The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice. / Psychology / (D. Phil. (Psychology))

Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed. / Psychology / (M.A.(Psychology))

Heroin addiction is inclined to arouse fear, rejection and discriminatory behavior among the general public. Evidence shows that the public perceives heroin as harmful and addictive. Heroin is ranked as the most stigmatized condition. While there is robust literature on mental illness stigma, there is limited research concerning addiction-related stigma. There are very few standardized stigma measures related to perceptions toward persons addicted to heroin. The overall aim of the dissertation was to validate an attribution measurement model toward persons addicted to heroin and to determine its psychometric properties. The dissertation’s study employed an adapted 7-factor measurement model (Corrigan et al., 2002) to examine stigmatizing perceptions towards persons addicted to heroin. This is the first study to systematically evaluate model fit by implementing Exploratory Structural Equation Modeling (ESEM). A total of 657 Sociology students were analyzed over four stages: questionnaire review by expert panel, pilot-test, validation and replication. The study tested multiple incremental models and successfully determined that the results met multiple goodness-of-fit indices. Through ESEM, Sociology-Social Control students supported the hypothesis that the adapted 7-factor attribution measurement model would fit data. The model included: Personal Responsibility, Pity, Anger, Helping Behavior, Dangerousness, Fear and Social Distance factors. Adequate power and sample size was demonstrated to support acceptance of the null hypothesis. In addition to conducting Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), ESEM tested the psychometric properties of the attribution measurement model. Implementing maximum likelihood extraction with oblique geomin rotation using Mplus software, the Sociology-Social Control students’ validation and replication datasets showed an excellent model fit to the data. Results confirmed support for the superiority of the ESEM solution. The ESEM attribution measurement model fit better than the CFA model. Compared to the ESEM model, elevated factor correlations found in the CFA model were caused by the exclusion of meaningful cross-loadings. Strong psychometric properties for the ESEM attribution model were evidenced, with good internal consistency and excellent test-retest reliability. The factor structure was replicable across the two groups of Sociology-Social Control students. Adequate ESEM incremental and convergent validity was supported by the simultaneous examination of the Social Distance scale and the Personal Consequences of Criminal Stigma measures with the measurement model. In the replication sample, familiarity demonstrated less stigmatizing perceptions than the SOC313 Course. Our findings highlight marked differences between the Sociology-Social Control students and the general population’s perceptions of heroin addicts. The Sociology-Social Control students are not afraid of persons addicted to heroin, nor do they hold them responsible for their condition. To conclude, the study provides newly validated measures with adequate reliability to allow investigators to assess other students’ level of addiction stigma. It is anticipated that the dissertation’s study will lead to further comparative psychometric testing with healthcare students that are directly involved with the care and treatment of persons addicted to heroin to provide a better understanding of the factorial structure of the attribution measurement model. Longitudinal data is also needed to examine our model and how levels of perceptions change over time.

<p>Studiens syfte var att undersöka om naturläkemedlet Ibogain kunde vara en bra behandling för missbruk. För att kunna besvara detta har kvalitativa intervjuer genomförts med fyra personer som genomgått Ibogain-behandling och en psykolog/psykoterapeut på en beroendeklink, Lars Lundell. Utöver dessa intervjuer har en klinik i London besökts som utför Ibogain-behandling. På kliniken gjordes en observationsstudie av behandlingen, samt intervjuer med klinikchefen Dr Brackenridge och en av hans patienter, i uppsatsen kallad Will. Studiens perspektiv utgår från informanterna och våra egna observationer om Ibogain-behandling. Intervjufrågorna har bildats utifrån dessa 3 frågeställningar:</p><p>1. Hur går en behandling tillväga rent praktiskt?</p><p>2. Hur har livet påverkats av Ibogain-behandling?</p><p>3. Vilken syn har informanterna på Ibogain-behandling?</p><p>I analysen söktes gemensamma nämnare och skillnader i informanternas svar, uppdelat i de tidigare nämnda frågeställningarna. Sedan tolkades denna information med hjälp av litteratur, observationer och egna tankar.</p><p>I studien ges en mycket samstämmig syn på att utan Ibogain-behandling hade troligtvis inte informanterna varit i livet idag.</p><p>Resultatet visar tydligt på att informanterna upplever att de fått en mycket bättre livskvalité efter behandlingen.</p><p>Av de uppgifter som framkommit i studien anser vi att Ibogain är att rekommendera.</p> / <p>The purpose of this study was to investigate if the naturally occurring substance Ibogaine could be a good treatment for substance abuse. In order to answer this question, qualitative interviews have been performed with five persons who have been subject to Ibogain treatment and one psychologist/psychotherapist at an addiction treatment clinic, Lars Lundell.</p><p>In addition to these interviews an Ibogaine treatment clinic located in London has been visited. At the clinic an observational study of the treatment was carried out as well as interviews with the responsible physician Dr Brackenridge one of his patients, named Will in this paper. The perspective of this study is substance abuse treatment with Ibogaine based on the informants experiences and our own observations.</p><p>The interviews have been formed based on the following three questions:</p><p>1. How is a treatment carried out?</p><p>2. How have their lives been affected by the Ibogain treatment?</p><p>3. What are the informant’s views on Ibogain treatment?</p><p>The analysis was made looking for similarities and dissimilarities in the informants answers, divided into the three previously described questions. This information was subsequently interpreted using literature, observations and our own thoughts.</p><p>The study shows that among the informants there is an almost unanimous opinion that without the Ibogaine treatment they would not be alive today.</p><p>The study clearly shows that the informants feel that they have a much better quality of life after the treatment. The conclusion of this study is that Ibogaine can be a successful treatment for substance abuse.</p>

