<p>Despite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future. </p>

In 2013–2014, a cross-sectional, exploratory, survey design was used to obtain a conservative estimate of relapse among a sample of recovering addiction professionals in the United States and to identify potential predictors for relapse. The sample (n = 265) was drawn from the International Certification and Reciprocity Consortium. The relapse rate for the sample was 14.7%. Two predictors for relapse were identified in the stepwise logistic regression. The more mutual-aid group meetings respondents attended per month, the less likely they were to have experienced relapse (Wald = 7.956, p =.005), and the longer participants had been in recovery when their careers began, the less likely they were to have experienced relapse (Wald = 4.366, p =.037). The authors provide suggestions regarding the recovery health of recovering addiction professionals as well as recommendations for future research.

Rationale: Evidence indicates that drug-paired stimuli can evoke drug-craving leading to drug-seeking and repeated relapse periods can influence drug-seeking behaviors. Objectives: The present study examined (1) the effect of an interaction between repeated deprivation cycles and excitatory conditioning stimuli (CS+) on ethanol (EtOH)-seeking; (2) the effects of EtOH-paired cue-exposure in a non-drug-paired environment on subsequent conditioning in a drug-paired environment; and (3) the temporal effects of conditioned cues on subsequent EtOH-seeking. Methods: Adult female alcohol-preferring (P) rats were exposed to three conditioned odor cues; CS+ associated with EtOH self-administration, CS− associated with the absence of EtOH (extinction training), and a neutral stimulus (CS0) presented in a neutral non-drug-paired environment. The rats underwent four deprivation cycles or were non-deprived, following extinction they were maintained in a home cage for an EtOH-free period, and then exposed to no cue, CS+, CS−, or CS0 to assess the effect of the conditioned cues on EtOH-seeking behavior. Results: Repeated deprivations enhanced and prolonged the duration of CS+ effects on EtOH-seeking. Presentation of the CS− in a non-drug-paired environment blocked the ability of a CS+ to enhance EtOH-seeking in a drug-paired environment. Presentation of the CS+ or CS− in a non-drug-paired environment 2 or 4 h earlier significantly altered EtOH-seeking. Conclusion: Results indicated an interaction between repeated deprivation cycles and CS+ resulted in a potentiation of CS+ evoked EtOH-seeking. In addition, a CS− may have therapeutic potential by providing prophylactic protection against relapse behavior in the presence of cues in the drug-using environment.

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.

Background: Response to treatment in anorexia nervosa entails various challenges, including an increased risk of relapse and re-admission in those treated as inpatients. A better understanding of patients’ experiences is paramount to improve treatment acceptability and outcome. This qualitative study aimed to explore the lived experiences of adult female inpatients undergoing a specialist inpatient treatment programme for anorexia nervosa. Methods: Semi-structured interviews were carried out with 21 female participants (aged 18-41 years) with a diagnosis of anorexia nervosa, undergoing treatment in a specialist inpatient eating disorder unit. Data were analysed using interpretative phenomenological analysis (IPA). Results: Qualitative analysis highlighted 5 master themes which underpinned treatment experiences: (1) Shifts in control, (2) Experience of transition, (3) The importance of supportive staff relationships, (4) Sharing with peers and (5) Process of recovery and self-discovery. Conclusions: Overall, findings suggest patients experience a process of change and adjustment during inpatient treatment in relation to their levels of perceived control, attachment to the treatment environment and a sense of self-identity. Treatment experiences appear to be influenced by the development of supportive relationships and the provision of individualised care.

