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The aim of this qualitative study was to map the preparation and process of relapse prevention programs in therapeutic community for treating addictions in Czech republic called Magdaléna o.p.s.. The next aim was to describe the specifics of these programs and analyse methods that are mostly applied. For fullfilling these aims, four methods were chosen: analisys of documents, semistructured interwiews with the members of the team of therapists, observation of the researcher in the specific relapse prevention program during her internship and one semistructured interview with client of this therapeutic community. The final number of respondents for this research was four therapists and one client. Three metodic relapse prevention documents were analysed and for setting the final outcomes of this research were also used the outputs from the observation of the researcher from the specific relapse prevention program. Based on this research it was found out, that the specific relapse prevention programs in Magdaléna have been part of the long-term structured schedule of the treatment. This program is on the schedule once per week in duration of one hour and it is managed by one of the therapists. The program have been carried out in group and it is always based on one specific topic. Educational and...

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Thesis (MPH.) -- University of Limpopo, 2021 / PURPOSE OR OBJECTIVE: The purpose of this study was to investigate factors that contribute to the relapse of substance abusers post rehabilitation at South African National Council On Alcoholism And Drug Dependence (SANCA) Polokwane. METHOD: A quantitative research method or approach, and a descriptive research design were employed respectively to conduct the study. Data was collected using group-administered questionnaires / surveys amongst substance abusers who relapsed post rehabilitation at the SANCA, and a total number of sixty-one (61) respondents at the centre responded to the questionnaires. FINDINGS: Findings revealed that personal factors that predisposed the relapse of substance abusers post rehabilitation include lack of coping mechanism; less committed and motivated towards staying clean or sober; having a craving for drugs; challenged with too many triggers; lack of believe in themselves; thinking they could deal with their emotions by using drugs; thinking they could be able to control my use; community members still look down on them for using drugs; peer pressure from peer group; easily influenced by others; significant relationship in their lives ending; social group still abusing drugs; finding it difficult to avoid social gathering; lack of financial support; feeling lonely and being bored. Findings also indicated that substance abuser receive sufficient support from their family. On the contrary, however, findings further show that respondents have indicated that they receive poor from their friends, community members, peers and the rehabilitation centre attended. CONCLUSION: The study successfully identified, and discussed diverse causes or factors that contribute or influence relapse amongst substance abusers post rehabilitation at SANCA, as listed above. Furthermore, also assessing the availability of social support systems post rehabilitation.

Syftet med studien är att skapa en djupare förståelse för återfallsprocessen i ett substansmissbruk utifrån intervjuer med behandlare inom socialtjänstens öppenvård. Vidare syftar studien till att belysa eventuella likheter och skillnader mellan män och kvinnors återfallsprocesser. Studien genomfördes med en kvalitativ metod genom semistrukturerade intervjuer, vilka analyserades utifrån en tematisk analys. Bekvämlighets- och snöbollsurval har använts, vilket resulterade i nio intervjupersoner, fem kvinnor och fyra män från en kommuns öppenvård. Studien visar att återfallsprocessen är komplex och individuell, vilket innebär betydande svårigheter att upptäcka förloppet. Det börjar alltid med en beteendeförändring mot tidigare levnadsmönster och med tiden kan individen återta sin gamla identitet, där drogen blir det sista steget i återfallsprocessen. Flera generella faktorer synliggörs i studien, exempelvis motgångar, relationsproblem och riskmiljöer. Återfallsprocessen påverkas när individen inte kan hantera medföljande känslor och beteende. Dessutom visar studien att flykten från negativa känslor var den faktorn som direkt kan utlösa ett återfall i ett substansmissbruk. Faktorerna är likartade mellan könen, men studien uppmärksammar däremot hur hanteringen av känslor skiljer sig, vilket har sin bakgrund i könsroller. Män har svårare att synliggöra och visa sina känslor, medan kvinnor i högre grad upplever skuld och skam till följd av samhällets stigmatisering. / The point of the study is to create a deeper understanding of the relapse process in substance abuse disorder in regard to interviews with treatment facilitators within the social service outpatient care system. Furthermore, the study aims to shine a light on possible differences and similarities between the sexes when it comes to the process of relapsing into substance abuse. The study was conducted using a qualitative method through semi-structured interviews, which were analysed by a thematic analysis. Convenience and snowball sampling was used, which resulted in nine interviewees, five women and four men from one municipality’s outpatient care system. The study shows that the relapse process is complex and individual, which causes significant difficulties to discover the relapse process. It always starts with a change in behaviour towards previous life patterns, where the drug becomes the final step on the path to relapsing. Several factors influence the process of relapsing, setbacks, issues with relationships and risk environments. The relapse process is affected when the individual cannot deal with the subsequent feelings and behaviour. Additionally, the study indicates that escaping negative feelings was the single most contributing reason behind a relapse. The contributing factors are similar between the sexes, but the study shows that the handling of feelings differs, which has its background in gender roles. Men struggle to expose and display their emotions while women at a higher frequency experience shame and guilt in relation to society and its stigmatisation.

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety. Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II. As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis. The Internet increases the possibilities for health care providers in the management of depression.

