La méthamphétamine (METH) est une drogue stimulante qui peut causer des déficiences des fonctions cognitives et des dommages irréversibles dans le cerveau des utilisateurs. Il est important de comprendre les mécanismes moléculaires de la toxicité de la drogue pour pouvoir développer des traitements pour contrer les effets toxiques de la METH. Plusieurs études dans notre laboratoire et autres ont montré qu’une seule dose élevée de METH (30-40 mg/kg de poids corporel) suffit à endommager l’arborisation terminale des neurones dopaminergiques dans le striatum et le cortex chez les rongeurs, de même qu’elle peut causer l’activation des signaux apoptotiques produits a partir du réticulum endoplasmique (RE) et de la mitochondrie dans le striatum. De ce fait, le but de cette thèse était d’analyser si la dose toxique de 40 mg/kg de METH injectée par faibles doses répétées (4 fois, avec des intervalles de 2 heures), appelée « binge METH », peut aussi causer des stress cellulaires du RE et de la mitochondrie dans le striatum. Des travaux récents ont suggéré que les récepteurs D1 et D2 de la dopamine pourraient être les intermédiaires de l’apoptose des neurones dans le striatum causée par l’administration d’une unique toxique dose de METH. Nous avons alors émis l’hypothèse que les messages cellulaires diriges par la stimulation des récepteurs D1 et D2 de la dopamine pourraient être à l’ origine des effets toxiques du « binge modele ». Le rôle des récepteurs de la dopamine sur l’activation des signaux de l’apoptose a été examiné en utilisant des antagonistes de ces récepteurs. Dans cette dissertation, je donne la preuve que « binge METH » affecte l’expression des immediate early genes de façon différente. Il semble que ces effets soient dépendants de la stimulation du récepteur D1. Un autre volet de cette dissertation a analysé les effets de « binge METH » sur l’expression de gènes impliqués dans la réponse au stress du RE et à l’altération de la fonction de la mitochondrie. Le prétraitement avec l’antagoniste du récepteur D1 de la dopamine, SCH23390, a complètement bloqué l’apparition de ces stress cellulaires après les injections de METH, alors que l’antagoniste du récepteur D2, raclopride, a eu des effets minimes. SCH23390 a aussi bloqué l’effet de METH à causer l’augmentation de la température corporelle des animaux, mais pas raclopride. Cependant, les deux antagonistes ont protégés contre les pertes dans plusieurs marqueurs des neurones de dopamine et sérotonine dans le striatum. De plus, SCH23390, mais non raclopride, a aussi protégé les neurones de sérotonine dans le cortex. Durant mes travaux, j’ai aussi identifié qu’il y a une augmentation de l’ARN messager de activin βA, la protéine TGF-β et Smad2 phosphorylée après les injections de METH. Ces effets sont réduits suite à un prétraitement par SCH23390 ; cependant, raclopride n’a eu aucun effet sur l’expression de TGF-β.En résumé, ces nouvelles données suggèrent que le récepteur D1 joue un rôle prédominant dans la toxicité de la METH. / Methamphetamine (METH) is a potent psychostimulant known to cause cognitive abnormalities and neurodegenerative changes in the brains of METH abusers. One approach for developing therapies for METH abuse is to understand the molecular mechanisms of toxicity of the drug. Investigations in our laboratory and elsewhere have shown that single intraperitoneal injections of METH (30-40 mg/kg of body weight) can cause damage to striatal and cortical monoaminergic systems and induce neuronal apoptosis in the striatum of rodents via activation of endoplasmic reticulum (ER) and mitochondrial death pathways. Hence, the purpose of this thesis was to investigate if toxic binge METH injections can cause ER- and mitochondria-induced stress in the rat striatum. Recent studies have suggested that dopamine (DA) D1 and D2 receptors might mediate neuronal apoptosis in the striatum after single toxic METH doses. We therefore hypothesized that signaling through these two types of DA receptors might activate