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Most ALL cases originate from immature B-cells (BCP-ALL) and are characterized by reoccurring structural genetic aberrations. These aberrations hold information of the pathogenesis of ALL and are used for risk stratification in treatment. Despite increased knowledge of genetic aberrations in pediatric T-cell ALL (T-ALL), no reliable molecular genetic markers exist for identifying patients with higher risk of relapse. The lack of molecular prognostic markers is also evident in patients with relapsed ALL. During the last decades, aberrant epigenetic mechanisms including DNA methylation have emerged as important components in cancer development. Telomere maintenance is another important factor in malignant transformation and is crucial for long-term cell survival. Like DNA methylation, telomere length maintenance has also been implicated to reflect outcomes for patients with leukemia. In this thesis, the prognostic relevance of DNA methylation and telomere length was investigated in pediatric ALL at diagnosis and relapse. The telomere length (TL) was significantly shorter in diagnostic ALL samples compared to normal bone marrow samples collected at cessation of therapy, reflecting the proliferation associated telomere length shortening. Prognostic relevance of TL was shown in low-risk BCP-ALL patients where longer telomeres at diagnosis were associated with higher risk of relapse. Genome-wide methylation characterization by arrays in diagnostic T-ALL samples identified two distinct methylation subgroups denoted CIMP+ (CpG Island Methylator Phenotype high) and CIMP- (low). CIMP- T-ALL patients had significantly worse outcome compared to CIMP+ cases. These results were confirmed in a Nordic cohort treated according to the current NOPHO-ALL2008 protocol.  By combining minimal residual disease (MRD) status at treatment day 29 and CIMP status at diagnosis we could further separate T-ALL patients into risk groups. Likewise, the CIMP profile could separate relapsed BCP-ALL patients into risk groups, where the CIMP- cases had a significantly worse outcome compared to CIMP+ cases.  From these data we conclude that DNA methylation subgrouping is a promising prognostic marker in T-ALL, as well as in relapsed BCP-ALL two groups where reliable prognostic markers are currently missing. By elucidating the biology behind the different CIMP profiles, the pathogenesis of ALL will be further understood and may contribute to new treatment strategies.

M.Cur. / The problem of relapsed psychiatric patients is global, it is high in rural areas where services are not readily available. Lack of knowledge of psychiatric conditions and the management by family of patients play a part in psychiatric patients relapsing. Families reject their family members (patients) when they are in hospital, for what they did when their illness started. Some patients assaulted people, stripped naked in the street. The family then disassociate themselves from the patient because of that behaviour. Studies have indicated that the following reduce the rate of relapse of psychiatric patients: • psycho-education for families regarding the causes of mental illness and its management; and • active involvement of families of patients in the treatment plan of these patients. The researcher’s interest was triggered by the high rate of psychiatric patient relapses in the institution where she works. The researcher decided to investigate the experiences of patients who have relapsed. An investigation was done whereby an explorative, descriptive, contextual and qualitative design was used to find out what the experiences of patients are who have relapsed. Phenomenological interviews were done with seven participants who were purposively selected. Permission was first obtained from the gatekeepers and participants. Thereafter, a pilot study was done with one patient who met the selection criteria for the study. This was done to help the researcher to discover the strong and weak points of the research and to make corrections where necessary. Following Guba’s model (Krefting, 1991:214-222) strategies ensured trustworthiness. Data analysis was done following Tesch’s method of data analysis (Creswell, 1994:154-156). The results showed that patients’ basic needs are neglected in some areas. Emotional dimensions of participants were not catered for by health workers, which resulted in participants getting frustrated and angry. After the data analysis guidelines for psychiatric nurses were described to assist psychiatric patients to mobilise their resources. Recommendations were made regarding the application of the results of the study in psychiatric education, nursing practice and research and for family members. It was concluded that the questions of the study were answered and the objectives were achieved.