Substance abuse has been identified internationally and in South Africa as an escalating problem that has harmful effects on the substance user and on society. The cost of treating substance-related disorders places a strain on the allocation of financial resources to treat the problem. When relapse occurs in substance users who have already undergone rehabilitation, it increases the costs of treatment. Waiting lists at treatment centres are also negatively affected for first-time admissions when relapsed substance users are re-admitted. The study aimed to identify relapse indicators by post-discharge follow-up of adult substance users in a registered, non-profit, state-subsidised treatment facility in Cape Town. Marlatt’s Dynamic model of relapse was used to explore the individual and socio-cultural factors which were potentially associated with relapse. A quantitative research design using archival data and purposive sampling was used to identify possible relapse indicators. The participants were ex-patients who had undergone an inpatient treatment programme and who had been followed up post discharge. Ethical clearance was obtained from the University of the Western Cape Higher Degrees Committee. Written permission was granted by the treatment centre who is the original data owner.The majority of participants were male. More than half of the sample reported polysubstance use and, for more than half of them, the age of onset of substance use was between 11 and 15 years. Severe depression was present for more than a third of the participants, whilst the majority of the sample was assessed as being substance dependent. A large proportion of patients had family members who also used substances. The majority of the sample was unemployed and more than half had received previous substance abuse treatment. Significant associations were not established between the identified variables within the groups of factors. Additional studies are required to explore the factors contributing to relapse in this patient population. / Magister Artium (Psychology) - MA(Psych)

Thesis (DPhil (Social Work))--University of Stellenbosch, 2005. / It is generally accepted that pre-teen sexual offences are becoming a widespread problem in South Africa and social workers are ill-equipped to render a competent service to prevent these youth offenders from re-offending. To date, the social, judicial and legislative systems do not provide any definite guidelines to prevent pre-teen sexual offenders from re-offending. The purpose of this study was to present guidelines which could serve as a framework when designing prevention programmes for pre-teen sex offenders. With the results of the study an attempt will be made to augment the knowledge and skills in this area in the social service delivery system, in order to render a professional and effective service to prevent pre-teen sexual offenders from reoffending. The objectives of the study were: first, to explain policy under the South African criminal justice system regarding crime according to the Sexual Offences Act, no 23 of 1957, and the Child Care Act, no 74 of 1983, as well as government and non-government services available to children under the age of 13 who sexually offend; second, to describe the social and personal circumstances of pre-teen sexual offenders in order to illustrate the nature of the deviant sexual behaviour of these children and to determine the need for prevention programmes; third, to reflect on the nature and function of prevention programmes for pre-teen sexual offenders and to investigate the need for social workers to utilize these programmes in welfare agencies in South Africa; fourth, to determine the nature of social work programmes which social workers in welfare agencies are using to address the needs and/or problems of pre-teen sexual offenders; and finally, to describe the knowledge and practice skills needed by social workers to design prevention programmes for pre-teen sexual offenders. The literature review was focused on research findings relating to issues examined in this study. An exploratory research design for the study was confined to a purposive sample of 79 respondents who were identified from a universe of 130 social workers to assess their need to develop prevention programmes in order to render a competent service to pre-teen sex offenders and their families. The results were analysed mainly quantitatively. The empirical study enabled the researcher to draw certain conclusions. The main finding was that pre-teen sex offences were on the increase, and that social workers therefore required ever greater knowledge and skills to empower them to use existing prevention of re-offending programmes for preteen sexual offenders, or alternatively, needed to develop their own such programmes. A number of recommendations flowed from the findings. The main recommendation was that welfare organisations rendering child care service should ensure that social workers have at their disposal a diverse knowledge and skills base consisting of the most significant prevention models and approaches to enable them to design their own prevention programmes for pre-teen sexual offenders. The welfare organisations should further supply social workers with training opportunities to enable them to design prevention programmes, thereby empowering them to render a professional service to pre-teen sexual offenders and their families. Finally, preventing pre-teen sex offenders from reoffending should be a state-driven initiative and national and provincial governments should provide adequate policies and facilities for the implementation of prevention programmes for pre-teen sexual offenders.

published_or_final_version / Community Medicine / Master / Master of Public Health

Alcohol dependence is a major public health concern. Despite the FDA’s approval of multiple anti-relapse drugs, relapse rates remain unacceptably high. Furthermore, cognitive deficits among chronic drinkers are evident and are suggested to contribute to relapse risk. Current evidence suggests that several critical features of alcoholism and alcohol-associated neurodegeneration are mechanistically linked to glutamatergic actions; specifically, they appear positively affected by glutamatergic inhibition, particularly inhibition via polyamine modulation of a subpopulation of n-methyl-d-aspartate receptors. The current project was designed to evaluate the performance of two putative polyamine modulators (JR-220 and CP-101,606) in a variety of screens designed to identify the potential to reduce withdrawal severity, neurotoxicity and relapse risk. Screens included a complex organotypic screen designed to assess neuroprotective potential (Experiment 1), a simple behavioral screen designed to assess withdrawal severity (Experiment 2) as well as several more complex behavioral screens designed to examine cue-conditioning during withdrawal (Experiment 3), relapse behavior (Experiment 4), stress-associated consumption (Experiment 5) and binge-like consumption (Experiment 6). An additional open field experiment (Experiment 7) was conducted in order to address interpretational issues concerning activity in Experiments 2-6. Finally, as a first step in moving beyond simple screening, we expanded our binge screen to adhere more closely to an established, validated model of binge consumption (Experiment 8). While some interpretational issues were noted, taken together, the results from these experiments provide strong evidence for both drugs as potential pharmacotherapies for alcoholism and further implicate polyamines and NR2B subunits as critical mechanisms in ETOH consumption and withdrawal.