toxic effects of the binge METH regimen. The role of DA D1 or D2 receptors in METH-induced cell death pathways was thus examined by using pharmacological inhibitors of these receptors. In this dissertation, I report that binge METH regimen caused differential changes in immediate early genes (IEGs) that are known to influence synaptic changes in the brain. METH-induced changed in the expression of the IEGs were dependent on DA D1 receptor stimulation. The second study examined the effects of binge METH on the expression of ER stress- and mitochondrial dysfunction-responsive genes. Pretreatment with the DA D1 receptor antagonist, SCH23390, caused complete inhibition of METH-induced ER and mitochondrial stresses whereas the DA D2 receptor antagonist, raclopride, provided only partial blockade. SCH23390 also blocked METH-induced hyperthermia whereas raclopride failed to do so. Interestingly, both antagonists attenuated METH-induced dopaminergic and serotonergic deficits in the striatum. Moreover, SCH23390 but not raclopride blocked METH-induced serotonergic deficits in cortical tissues. I also found that METH treatment induced upregulation of activin βA mRNA, increased TGF-β and phosphorylated Smad2 proteins in the rat striatum. SCH23390 pretreatment completely blocked all these effects whereas raclopride did not block METH-induced increases in TGF-β expression.

Background: Injecting drug users (IDUs) represent considerable group of patients infected with hepatitis C virus (HCV). HCV treatment is an effective tool for reduction of HCV transmissions among IDUs. Nevertheless treatment rate among IDUs is rather insufficient. Treatment uptake, provision and adherence as well as its efficacy in IDUs are determined by number of specific factors. Aims: Mapping an extent of the provision of HCV treatment to IDUs in the Czech Republic, rules and practices for the admission of IDUs into HCV treatment and its provision, describing relevant factors related to drug use. Material and methods: From January to March 2011, a questionnaire survey among centres for treatment of viral hepatitis in the Czech Republic was conducted. 76 identified centres were addressed, of which 45 (59%) responded, and 40 (53%) filled in an online questionnaire. Results: Estimated number of centres treated HCV with combination of pegylated interferon α and ribavirin in the Czech Republic in 2010 was 61, 39 of them treated IDUs. Estimated 780 persons were treated, of whom 370 were (mostly ex-) IDUs. Reported treatment uptake in IDUs was 60% on average (range 0-90%). Treatment is completed by 80% of IDUs on average (0-100%) according to clinicians. Most clinicians reported no difference in the treatment...

The aim of this diploma thesis is to describe cooperation with clients / users of methamphetamine with a severe psychiatric disorder from the schizophrenic spectrum using case management methods. The theoretical part summarizes current knowledge of the negative consequences of using methamphetamine, focussing on serious psychiatric comorbidity from the schizophrenic spectrum. It includes research of current studies (both Czech and foreign), information on specific comorbid diagnoses and a description of the case management method, including its specific application within the SANANIM addictology ambulance. The practical part contains three case studies structured into six sections: (1) Initiation of the program entry, (2) The first contact and setting, (3) Entrance evaluation and indication, (4) Establishing a relationship and developing cooperation, (5) Cooperation with other experts and stakeholders (6) The results of cooperation focussed on changes in relation to: comorbid illness, severity and frequency of use of a primary drug and other addictive substances, social situation and relational healing. I chose AA SANANIM clients by a deliberate targeting method based on the following criteria: (1) 7-month co-operation with a minimum of 28 personal contacts (roughly equivalent to once a week), (2)...