O presente estudo objetivou comparar retrospectivamente a estabilidade póscontenção do alinhamento dos incisivos ântero-superiores em pacientes Classe I e Classe II de Angle. A amostra consistiu-se de 38 pacientes de ambos os gêneros, tratados sem extrações e mecânica Edgewise. A amostra foi dividida em dois grupos: Grupo 1 (Classe I) constituído por 19 pacientes (12 do gênero feminino e 7 do gênero masculino), com idade inicial média de 13,06 anos (d.p. = ± 1,27), portadores da má oclusão de Classe I com apinhamento ântero-superior inicial maior que 3mm. Grupo 2 (Classe II) apresentando 19 pacientes (14 do gênero feminino e 5 gênero masculino), com idade inicial de 12,54 (d.p. = ± 1,37), portadores da má oclusão de Classe II, e também com apinhamento ântero-superior inicial maior que 3mm. Foram medidos nos modelos de estudo das fases pré (T1), pós-tratamento (T2) e pós-contenção (T3), o índice de irregularidade de Little, as distâncias intercaninos e entre os primeiros e segundos pré-molares, a distância intermolares e o comprimento do arco superior. Após a obtenção dos dados, realizou-se a análise estatística. Para a comparação intragrupo nos 3 tempos de avaliação, utilizou-se a análise de variância a um critério de seleção, e em caso de resultado significante, o teste de Tukey. A comparação intergrupos foi realizada por meio de testes t independentes. Para verificação da presença de correlação entre a recidiva do apinhamento ântero-superior e a recidiva das variáveis: distâncias intercaninos, interpré-molares, intermolares e comprimento do arco, utilizou-se o teste de correlação de Pearson. Os resultados evidenciaram maior estabilidade do tratamento no grupo 2 (Classe II), pois durante o período pós-contenção, foi observada uma menor recidiva do apinhamento dos dentes ântero-superiores no grupo 2 (0,80mm) do que no grupo 1 (1,67mm). Concluiu-se que o tratamento do apinhamento dos dentes ântero-superiores é mais estável na má oclusão de Classe II do que na má oclusão de Classe I. / The present study aimed to retrospectively compare the postretention stability of maxillary anterior incisors alignment in Angle Class I and Class II patients. Sample comprised 38 patients of both genders, treated nonextraction and edgewise mechanics. Sample was divided into two groups: Group 1 (Class I) comprised 19 patients (12 females and 7 males), at a mean age of 13,06 years (d.p. = ± 1,27), with Class I malocclusion and initial maxillary anterior crowding greater than 3mm. Group 2 (Class II) comprised 19 patients (14 females and 5 males), at a mean age of 12,54 (d.p. = ± 1,37), with Class II malocclusion, and also with a initial maxillary anterior crowding greater than 3mm. It was measured the dental casts of pre (T1), posttreatment (T2) and postretention (T3), the Little irregularity index, intercanine distance and between first and second premolars, intermolar distance and maxillary arch length. After obtainment of data, the statistical analysis was performed. For intragroup comparison among the three times of evaluation, it was used the one-way ANOVA followed by Tukey test in case of a significant result. Intergroup comparison was performed by independent t tests. To verify the presence of correlation among the relapse of maxillary anterior crowding and the relapse of the variables: intercanine, interpremolar and intermolar distances and arch length, the Pearson correlation test was used. Results evidenced greater stability of treatment in group 2 (Class II), because during the postretention period, it was observed a lesser relapse of maxillary anterior crowding in group 2 (0,80mm) than in group 1 (1,67mm). It was concluded that treatment of maxillary anterior crowding is more stable in Class II malocclusion than in Class I malocclusion.

