Thesis (Ed.M.)--Boston University

Introduction: A range of factors including individual, socio-cognitive, political and those relating to geographical location provide important contexts for understanding influences on drinking behaviour. The relationship between these factors is an area that has been under-researched, so too are comparisons between the drinking behaviour of people in different cultural contexts. This is important when national rates of average alcohol suggest that lessons can be learned from countries with relatively low levels of alcohol consumption. The research reported in this thesis provides an in-depth exploratory analysis of individuals’ experiences of drinking in Italy and England, and investigates a range of motivations to drink alcohol, including, motives to drink, alcohol outcome expectancies and factors which promote drinking in moderation or abstention. Methods and participants: This research adopted a mixed methods design comprised of two studies. In the first study, a qualitative approach was adopted to explore the experience of n=24 social drinkers based in Italy and England. The second study used a quantitative approach and involved an overall total of n=403 (inclusive of abstainers) participants in Italy and England, who were asked to complete a battery of questionnaires to assess alcohol intake and a range of measures related to drinking behaviour. Findings: National differences were demonstrated for Italian and English respondents. Key findings were that English respondents were more likely to associate drinking with positive outcome expectancies, and were more likely to see drinking as a means of coping. Findings for the Italian sample suggested that drinking was linked to positive perceived parental attitude, self-perception / monitoring expectancies, and conformity; all these factors appeared to reduce levels of alcohol intake. Abstention and limiting factors suggested that ‘indifference towards’ alcohol was important for Italian abstainers when compared to limiters and to heavier drinkers. Additionally, outcomes for English abstainers suggested that indifference towards alcohol, family constraint, and religious constraint, were deciding factors that play a part in an individuals’ decision not to drink alcohol. Conclusion: The differences between the drinking patterns of Italian and English drinkers is complex and context specific. However, emerging from this research are key areas for informing policy which seek to promote levels and patterns of safe drinking. Following findings on the relationship between the “drinking to cope” motive and rising unitary intake in the English sample, it is suggested that further lines of research could explore using mindfulness techniques to enhance coping strategies in people who drink excessively.

There is a distinction between physiological and psychological aspects of addiction. Both of which are important for the development and maintenance of substance abuse. Within psychological aspects of addiction, attention and learning may play integral roles in substance abuse behaviour. This thesis explores how an environment seems to become increasingly occupied by substance-related stimuli, as a result of substance use (Chapter 5). It is demonstrated how such stimuli are able to initially attract attention (Chapter 2.6) and such attentional biases are difficult to inhibit (Chapter 2). Such attentional biases appear to be robust behaviours which are not overly affected by craving and outcome expectancies (Chapter 3). Moreover, it is discussed how attentional biases may be associated with automaticity development (Chapter 6). This research is performed using a dyslexic population, as dyslexia has been hypothesised as an impairment in automaticity development. Therefore a population potentially impaired in automaticity development may demonstrate different patterns of substance-related attentional bias, compared to control participants (Chapter 6.6). This means that a deeper understanding of how automaticity develops for some stimuli rather than others may be beneficial for the study of substance abuse (Chapter 7). Finally, it is suggested how substance abuse interventions may benefit from closer consideration of the attentional and learning aspects of addiction (Chapter 8).

The research study aimed to identify the factors contributing to premature termination of treatment for addiction. The study took the form of a differential research design based on archival data and sought to establish patient-related predictors of treatment adherence and premature drop-out. One independent variable and 14 dependent variables were chosen. The data comprised a variety of characteristics which predispose certain addicts seeking treatment to drop out of the treatment programme before completion. The most significant finding was that a history of general abuse of medication has a negative influence on treatment outcome. The limitations of the study are discussed and recommendations are made regarding further research on the topic. / Dr. J.T.R. Beuster

The need for cultural competence in making services more responsive to the diverse needs of patients has been highlighted by many authors (NCCC, 2004b; Geiger,2001; Philleo and Brisbane, 1997; Ehrmin, 2005). Philleo and Brisbane (1997)argued that at a time of increasing globalisation and international communication,cultural competency is as important as computer literacy. This means that to be considered a competent professional, such as a nurse, drug worker, youth worker or social worker, one needs to take into account the wider cultural context of the person who is coming for help. A cultural dialogue, where the healthcare worker is able to communicate with people from a different cultural group, should be part of professional approach. With regard to the treatment of substance use problems,Philleo and Brisbane (1997) pointed out that a competent professional must know more than the harm alcohol and drugs can do to the body. Substance problems call for cultural solutions and a cultural dialogue, otherwise professionals are unlikely to achieve a change in their patients' behaviour. The need for better quality services for people from different cultural backgrounds has been recognised in a number of UK government policies, for example the Race Relations (Amendment) Act 2000 (RR(A)A 2000) (The Home Office (HO), 2000). These policies have pressurised organisations into promoting anti-racism and equal opportunities for both service users and staff, and to provide more accessible and culturally competent services. There has been much debate since the 1980s about how to make services more culturally aware and many training initiatives have been developed. Yet, there has been much confusion abuiot the focus of training such as, what needs to be addressed more: racism, discrimination, equal opportunity or diversity? There has been little discussion on the effectiveness of these training activities. Few have been evaluated to measure their impact, such as change in knowledge, attitude and behaviour of those trained, or their organisation's performance towards clients (Papadopoulos et al., 2004; Bhui et al., 2007). Consequently there is little evidence concerning the success of these educational activities. This PhD wants to make an original contribution to the debate surrounding cultural competence and educational practice by evaluating the effectiveness of an educational module to enhance the cultural competence of staff dealing with people with drug and alcohol problems. This study also includes an evaluation of the teaching and learning strategy used.