: Methamphetamine-related deaths have been rising along with those involving synthetic opioids, mostly fentanyl and fentanyl analogs (FAs). However, the extent to which methamphetamine involvement in deaths differs from those changes occurring in synthetic opioid involvement is unknown.: To determine the patterns and temporal changes in methamphetamine-related deaths with and without other drug involvement.: Data from all methamphetamine-related deaths in West Virginia from 2013 to 2018 were analyzed. Quasi-Poisson regression analyses over time were conducted to compare the rates of change in death counts among methamphetamine and fentanyl//FA subgroups.: A total of 815 methamphetamine-related deaths were analyzed; 572 (70.2%) were male and 527 (64.7%) involved an opioid. The proportion of methamphetamine only deaths stayed relatively flat over time although the actual numbers of deaths increased. Combined fentanyl/FAs and methamphetamine were involved in 337 deaths (41.3%) and constituted the largest increase from 2013 to 2018. The modeling of monthly death counts in 2017-2018 found that the average number of deaths involving fentanyl without methamphetamine significantly declined (rate of change -0.025, < .001), while concomitant fentanyl with methamphetamine and methamphetamine only death counts increased significantly (rate of change 0.056 and 0.057, respectively, < .001).: Fentanyl and FAs played an increasingly significant role in methamphetamine-related deaths. The accelerating number of deaths involving fentanyl/FAs and methamphetamine indicates the importance of stimulants and opioids in unintentional deaths. Comprehensive surveillance efforts should continue to track substance use patterns to ensure that appropriate prevention programs are undertaken.

Despite decades of research on amphetamine derivatives, a class of compounds sharing a structural foundation with amphetamine, crucial gaps remain in our understanding of these drugs in a variety of animal species and humans. This dissertation addresses three of these gaps through a multi-level approach involving studies in both humans and mice. Specifically, it focuses on investigating the lack of information regarding: 1) repeated dosing of 3,4-methylenedioxymethamphetamine in humans, 2) methamphetamine/alcohol combinations in humans and 3) methamphetamine/oxycodone combinations in mice. Study 1 involved administering three consecutive doses of 3,4 methylenedioxymethamphetamine to human volunteers at 12- and 24-hour intervals while physiological, behavioral, and subjective measures were collected. Study 2 reanalyzed Kirkpatrick and colleagues (2012a) data to evaluate repeated administrations of methamphetamine and alcohol. The reanalysis focused on quantifying the physiological and subjective effect differences between the first and second administrations, which occurred at a 12-hour interval on the same day, an aspect not previously analyzed or reported by the original authors. Study 3 utilized well-established animal models such as Conditioned Place Preference, Open Field Test, and Novel Object Recognition to evaluate the reward-like and aversive effects of methamphetamine and oxycodone combinations in mice. Study 1 was the first to quantify the effects of multiple 3,4-methylenedioxymethamphetamine doses administered over a 36-hour period of time. Initially, acute 3,4-methylenedioxymethamphetamine produced dose-dependent increases in peak heart rate, blood pressure, and more positive than negative subjective effects. However, by the third dose, many of these effects dissipated, heart rate was no longer elevated, and residual mood effects were minor. Overall, the data do not support the general perception that 3,4-methylenedioxymethamphetamine produces dangerous cardiovascular and residual mood effects in humans following repeated administration. The results of Study 2, again a first in the field, discovered that contrary to expectations, heart rate increases produced by the methamphetamine/alcohol combination were not further increased with repeated dosing, but rather attenuated. In fact, methamphetamine offset alcohol-induced intoxication, even after repeated administration. Study 3 revealed that combining methamphetamine and oxycodone in mice increased reward as measured by Conditioned Place Preference, but not more than either drug alone. However, methamphetamine lengthened the duration of Conditioned Place Preference for the lower oxycodone dose and offset the oxycodone-induced disruptions in novel object recognition performance. One crucial cross-species observation was that methamphetamine mitigated adverse effects such as alcohol-related intoxication and oxycodone cognitive disruption, even after repeated administration. While seemingly beneficial, this observation raises concerns that individuals who combine these drugs may be at risk of underestimating their overall degree of impairment, potentially leading to hazardous activities like driving while intoxicated or engaging in risky behaviors. Sharing this insight is crucial to encourage informed, responsible behavior and safeguard public safety. In conclusion, these studies have significantly enhanced our understanding of two frequently used amphetamine derivatives and their interactions with two commonly used psychoactive drugs—oxycodone and alcohol. Most importantly, we strongly advocate for robust empirical experimentation to counteract misinformation related to 3,4-methylenedioxymethamphetamine and methamphetamine. These endeavors are crucial for developing more precise assessments of the risks and benefits associated with these substances, and for improving drug policies and optimizing public health interventions.