Tendo em vista a imprevisibilidade da estabilidade oclusal pós correção ortodôntica, este estudo objetivou correlacionar a recidiva da sobremordida e da sobressaliência com a recidiva do apinhamento ântero-superior e ântero-inferior, em casos com má oclusão de Classe I e Classe II de Angle, tratados ortodonticamente com extração de 4 pré-molares, tratados pela técnica Edgewise. Para isso, foram selecionados 40 pacientes (20 do gênero feminino e 20 do gênero masculino), 25 pacientes portadores de má oclusão de Classe I e 15 de Classe II de Angle, com idade média inicial de 13,01 anos, que foram tratados por um tempo médio de 2,15 anos, e avaliados na fase pós-contenção após um período médio de 5,43 anos. Todos os pacientes apresentavam pelo menos 3 mm de sobremordida e 4mm de sobressaliência ao início do tratamento ortodôntico. Foram utilizados os modelos de gesso das fases do início do tratamento (T1), final de tratamento (T2) e da fase pós-contenção, em média 5 anos após o término do tratamento (T3) de todos os casos selecionados para que fossem quantificadas as recidivas dessas duas variáveis, assim como a recidiva do apinhamento anterior. Utilizou-se a análise de variância a um critério de seleção, e em caso de resultado significante, o teste de Tukey, para comparação intragrupos dos 3 tempos avaliados. Para verificação da presença de correlação entre a recidiva da sobressaliência e da sobremordida, com o apinhamento anterior, utilizou-se o teste de correlação de Pearson. A comparação intergrupos foi realizada por meio do teste t independente. Os resultados mostraram que houve uma correção significante do trespasse horizontal, vertical e apinhamento com o tratamento. Não houve uma recidiva significante do trespasse horizontal, vertical e do apinhamento ântero-superior no período pós-contenção, ao contrário do apinhamento ântero-inferior, que apresentou uma recidiva significante. Houve correlação significante da recidiva do trespasse horizontal com a recidiva do trespasse vertical. Não houve correlação significante entre a recidiva do trespasse horizontal e a recidiva do apinhamento anterior. Não houve correlação entre a recidiva do trespasse vertical e a recidiva do apinhamento anterior, assim como também não houve correlação entre a recidiva do apinhamento ântero-inferior e ântero-superior. Houve diferença intergrupos apenas para o apinhamento ântero-inferior ao início do tratamento, que foi maior no grupo Classe I, que apresentou também uma maior correção com o tratamento e um maior apinhamento na fase pós-contenção. / Due to the unpredictability of the occlusal stability after orthodontic correction, this study aimed to correlate the relapse of overbite and overjet with the relapse of maxillary and mandibular anterior crowding, in cases of Class I and Class II malocclusions, treated orthodontically with four premolars extraction and Edgewise technique. For this, 40 patients were selected (20 females and 20 males), 25 patients with Class I malocclusion and 15 with Class II, with initial age of 13.01 years, which were treated for a mean period of 2.15 years, and evaluated postretention after a mean period of 5.43 years. All patients had at least 3mm of overbite and 4mm of overjet at the beginning of orthodontic treatment. The dental casts from pretreatment (T1), posttreatment (T2) and postretention, on average 5 years after completion of treatment (T3), were used. It was used the one-way ANOVA, and in case of a significant result, Tukey\'s tests were used for intragroup comparison of the three times evaluated. To verify the presence of correlation between the relapse of overjet and overbite, with the relapse of anterior crowding, the Pearsons correlation test was used. Intergroup comparison was performed with independent t tests. The results showed a significant correction of the overjet, overbite and crowding during treatment. There was not a significant postretention relapse of overjet, overbite and crowding of the maxillary anterior segment, unlike the mandibular anterior crowding, which presented a significant relapse. There was a significant correlation of relapse of the overjet with the relapse of the overbite. No significant correlation between relapse of overjet and relapse of anterior crowding. There was no correlation between relapse of the overbite and relapse of anterior crowding, and there was also no correlation between mandibular anterior crowding relapse and maxillary anterior crowding relapse. There were differences between groups only for the mandibular crowding at pretreatment, which was higher in Class I, which also showed a larger correction with treatment and greater relapse of this crowding in the postretention.

The purpose of this research study was to determine the effects of Fostering Resilience™ (FR), a new integrative relapse prevention group protocol for improving relapse risk, internalized shame, and psychological well-being in adults with substance use disorders (SUD). This study also sought to identify any relationship among relapse risk, internalized shame, and psychological well-being. It is the first study to investigate the new FR manualized program model compared to treatment as usual (TAU). The FR model was created based upon direct client experience, the supposition of the intrinsic role shame plays in SUD, and the corresponding belief in the essential value of implementing shame reduction techniques for improving treatment outcomes. Participants were 43 adults with SUD (19 FR and 24 TAU) seeking outpatient treatment. All participants received the 8-week intensive outpatient (IOP) treatment, with the FR group receiving 16 sessions of the manualized FR relapse prevention group protocol in lieu of other TAU group options. Assessments were administered pre and postintervention. Results indicated that the FR treatment group produced a significant reduction in relapse risk (p = .002, ES = .825), shame (p = .004, ES = .763), and psychological wellbeing (p = .008, ES = .679) from baseline to post-intervention, while the TAU comparison group produced a non-significant improvement in relapse risk (p = .209, ES = .264), shame (p = 055, ES = .409) and psychological well-being (p = .088, ES = .456). Correlation results indicated highly significant correlations between all the dependent variables. All correlations dropped post-intervention, although remained significant. The strongest relationship was found between shame and relapse risk at baseline: ALL (n = 43, r = .880), FR (n = 19, r = .869), TAU (n = 24, r = .908). This preliminary study establishes support for the new FR model as a beneficial treatment for significantly improving relapse risk, internalized shame, and psychological well-being in adults with SUD. It also provides important knowledge and insight regarding the critical nature of shame and its role relative to relapse risk and psychological well-being in those with SUD. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection