use and adolescent alcohol, cigarette, and marijuana use. Research is conducted using survey data from a probability sample of 4,987 adolescents in grades 9–12 in Utah. To account for the limited frequency of drug use among respondents, Poisson regression is used to estimate models for each type of drug. In support of current literature, findings indicate that having a sibling who uses drugs increases the frequency of drug use substantially, even when peer influences are taken into account. Significant sibling associations with adolescent drug use found in this study support the assumptions of social learning theory. Findings suggest that sibling influence is largely due to social learning, as older sibling influences are demonstratively more significant than younger sibling influences.

The hypocretin/orexin (HCRT) system is associated with compulsive stimulant drug use, involving both HCRT-receptor 1 (-R1) and HCRT-receptor 2 (-R2). Few studies, however, have examined the role of HCRT-R2 or combined HCRT-R1/2 on compulsive methamphetamine (METH) taking behavior. In this study, we examined the effects of HCRT-R1, -R2, and -R1/2 antagonists on compulsive METH self-administration, as modeled by escalated intake in adult male Wistar rats allowed extended access to METH. Three cohorts of rats were allowed either short (1h; ShA; n=7-10/cohort) or long (6h; LgA; n=7-9/cohort) access to METH intravenous self-administration for 14 sessions (fixed ratio 1 schedule). Each cohort was then systemically administered a single- or dual-HCRT-R antagonist 30 min prior to METH self-administration testing: cohort 1, selective HCRT-R1 antagonist (RTIOX-276; RTI-R1; 0, 10, and 20 mg/kg); cohort 2, selective HCRT-R2 antagonist (JNJ-10397049; JNJ-R2; 0, 10, and 20 mg/kg); and cohort 3, dual HCRT-R1/2 antagonist (Suvorexant; SUV-R1/2; 0, 30, and 60 mg/kg). RTI-R1 elicited a dose-dependent reduction in METH intake in LgA, but not ShA, in the first hour. Administration of JNJ-R2 had no effect on METH intake in the first hour in neither ShA nor LgA rats, but reduced METH intake during the full 6 h session at the lowest dose. SUV-R1/2 administration had no effect on METH intake in ShA rats, but showed significant attenuation of METH-taking at the highest dose in both the first hour and full 6h session for LgA rats. Locomotor activity was significantly reduced following RTI-R1 and SUV-R1/2 in ShA rats only. To further explore the role that HCRT plays in METH dependence after a period of abstinence, we used a shRNA-encoding adeno-associated viral vector (AAV) to silence Hcrt in a separate cohort of previously-escalated METH-dependent rats. Following an initial escalation phase, and prior to a 3-week period of drug abstinence, rats were injected with either a control scramble-RNA AAV (AAV-Scram; n= 4) or a Hcrt-knockdown AAV (AAV-HCRT-KD; n= 5). AAV-Scram rats showed a significant decrease in METH self-administration post-abstinence, and a subsequent increase in METH-taking following a re-escalation period. In contrast, AAV-HCRT-KD rats showed a significant attenuation of METH self-administration following the re-escalation period. Combined, these results suggest HCRT neurotransmission at both HCRT-R1 and -R2 may contribute to compulsive METH-taking behavior.

The purpose of this study has been to gain an understanding of how drug addicts get out of an addiction from the perspective of people who have previously been addicted to narcotics. To achieve the purpose of this study we interviewed former addicts and social workers whose work is to help drug addicts. The interviews with the informants have been semi structured where as we had prepared some open questions but also as the interviews went on we thought of follow up questions to ask. The analysis was conducted with three theories: the turning point, natural recovery and social bond. The results show that there are different ways to reach a turning point when you decide to quit the habit and then there are various factors that facilitate a person of getting out of an addiction that also prevent relapse. Furthermore, the results show that their own perspective on what mattered the most during their way out of an addiction was the support of people who had gone through the same process of changing their lifestyle. They found that fellowship is essential to recovery and relapse prevention.

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This dissertation explores the potential of documentary films to impact the discourse around a public health issue and in particular the current opioid epidemic. In addition to reviewing the history of drug policy and drug epidemics, this dissertation analyzed an HBO documentary about the opioid epidemic as a means of contextualizing the current crisis and understanding whether documentary can change the narrative around a public health matter. A systematic review of the literature was conducted to evaluate the existing published evaluation studies relating to the potential role of documentary films to influence the levers of discourse related to the opioid epidemic and related substance use and mental health disorders and found the existing research was limited to fifty-four citations. Documentaries can have a potential impact on public discourse most notably through raising public awareness but the impact is limited as drug use epidemics are complex and multifactorial. Further study is needed to fully understand the role that documentary films can play in shaping public discourse.

The aim of this study is to examine which individual and surrounding factors that are of importance for maintaining drug-freedom after treatment. The study is based on scientific papers found through a scoping review. The result of the study is thematized and analysed with the labelling theory, sense of coherence and the transtheoretical model stages of change. The results show that the individual factors involve occupation (employment, education and activities), health, thoughts and behaviour, network and aftertreatment, and emphasises the inner process and resources one by themselves can develop. The surrounding factors include occupation (employment, education and activities), network, aftertreatment and demographic factors. Here with the perspective on the support that comes from other groups, organisations and people. In the discussion there is a reasoning on the need for a view on relapse as something natural, and sometimes, part of the process. The path to a stable abstinence is not always a straight line or desirable goal, therefore the support should exist in every phase. Another central conclusion is that the Alcoholics Anonymous and Narcotics Anonymous gives a big support but is not used by everyone for different reasons. There should be similar support from public services. Future research could search factors for maintaining drug-freedom outside of the AA and NA community. The factors for stable abstinence could also differ depending on the type of abuse, which can be the subject for a possible future study.

The intent of this study was to compare life value differences using the Life Values Inventory. Differences among non-psychedelic users and psychedelic users were examined. Participants, ranging from age 18 to 48 from the University of Central Florida (UCF), a large state university, were recruited on a voluntarily basis. This was primarily done through online message board, the Sona System, and classroom announcements. The study was presented through the Sona System provided by UCF. In addition, all participants were students of the university. Results indicated significant differences among three out of 14 life values measured. The three life values that were shown to be significantly different among the non-psychedelic users and psychedelic users were: 1) concern for others, 2) loyalty to family or group, and 3) responsibility. In addition, the life value of spirituality was only found to be marginally significant.

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