Methamphetamine (METH) abuse has become a fast growing drug problem that has developed into a global epidemic. In fact, METH is one of the most commonly abused substances with an estimated 35 million abusers worldwide and is said to be the second most popular illicit drug. The Western Province of South Africa has seen a dramatic increase in drug abuse in recent years where METH is the primary or secondary drug of abuse. Interestingly, more than 50% of these individuals are under the age of 20 years. The longer duration of euphoric effects of METH has attracted many users away from cocaine in favour of METH. In addition to the rapid euphoric effect of METH, the direct short-term effects include arousal, reduced fatigue, an increase in blood pressure, reduced appetite as well as sustained attention. Chronic METH abuse may result in debilitating and long-lasting effects that includes mood disorders such as depression. Studies suggest a strong relationship between exposure to adverse environmental factors early in life and the later development of a neuropsychiatric disorder, such as depression. However, these severe consequences do not seem to invoke cessation of the drug. The euphoric and addictive properties of METH causes users to abuse the drug with an increase in frequency and dose, even though it might not have been their original intention. The primary objective of this study was to investigate the effect of early-life administration of METH to stress-sensitive (Flinders Sensitive Line - FSL) and control (Flinders Resistant Line - FRL) rats on depressive-like behaviour and regional brain monoamine levels later in life. The study implemented a sixteen-day period for administration of METH or a vehicle control from postnatal day 19 (PnD19) to postnatal day 34 (PnD34). The latter developmental stage corresponds to pre-adolescence in the rat when neurological development are similar to that seen in human adolescents, and represents the stage when drug abuse is most common in humans. Chronic dosing of METH and saline was performed twice daily at 09:00 and at 15:00. The animals received a sub-cutaneous (SC) escalating dose regimen of METH during the 16 day period (mimicking binging behaviour in humans), with every dose escalating in increments of 0.2 mg/kg from 0.2 mg/kg to 6.0 mg/kg. The study then investigated whether early-life administration of METH would cause depressive-like behaviours directly after the injection period (immediate drug effects before withdrawal on PnD35) or later in life (after the withdrawal period in early adulthood on PnD60). The behavioural effects were assessed in a battery of tests and thereafter the rats were sacrificed and the frontal cortex removed and snap frozen for later analyses of altered neurochemistry. The study demonstrated that chronic METH treatment during pre-adolescence induces significant behavioural changes related to depression in humans directly after the injection period (PnD35) and later in life (PnD60). The animals displayed antidepressant-like behaviour in the forced swim test (FST) before withdrawal, yet a depressogenic effect was observed 25 days post-withdrawal. This effect also seems to be additive to the congenital depressive-like phenotype of FSL rats, suggesting a role for genetic susceptibility. This observation would be in line with the two-hit hypothesis of depression, suggesting that the manifestation of depression will result when a genetic predisposition is followed by an environmental stressor (i.e. METH) later in life. The data suggests a working hypothesis that individuals that already have a predisposition to depression may be more susceptible to developing depression when abusing METH. The fact that the FSL control rats were more immobile than FRL control rats also confirmed the face validity of the FSL genetic rat model of depression. Locomotor activity assessment indicated that METH treatment decreased locomotor activity in FSL and FRL rats compared to their vehicle controls on PnD35 but not on PnD60. It is important to note that the effects observed in locomotor activity could not have contributed to the immobility observed in the FST, confirming that the immobility in the FST indeed reflects psychomotor and not locomotor effects. The study also demonstrated that METH significantly lowers social interaction behaviour in both FRL and FSL rats, both immediately following