Studiens syfte var att undersöka om naturläkemedlet Ibogain kunde vara en bra behandling för missbruk. För att kunna besvara detta har kvalitativa intervjuer genomförts med fyra personer som genomgått Ibogain-behandling och en psykolog/psykoterapeut på en beroendeklink, Lars Lundell. Utöver dessa intervjuer har en klinik i London besökts som utför Ibogain-behandling. På kliniken gjordes en observationsstudie av behandlingen, samt intervjuer med klinikchefen Dr Brackenridge och en av hans patienter, i uppsatsen kallad Will. Studiens perspektiv utgår från informanterna och våra egna observationer om Ibogain-behandling. Intervjufrågorna har bildats utifrån dessa 3 frågeställningar: 1. Hur går en behandling tillväga rent praktiskt? 2. Hur har livet påverkats av Ibogain-behandling? 3. Vilken syn har informanterna på Ibogain-behandling? I analysen söktes gemensamma nämnare och skillnader i informanternas svar, uppdelat i de tidigare nämnda frågeställningarna. Sedan tolkades denna information med hjälp av litteratur, observationer och egna tankar. I studien ges en mycket samstämmig syn på att utan Ibogain-behandling hade troligtvis inte informanterna varit i livet idag. Resultatet visar tydligt på att informanterna upplever att de fått en mycket bättre livskvalité efter behandlingen. Av de uppgifter som framkommit i studien anser vi att Ibogain är att rekommendera. / The purpose of this study was to investigate if the naturally occurring substance Ibogaine could be a good treatment for substance abuse. In order to answer this question, qualitative interviews have been performed with five persons who have been subject to Ibogain treatment and one psychologist/psychotherapist at an addiction treatment clinic, Lars Lundell. In addition to these interviews an Ibogaine treatment clinic located in London has been visited. At the clinic an observational study of the treatment was carried out as well as interviews with the responsible physician Dr Brackenridge one of his patients, named Will in this paper. The perspective of this study is substance abuse treatment with Ibogaine based on the informants experiences and our own observations. The interviews have been formed based on the following three questions: 1. How is a treatment carried out? 2. How have their lives been affected by the Ibogain treatment? 3. What are the informant’s views on Ibogain treatment? The analysis was made looking for similarities and dissimilarities in the informants answers, divided into the three previously described questions. This information was subsequently interpreted using literature, observations and our own thoughts. The study shows that among the informants there is an almost unanimous opinion that without the Ibogaine treatment they would not be alive today. The study clearly shows that the informants feel that they have a much better quality of life after the treatment. The conclusion of this study is that Ibogaine can be a successful treatment for substance abuse.

