Syftet med vår undersökning är att belysa praktikers erfarenhet av olika aspekter som är av betydelse för att klienter inom missbruksvård ska kunna vidmakthålla stabil drogfrihet, samt att belysa olika insaster som kan främja drogfrihet. Den metodologiska utgångspunkten är kvalitativ forskningsansats med semistrukturerade intervjuer. För att få svar på frågeställningen har fem verksamma personer inom missbruksvården intervjuats. Resultaten undersöks med utgångspunkt från Prochaska och DiClemente teori om förändringsprocessen plus andra sekundära teorier som identitesutveckling, socialisationsprocessen och stämplingsteorin. Studiens resultat visar att stöd från familjen eller nätverket och hitta en väl fungerade vardagsstruktur kan bidra till att främja en bestående drogfrihet.  Att bygga nya relationer och lyckas skapa en ny accepterad social roll kan vara betydelsefullt för att lyckas förbli stabilt drogfri. Studien visar också att det finns glapp mellan behov och befintligt stöd för de personer som kämpar med att förbli drogfria och att det finns behov att implementera andra nya insatser.

The aim with our study was to understand former addict´s experience of social networks from the Lewi Pethrus foundation (LP foundation) aftercare. The method we have used is qualitative semi-structured interviews. We have interviewed eight persons, four men and four women. They have all been in contact with the LP foundation and are today drug free. The result of the study has shown that the fellowship, in the different social networks have been very important to maintain a drug free life. A feeling of affinity, being seen, feel supported and trusted, experience that someone believe in you, has been the most regarded in the social networks. The contact with the LP foundation and the church appeared to have a significant role in the LP foundation and the church appeared to have a significant role in the LP foundation aftercare to create new social networks. Having a job or study is also a key to build new relationships and is something that the LP foundations aftercare has contributed to. Our study also showed the necessity to break up with old friends from the time when they were addicts, who had a negative influence. Furthermore it was vital to re-establish the relationship with their children and also with their siblings.

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.

Frågor som rör missbruk och missbrukare är omdebatterade i samhället. Ofta sker debatten i kombination med de ekonomiska aspekterna. Missbrukare som grupp är tärande för samhället och ofta hörs åsikter om hur problemen bäst kan lösas. Vår intention med undersökningen är att belysa problemet med ett inifrånperspektiv för att på det sättet utveckla en annars ganska ensidig debatt. Undersökningen baseras på kvalitativa intervjuer med personer som själva varit drogmissbrukare. Vi har valt att undersöka tiden efter brytpunkten och har varken intresserat oss för deras aktiva missbruk eller hur och varför de bröt med drogerna. Studiens syfte är att undersöka vad som gör det möjligt att behålla en drogfrihet. Detta har vi belyst utifrån frågeställningarna: "Vad anser personer med egen erfarenhet av drogmissbruk att de behövt för hjälp för att hålla sig drogfria", samt "vilka faktorer tycker tidigare drogmissbrukare har bidragit till att de kunnat behålla drogfriheten?" Vi har valt att analysera vår empiri utifrån de teoretiska begreppen förändring, nätverk och identitet. Resultatet visar att denna grupp har stora behov som samhället och det sociala skyddssystemet behöver uppmärksamma. Det sociala nätverk som omger personen är en faktor som fyller en betydande funktion, liksom en fungerande sysselsättning som ger personen förutsättningar att utvecklas på flera plan. Personerna behöver till detta också förståelse och stöd i olika former och de behöver framför allt gott om tid att genomföra sin omfattande förändring i sin egen takt. Nyckelord: Förändring, Nätverk, Sysselsättning, Identitet, Drogfrihet, Behov / Issues related to drug abuse and drug abusers are debated in society. Often the debate is done in combination with economic aspects. Addicts as a group is debilitating to society and often hear opinions on how best to resolve. Our intention with the survey is to illustrate the problem with an inside perspective on the development of an otherwise fairly one-sided debate. The survey is based on interviews with people who themselves were drug addicts. We chose to investigate the post-break point and have no interest in us for their active addiction or how and why they broke away from drugs. The purpose of this study is to examine what makes it possible to maintain a drug-free. This has been highlighted on the basis of questions: "What do people with personal experience of drug abuse that they needed help to stay drug-free", and "what factors like former drug addicts have contributed to those able to maintain drug-free?" We have chosen to analyze our empirical data by the theoretical concepts of change, network and identity. The result shows that this group has great needs that need attention by society and the social protection system. The social network surrounding the person is a factor that plays a significant function, as well as a functional activity that gives the person the opportunity to develop on several levels. Those people also need understanding and support in various forms and they need above all plenty of time to implement its comprehensive change at their own pace. Keyword: Change, Network, Employment, Identity, Drug-free, Needs