drug treatment (PnD35) and after withdrawal (PnD60). It is therefore clear that this effect of METH is long-lasting, putatively related to neurodevelopmental effects. In addition, the rats investigated the familiar object for a greater amount of time in the novel object recognition test (nORT) on PnD35 and PnD60 and may be the result of loss of recognition memory for the familiar object. This data confirms that METH results in cognitive memory deficits probably due to sustained adverse neurodevelopmental effects. Neurochemical analyses of the frontal cortex indicated decreased serotonin (5-HT) and norepinephrine (NE) levels on PnD35. METH is widely recognised for its pro-inflammatory effects, while the reduced 5-HT levels observed may have been the result of an increase in circulating pro-inflammatory cytokines. Neurochemical analyses provided thought-provoking data concerning the role of the permissive hypotheses of depression, indicating that dopamine (DA) is most likely not responsible for the behavioural effects observed, at least under the current study conditions, whereas 5-HT is decidedly more involved than expected. The data also suggest that depletion in NE plays a role in the development of depressive-like behaviours following METH exposure. Based on these findings, we propose that disturbances in 5-HT and NE are a crucial mechanism in how METH abuse may precipitate or worsen depressive-like symptoms in individuals who abuse METH. It should be noted that this study does not discard the role of DA in the development of depression after METH exposure, although under the current study conditions it appears that DA does not play a central role. The current study demonstrated that pre-adolescent exposure to METH can reproduce most of the behavioural changes seen in depressed individuals, and that these behavioural data can be used to identify causal neurochemical factors. Environmental stressors such as METH abuse should be regarded as an additional diagnostic criterion and is relevant to an accumulative risk factor hypothesis. Furthermore, although further study is required, the data suggests that early-life exposure to METH may predispose an individual to mood disorders and behavioural abnormalities later in life. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2015

Methamphetamine (METH) abuse has become a fast growing drug problem that has developed into a global epidemic. In fact, METH is one of the most commonly abused substances with an estimated 35 million abusers worldwide and is said to be the second most popular illicit drug. The Western Province of South Africa has seen a dramatic increase in drug abuse in recent years where METH is the primary or secondary drug of abuse. Interestingly, more than 50% of these individuals are under the age of 20 years. The longer duration of euphoric effects of METH has attracted many users away from cocaine in favour of METH. In addition to the rapid euphoric effect of METH, the direct short-term effects include arousal, reduced fatigue, an increase in blood pressure, reduced appetite as well as sustained attention. Chronic METH abuse may result in debilitating and long-lasting effects that includes mood disorders such as depression. Studies suggest a strong relationship between exposure to adverse environmental factors early in life and the later development of a neuropsychiatric disorder, such as depression. However, these severe consequences do not seem to invoke cessation of the drug. The euphoric and addictive properties of METH causes users to abuse the drug with an increase in frequency and dose, even though it might not have been their original intention. The primary objective of this study was to investigate the effect of early-life administration of METH to stress-sensitive (Flinders Sensitive Line - FSL) and control (Flinders Resistant Line - FRL) rats on depressive-like behaviour and regional brain monoamine levels later in life. The study implemented a sixteen-day period for administration of METH or a vehicle control from postnatal day 19 (PnD19) to postnatal day 34 (PnD34). The latter developmental stage corresponds to pre-adolescence in the rat when neurological development are similar to that seen in human adolescents, and represents the stage when drug abuse is most common in humans. Chronic dosing of METH and saline was performed twice daily at 09:00 and at 15:00. The