Die Neubildung von Neuronen persistiert lebenslang in der Subgranularzellschicht des Hippocampus und der Subventrikularzone des Großhirns und wird als adulte Neuroge-nese bezeichnet. Es wird vermutet, dass diese beim erwachsenen Menschen einen rele-vanten Einfluss auf degenerative Veränderungen, verschiedene neurologische Krank-heitsbilder und auf die (Dys-)Funktion des Gedächtnisses hat. Im Tiermodell wurde eine Verringerung der Neurogenese nach chronischer Morphingabe nachgewiesen. Vorarbeiten zeigten einen Zusammenhang zwischen chronischem Heroinmissbrauch und reaktiver Astrogliose, Mikrogliose und einer vermehrten Expression des polysialylated neural cell adhesion molecule im humanen Hippocampus. Daraus leitet sich die Hypothese ab, dass chronischer Heroinmissbrauch, als Modell für eine Abhängigkeitserkrankung, einen Einfluss auf die adulte humane Neurogenese hat. Es wurden in Formalin fixierte Gewebeproben aus dem Hippocampus von Verstorbenen mit einer letalen Heroinintoxikation und mit bekanntem Heroinmissbrauch (n = 20) un-tersucht und mit einer nach Alter und Geschlecht angepassten Kontrollgruppe (n = 28) verglichen. Hierbei wurden spezifische Neurogenesemarker mittels immunhistochemi-scher Methoden angewendet und ausgewertet. Es bestand eine generell sehr geringe zelluläre Proliferationsrate und eine signifikante Reduktion Musashi-1 positiver neuro-naler Vorläuferzellen bei gleichzeitig unveränderter Anzahl Nestin positiver reifender und Calretinin positiver migrierender postmitotischer Neurone. Zudem wurde ein ver-ändertes Calretinin-Expressionsmuster als Hinweis auf eventuelle funktionelle neuronale Defizite bei Drogenabhängigen festgestellt. Der potentielle Einfluss von chronischem Heroinmissbrauch auf die adulte humane Neurogenese wird erstmals gezeigt. Die Ergebnisse weisen auf eine negative Beeinflus-sung im Stadium neuronaler Vorläuferzellen und der Zellfunktion migrierender Neurone in der Fallgruppe im Vergleich zu einer gesunden Kontrollgruppe hin. Diese Hemmung der Neurogenese könnte eine Erklärungsmöglichkeit für kognitive Defizite und Funktionsstörungen des Gedächtnisses infolge chronischen Drogenkonsums bieten und zugleich eine Bedeutung bei der Entstehung von Abhängigkeitserkrankungen haben. Insofern könnte sich hier ein Ansatzpunkt für zukünftige Therapiestrategien derartiger Erkrankungen oder ihrer Folgen bieten.

Die Neubildung von Neuronen persistiert lebenslang in der Subgranularzellschicht des Hippocampus und der Subventrikularzone des Großhirns und wird als adulte Neuroge-nese bezeichnet. Es wird vermutet, dass diese beim erwachsenen Menschen einen rele-vanten Einfluss auf degenerative Veränderungen, verschiedene neurologische Krank-heitsbilder und auf die (Dys-)Funktion des Gedächtnisses hat. Im Tiermodell wurde eine Verringerung der Neurogenese nach chronischer Morphingabe nachgewiesen. Vorarbeiten zeigten einen Zusammenhang zwischen chronischem Heroinmissbrauch und reaktiver Astrogliose, Mikrogliose und einer vermehrten Expression des polysialylated neural cell adhesion molecule im humanen Hippocampus. Daraus leitet sich die Hypothese ab, dass chronischer Heroinmissbrauch, als Modell für eine Abhängigkeitserkrankung, einen Einfluss auf die adulte humane Neurogenese hat. Es wurden in Formalin fixierte Gewebeproben aus dem Hippocampus von Verstorbenen mit einer letalen Heroinintoxikation und mit bekanntem Heroinmissbrauch (n = 20) un-tersucht und mit einer nach Alter und Geschlecht angepassten Kontrollgruppe (n = 28) verglichen. Hierbei wurden spezifische Neurogenesemarker mittels immunhistochemi-scher Methoden angewendet und ausgewertet. Es bestand eine generell sehr geringe zelluläre Proliferationsrate und eine signifikante Reduktion Musashi-1 positiver neuro-naler Vorläuferzellen bei gleichzeitig unveränderter Anzahl Nestin positiver reifender und Calretinin positiver migrierender postmitotischer Neurone. Zudem wurde ein ver-ändertes Calretinin-Expressionsmuster als Hinweis auf eventuelle funktionelle neuronale Defizite bei Drogenabhängigen festgestellt. Der potentielle Einfluss von chronischem Heroinmissbrauch auf die adulte humane Neurogenese wird erstmals gezeigt. Die Ergebnisse weisen auf eine negative Beeinflus-sung im Stadium neuronaler Vorläuferzellen und der Zellfunktion migrierender Neurone in der Fallgruppe im Vergleich zu einer gesunden Kontrollgruppe hin. Diese Hemmung der Neurogenese könnte eine Erklärungsmöglichkeit für kognitive Defizite und Funktionsstörungen des Gedächtnisses infolge chronischen Drogenkonsums bieten und zugleich eine Bedeutung bei der Entstehung von Abhängigkeitserkrankungen haben. Insofern könnte sich hier ein Ansatzpunkt für zukünftige Therapiestrategien derartiger Erkrankungen oder ihrer Folgen bieten.:I. Inhaltsverzeichnis 1 II. Bibliografische Zusammenfassung 2 III. Abkürzungsverzeichnis 3 1. Einführung 4 1.1. Drogenabhängigkeit und Epidemiologie 4 1.2. Heroin 6 1.3. Hippocampus 9 1.4. Adulte Neurogenese 11 1.5. Aufgabenstellung und Ziel der Arbeit 14 2. Materialen und Methoden 18 2.1. Fall- und Kontrollgruppe 18 2.2. Toxikologisch-chemische Untersuchungen 20 2.3. Immunhistochemie 21 2.4. Immunfluoreszenz und konfokale Mikroskopie 25 2.5. Quantifizierung, Datenanalyse und Statistik 26 3. Ergebnisse 28 3.1. Deskriptive Datenanalyse 28 3.2. Musashi-1 30 3.3. Nestin 31 3.4. Calretinin 32 3.5. Ki-67 34 3.6. Doublecortin 35 3.7. Doppelimmunfluoreszenz 36 4. Diskussion 37 4.1. Neurogenese – Proliferation (Ki-67) 38 4.2. Neurogenese – Differenzierung (MSI-1, Nestin) 39 4.3. Neurogenese – Reifung (Calretinin) 42 4.4. Methodische Grenzen und Fehlerbetrachtung 43 4.5. Fazit und Ausblick 46 5. Zusammenfassung der Arbeit 48 6. Literaturverzeichnis 52 7. Anlagen 1-8 65 IV. Selbständigkeitserklärung 73 V. Curriculum vitae 74 VI. Publikationen 75 VII. Danksagung 76