Le problème croissant de l’antibiorésistance fait en sorte que l'utilisation systématique des antibiotiques en production animale n'est plus considérée comme une pratique raisonnable et viable. De plus, la préservation de l'efficacité des antibiotiques représente un enjeu majeur pour la santé publique et la santé animale. Les Producteurs de poulet du Canada ont élaboré et mis en place une stratégie de réduction de l'utilisation des antibiotiques ayant comme objectif ultime d'éliminer l'utilisation préventive des antibiotiques d’importance en médecine humaine dans les productions de poulets à griller et de dindons. Alors que l’on sait que la réduction des antibiotiques en élevage de poulets de chair est associée à une augmentation de l’incidence d’entérite nécrotique causée par Clostridium perfringens, dont une proportion de cette population bactérienne produit l’entérotoxine qui peut engendrer des conséquences sur la santé humaine, il est difficile de prédire les impacts réels d’une telle stratégie sur les écosystèmes complexes que sont l’intestin des oiseaux et les élevages commerciaux de poulets de chair. Les principaux objectifs de la présente étude étaient donc de quantifier l'abondance des gènes de résistance aux antibiotiques, d'évaluer la présence de C. perfringens et de son entérotoxine et de caractériser la composition du microbiote cæcal dans les bâtiments de six fermes commerciales de poulets de chair, au Québec. À court terme (15 mois), les bâtiments de ces fermes ont été soumis à un régime conventionnel ou à un régime sans antibiotiques. Puis, à long terme (6 ans), les bâtiments ont utilisé un régime promouvant une utilisation judicieuse des antibiotiques ou un régime conventionnel. La mise en place d'un régime sans antibiotiques pendant une période de 15 mois n'a pas permis d’observer une réduction de l'abondance de plusieurs gènes de résistance aux antibiotiques, contrairement à l'utilisation judicieuse des antibiotiques pendant 6 ans. Le retrait des antibiotiques à court terme et l’utilisation judicieuse à long terme ont modifié la composition du microbiote cæcal, les familles de Ruminococcaceae et de Lachnospiraceae étant influencées négativement, en plus de diminuer les performances zootechniques et d’augmenter les populations de C. perfringens à court terme. Le régime conventionnel à long terme dans les élevages commerciaux de poulets de chair a été associé à une augmentation de plusieurs gènes de résistance aux antibiotiques dans de nombreuses fermes. Cette étude met en évidence les impacts potentiels des différents régimes d'élevage en production avicole et aidera à orienter les futures politiques afin de réduire l'utilisation des antibiotiques et ultimement contrer le phénomène de la résistance aux antibiotiques. / The ever-increasing problem of antibiotic resistance makes routine use of antibiotics in animal production no longer considered as a reasonable and viable practice. Preserving the effectiveness of antibiotics represents a major challenge for public and animal health. The Chicken Farmers of Canada have developed and are implementing an Antimicrobial Use Reduction Strategy which ultimate goal is eliminating the preventive use of medically-important antibiotics in broiler chicken and turkey productions. While it is known that the reduction of antibiotics in broiler chicken farms is associated with an increase in the incidence of necrotic enteritis caused by Clostridium perfringens, to which a proportion of this bacterial population produces the enterotoxin who can also generates consequences for human health, very little is known about the real overall impact of an antibiotic use reduction strategy in complex ecosystems such as the bird intestine or the commercial broiler chicken farm. The main objectives of the present study were to quantify the abundance of antibiotic resistance genes, to assess the presence of Clostridium perfringens and his enterotoxin and to characterize the composition of the cæcal microbiota in broiler chicken flocks from six commercial farms located in Québec and submitted to either a short-term conventional or drug-free program (15 months) or a long-term conventional or judicious antibiotic use program (six years). Implementing an antibiotic-free program over a 15-month period did not reduce the abundance of many antibiotic resistance-encoding genes, whereas a judicious use of antibiotics over six years did. The short-term antibiotic withdrawal and the long-term judicious use strategy altered the cæcal microbiota composition, with Ruminococcaceae and Lachnospiraceae families being negatively impacted, in agreement with the lower production performance and with the increased C. perfringens populations observed for farms phasing out the use of antibiotics in a short-term antibiotic withdrawal. Adopting a long-term conventional rearing program on commercial broiler chicken farms selected for specific antibiotic resistance-encoding genes in many barns. This study highlights the potential impacts of different rearing programs in poultry production and will help guide future policies in order to reduce the use of antibiotics and ultimately reduce the phenomenon of antibiotic resistance.