animals received a sub-cutaneous (SC) escalating dose regimen of METH during the 16 day period (mimicking binging behaviour in humans), with every dose escalating in increments of 0.2 mg/kg from 0.2 mg/kg to 6.0 mg/kg. The study then investigated whether early-life administration of METH would cause depressive-like behaviours directly after the injection period (immediate drug effects before withdrawal on PnD35) or later in life (after the withdrawal period in early adulthood on PnD60). The behavioural effects were assessed in a battery of tests and thereafter the rats were sacrificed and the frontal cortex removed and snap frozen for later analyses of altered neurochemistry. The study demonstrated that chronic METH treatment during pre-adolescence induces significant behavioural changes related to depression in humans directly after the injection period (PnD35) and later in life (PnD60). The animals displayed antidepressant-like behaviour in the forced swim test (FST) before withdrawal, yet a depressogenic effect was observed 25 days post-withdrawal. This effect also seems to be additive to the congenital depressive-like phenotype of FSL rats, suggesting a role for genetic susceptibility. This observation would be in line with the two-hit hypothesis of depression, suggesting that the manifestation of depression will result when a genetic predisposition is followed by an environmental stressor (i.e. METH) later in life. The data suggests a working hypothesis that individuals that already have a predisposition to depression may be more susceptible to developing depression when abusing METH. The fact that the FSL control rats were more immobile than FRL control rats also confirmed the face validity of the FSL genetic rat model of depression. Locomotor activity assessment indicated that METH treatment decreased locomotor activity in FSL and FRL rats compared to their vehicle controls on PnD35 but not on PnD60. It is important to note that the effects observed in locomotor activity could not have contributed to the immobility observed in the FST, confirming that the immobility in the FST indeed reflects psychomotor and not locomotor effects. The study also demonstrated that METH significantly lowers social interaction behaviour in both FRL and FSL rats, both immediately following drug treatment (PnD35) and after withdrawal (PnD60). It is therefore clear that this effect of METH is long-lasting, putatively related to neurodevelopmental effects. In addition, the rats investigated the familiar object for a greater amount of time in the novel object recognition test (nORT) on PnD35 and PnD60 and may be the result of loss of recognition memory for the familiar object. This data confirms that METH results in cognitive memory deficits probably due to sustained adverse neurodevelopmental effects. Neurochemical analyses of the frontal cortex indicated decreased serotonin (5-HT) and norepinephrine (NE) levels on PnD35. METH is widely recognised for its pro-inflammatory effects, while the reduced 5-HT levels observed may have been the result of an increase in circulating pro-inflammatory cytokines. Neurochemical analyses provided thought-provoking data concerning the role of the permissive hypotheses of depression, indicating that dopamine (DA) is most likely not responsible for the behavioural effects observed, at least under the current study conditions, whereas 5-HT is decidedly more involved than expected. The data also suggest that depletion in NE plays a role in the development of depressive-like behaviours following METH exposure. Based on these findings, we propose that disturbances in 5-HT and NE are a crucial mechanism in how METH abuse may precipitate or worsen depressive-like symptoms in individuals who abuse METH. It should be noted that this study does not discard the role of DA in the development of depression after METH exposure, although under the current study conditions it appears that DA does not play a central role. The current study demonstrated that pre-adolescent exposure to METH can reproduce most of the behavioural changes seen in depressed individuals, and that these behavioural data can be used to identify causal neurochemical factors. Environmental stressors such as METH abuse should be regarded as an additional diagnostic criterion and is relevant to an accumulative risk factor hypothesis. Furthermore, although further study is required, the data suggests that early-life exposure to METH may predispose an individual to mood disorders and behavioural abnormalities later in life. / MSc (Pharmacology), North-West University, Potchefstroom Campus, 2015