No description available.

Heroinberoende har en hög dödlighet och innebär stora kostnader för samhället, och den mest förekommande och effektiva behandlingen är läkemedelsassisterad behandling (LAB). Studiens syfte var att studera LAB vid heroinberoende ur ett omvårdnadsperspektiv. Omvårdnadsteorin som applicerades var ”Tidvattenmodellen” vars filosofi grundar sig på att det finns psykiska behov, att omvårdnad kan vara ett sätt att möta dessa behov, att människan redan har lösningen på sina livsproblem och att omvårdnad handlar om att ta fram dessa lösningar. En systematisk litteraturstudie gjordes. Resultatet baseras på tio kvantitativa artiklar och presenteras med tre teman: Bakgrundsfaktorernas roll, Personcentrerad omvårdnad och Accepterande omvårdnad. Olika bakgrundsfaktorer påverkar deltagande och fullföljande av behandlingen, så som att ha ett arbete samt civilstatus. För ett positivt resultat av LAB är det viktigt med en personcentrerad omvårdnad som erbjuder ett socialt stöd. För att öka deltagandet, och därmed tillgången till omvårdnad, måste behandlingens krav sänkas och omfattas av en högre acceptansnivå. I framtiden behövs det en bredare forskning gällande omvårdande insatser vid LAB samt diskussioner för att utforma en så säker vård som möjligt. / Heroin addiction has a high mortality and implies high costs to society, and the most common and effective treatment is maintenance treatment (MT). The study's aim was to study MT during a heroin addiction from a nursing perspective. The nursing theory applied was “The Tidal Model” whose philosophy is based on the existence of psychological needs, that nursing can be a way to meet those needs, that humans already have the solution to their problems of life and that nursing is about to develop these solutions. A literature review was made. The result is based on ten quantitative articles and presents three themes: The Meaning of Background Factors, Person-centered Care and Nursing Acceptance. Different background factors affect participation and retention in treatment, for example to have a job or the marital status. To get a positive outcome of the MT it is important with a person-centered care that provides a social support. To increase participation, and therefore the access to care, treatment policy must be lowered and have a higher level of acceptance. In the future we need comprehensive research on nursing during MT and discussions to design the safest care possible.

published_or_final_version / Social Work / Master / Master of Social Work