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Clinical results have indicated that abuse of multiple drugs/substances has devastating health and social consequences. The combined abuse of alcohol and the highly addictive methamphetamine has worsened the drug epidemic in South Africa, especially in the Western Cape Province. Using non-linear ordinary differential equations, we formulate a deterministic mathematical model for alcohol-methamphetamine coabuse epidemic. We prove that the growth of the co-abuse epidemic is dependent on the threshold parameters of the individual substances of abuse. The substance with the maximum reproduction number dominates the epidemic. We also prove that the equilibria points of the co-abuse sub-models are locally and globally asymptotically stable when the sub-model threshold parameters are less than unity. Using parameters values derived from the sub-model fittings to data, a population estimate of co-users of alcohol and methamphetamine under treatment is estimated with a prevalence of about 1%. Although the results show of a small proportion of co-users of alcohol and methamphetamine in the province, the prevalence curve is indicative of a persistent problem. Numerical simulation results reveal that co-abuse epidemic would persists when both reproduction numbers are greater than one. Results from sensitivity analysis shows that the individual substance transmission rates between users of methamphetamine and/or alcohol and the general susceptible population are the most vital parameters in the co-abuse epidemic. This suggests the need to emphasise on preventive measures through educational campaigns and social programs that ensure minimal recruitment into alcohol or methamphetamine abuse. Model analysis using the time-dependent controls (policies) emphasizes the need to allocate even more resources on educational campaigns against substance abuse and on effective treatment services that minimizes or eliminates rampant cases of relapse into substance abuse. / AFRIKAANSE OPSOMMING: Kliniese resultate toon dat die misbruik van meer as een dwelmmiddel verwoestende gesondheids-en sosiale gevolge het. Die gekombineerde misbruik van alkohol en die hoogsverslawende methamphetamine het die dwelm-epidemie in Suid-Afrika vererger, veral in die Wes-Kaapse provinsie. Deur van nie-lineere gewone diffensiaalvergelykings gebruik te maak, formuleer ons ’n deterministiese wiskundige model vir epidemie van die gesamentlike misbruik van alkohol en methamphetamine. Ons toon aan dat die groei van die sogenaamde mede-misbruik epidemie afhanklik is van die drumpelparameters van die individuele middels wat misbruik word. Die middels met die grootste voortbringende syfer domineer die epidemie. Ons bewys ook dat die ekwilibriumpunte van die mede-misbruik submodelle plaaslik en globaal asimptoties stabiel is wanneer die sub-model drumpelparameters kleiner as een is. Deur die submodelle op werklike data te pas word waardes vir die drumpelparameters afgelei en word daar beraam dat daar ongeveer 1% van die populasie mede-misbruikers van alkohol en methamphetamine onder behandeling is. Alhoewel die data ’n klein persentasie van mede-misbruikers van alkohol en methamphetamine in die provinsie toon, dui die voorkomskurwe op ’n groeiende endemie en voortdurende probleem. Resultate uit numeriese simulasie toon dat die mede-misbruik epidemie sal voortduur indien beide reproduserende syfers groter as een sal wees. Resultate van sensitiwiteitsanalise toon dat die individuele middeloordragkoerse tussen gebruikers van methamphetamine en/of alkohol en die gewone vatbare populasie die mees noodsaaklike parameters in die mede-misbruik epidemie is. Dit stel voor dat daar meer klem gelê moet word op voorkomingsmaatreëls deur opvoedkundige veldtogte en sosiale programme om te verseker dat minder alkohol en/of methamphetamine misbruik sal word. Model-analise wat gebruik maak van tyd-afhanklike kontroles (beleide) lê verder klem op die feit dat selfs meer hulpbronne aan opvoedkundige veldtogte teen dwelmmisbruik toegewy moet word, asook die effektiewe behandeling wat gevalle van terugval in dwelmmisbruik sal minimeer of elimineer.

<p>Substance abuse among adolescents is a global problem and South Africa is no exception. In the Western Cape there is an alarming popularity and increased use of an illicit highly addictive substance, locally known as 'tik-tik'/methamphetamine. Adolescents are particularly vulnerable to the neurotoxic effects of this substance and there is an urgent need to address the 'tik-tik' problem in the Westen Cape. Tik/methamphetamine has thus become a great concern to educators, social workers and health practitioners in the province. The goal of this study was to explore the life-world of the adolescent methamphetamine/'tik-abusers' in order to describe their experiences of personal, social and environmental issues in the process of tik-addiction.</p>

L’usage de drogues illicites et la symptomatologie dépressive sont associés, mais la nature de cette association demeure mal comprise. Une clarification des mécanismes en jeu est nécessaire afin de pouvoir intervenir sur la cooccurrence des deux phénomènes, dont les conséquences individuelles et sociales sont lourdes. Ces efforts de clarification débutent à l’adolescence, moment où sont typiquement initiés la consommation de substances et les problèmes affectifs. L’objectif de cette thèse est de contribuer à clarifier la nature des associations entre l’usage de certaines des drogues illicites les plus fréquemment consommées et les symptômes dépressifs chez les adolescents. Les données utilisées proviennent d’une cohorte de l’échantillon longitudinal de la Stratégie d’Intervention Agir Autrement (SIAA) comprenant plus de 3000 jeunes fréquentant des écoles en milieu défavorisé du Québec, qui ont été suivis pendant leur secondaire (2003-2007). Le premier article empirique de la thèse porte sur la relation entre l’usage de cannabis et la symptomatologie dépressive. Cette étude a examiné l’existence d’associations prospectives bidirectionnelles entre les deux phénomènes du début (13-14 ans) à la fin du secondaire (16-17 ans). Les analyses ont considéré des liens directs, mais également des liens indirects via deux facteurs reflétant des appartenances sociales normatives et non normatives : l’attachement à l’école et l’affiliation à des pairs déviants et consommateurs de drogues. Les résultats indiquent que les symptômes dépressifs et l’usage de cannabis peuvent représenter des facteurs de risque mutuels et suggèrent qu’un mécanisme indirect impliquant une érosion des attaches normatives pourrait jouer un rôle dans des cascades développementales reliant les deux manifestations. Le deuxième article empirique visait à déterminer si l’usage de deux drogues de synthèse, le MDMA (ecstasy) et les méth/amphétamines (speed), à 15-16 ans était associé au développement de symptômes dépressifs élevés un an plus tard, en prenant en considération des facteurs confondants potentiels. Tel qu’attendu, les résultats montrent une prédiction de la symptomatologie dépressive par l’usage de MDMA et de méth/amphetamines, particulièrement lorsque cet usage est concomitant. Ces résultats représentent une des premières évidences d’un risque posé par l’usage de drogues de synthèse par rapport au développement de symptômes affectifs chez les jeunes. / Illicit drug use and depressive symptoms are associated, but the nature of this association remains poorly understood. Clarifying the underlying mechanism(s) is necessary in order to design interventions which can potentially reduce the co-occurrence of the two phenomena, which accounts for sizeable individual and social costs. Clarification efforts should start in adolescence, when drug use and affective problems are typically initiated. The aim of this thesis is to help clarify the nature of the association between some of the most frequently used illicit drugs and depressive symptomatology in adolescents. This work was carried out using a cohort from the New Approaches, New Solutions (NANS) longitudinal dataset, which comprises more than 3000 students attending school in disadvantaged areas of Quebec (Canada) who were followed throughout high school (2003-2007). The first article of the thesis focuses on the association between cannabis use and depressive symptoms. This study examined prospective associations in both directions between the two phenomena from the beginning (grade 8) to the end (grade 11) of high school. Direct links were analysed, as well as indirect links involving two factors reflecting normative and non normative social connectedness: school bonding and affiliation with deviant and substance-using peers. Results indicate that depressive symptoms and cannabis use can be mutual risk factors and that a social mechanism involving an erosion of normative social connectedness may play a mediating role in bidirectional developmental cascades linking the two manifestations. The second article tested whether the use of two synthetic drugs, MDMA (ecstasy) and meth/amphetamines (speed), in grade 10 was associated with the development of elevated depressive symptoms the following year, independently from potential confounders. As hypothesized, the use of MDMA and meth/amphetamine was independently predictive of subsequent depressive symptoms. Concurrent use of the two substances was more predictive than singular use. Given the paucity of well-controlled longitudinal studies on the subject, these results provide some of the first compelling evidence that synthetic drug use may pose a risk for the development of affective symptoms in youth.