Background: Changes in neuropsychological and emotional systems are associated with substance dependence and reduce the chance of successfully maintaining abstinence after treatment. Impulsivity is strongly associated with substance dependence and is a risk factor for development, a consequence of excessive use and a marker for poor treatment outcomes. The focus of this thesis is impulsivity, as well as emotional and motivational factors, in the context of harmful substance use and dependence. The thesis is formed of two parts; the first (Studies 1 and 2) focusses on the multi-faceted role of impulsivity in substance dependence. The second part (Studies 3 and 4) investigates negative reinforcement and automatic approach and avoidance behaviour in heavy alcohol use. Study 1: A multi-dimensional investigation of impulsivity in abstinent substance dependent individuals using three complementary techniques: self-report, behavioural and neural measures. Results suggest that self-report measures of impulsivity are more sensitive in abstinent individuals than behavioural or fMRI measures. Study 2: An alternative approach to the classification of substance dependent individuals; using Latent Profile Analysis, abstinent substance dependent participants from Study 1 were regrouped based on personality risk factors rather than primary dependence. Important differences were detected within a previously undifferentiated group of abstinent substance dependent individuals; notably the greater incidence of childhood adversity and stimulant dependence history in one group, while the other did not differ from controls. Study 3: A behavioural investigation of the effect of stress induction on automatic approach and avoidance in heavy drinking individuals compared to light drinkers. Results indicated no differential effect of stress. These findings may suggest that the behaviour of older, more established heavy drinkers is comparable to that of alcohol dependent participants and reflects an advanced stage along the spectrum of alcohol use and dependence. Study 4: An fMRI investigation conducted on a subset of participants from Study 3 using neuroimaging paradigms to assess automatic approach and avoidance behaviour in heavy drinking individuals compared to light drinkers. Results can be interpreted to suggest that heavy drinkers approach alcohol in a less controlled manner than light drinkers, and that trait anxiety may be involved in the extent of avoidance behaviour. Conclusions: Although there are more questions raised by this research than are answered, some general conclusions can be drawn. Specifically, impulsivity measures need to be made more appropriate to all stages of substance use and dependence. Furthermore I propose a longitudinal theory of substance use and dependence with different neurocognitive profiles at each stage, as well as individual differences throughout the trajectory. This has implications for future addiction research that should enable better understanding for the benefit of clinical practice and treatment of substance related disorders.

This study explored the treatment of women's substance abuse from a critical theory perspective. The literature indicates that, within substance abuse treatment programs and in the research world, few treatment programs are sensitive to women's specific needs.

This study contributes to the INC theory by adding the stage of prevention to the parent-child relationships' timeline. Ten parents (six mothers and four fathers) were interviewed, and a memory enhancing timeline calendar was used to encourage parents to recall and talk about when they were trying to prevent substance (ab)use. Prevention strategies were coded on the basis of Inconsistent Nurturing as Control (INC) theory. Nurturing strategies consisted of 1.) Promoting open discussions, 2.) Monitoring behavior and activities in respectful ways, and 3.) Presenting a model for responsible use. Punishing strategies consisted of 1.) Reinforcing discipline and rules, 2.) Forcing discussions, 3.) Reprimanding perceived deviant behavior. Results demonstrated that a prevention stage exists in the parent-child relationship in the context of adolescent substance (ab)use, and parents used both nurturing and control strategies for prevention.

A dissertation submitted in partial fulfilment of the requirements for the degree of Magister Educationis in the Department of Educational Psychology and Special Education, University of Zululand, South Africa, 2011. / Substance use is on the increase among the youth in South Africa. Traditional concern about the youth (as the future of South Africa), and the portrayals in the media of severe drug and alcohol use among the country‟s youth have contributed to the need for research into this issue. Drugs and alcohol also have a close link to crime. The aim of this study is to investigate and report the prevalence of substance use and the need for intervention among male youth offenders at the Pollsmoor Youth Centre, in the Western Cape Province. The research has attempted to create an understanding of male youth drug abusers‟ attitudes towards intervention and rehabilitation programmes and also the Correctional Service‟s role in managing substance abuse. A survey research methodology using questionnaires has been employed. The data was analysed using descriptive and inferential statistics. The sample population consisted of the sentenced male youth offenders at the Pollsmoor Youth Centre. The results of the survey indicated that “Tik” (methamphetamines or crystal meths) was the most popular substance of choice in this sample. Tik was 23 % more popular than its nearest rival, cannabis. Tobacco was the most widely used drug owing to it being legal and obtainable at the Centre‟s shops. The majority of male youth offenders (74 %) believed that an intervention programme was necessary as part of their rehabilitation. The findings indicated that a department or unit needs to be established to handle the increasing drug abuse problem. The unit should identify substance abusers on admittance and place them on a rehabilitation programme. If necessary this programme should continue in their community after release from the correctional centre.

A thesis submitted to the Faculty of Arts in fulfillment of the requirements for the Degree of Master of Education in the Department of Educational Psychology & Special Needs Education at the University of Zululand, [2015] / Substance abuse is one of the major challenges experienced in our schools. If learners abuse substances/drugs, they do not learn and ultimately they fail or drop out of school. The researcher undertook a study on this challenge which reviewed research findings on substance abuse in South Africa. The study was aimed at finding out why learners abuse drugs, if there is any relationship between poor academic performance, school drop out and substance abuse. A quantitative study using semi structured interviews, focus groups and questionnaires as data gathering techniques focused on six learners that were referred to Education District offices for the substances abuse problem. These learners were selected from six secondary schools in the Nquthu area. Parents and educators of these six learners also participated in the study. The findings of the study showed that substance abuse negatively impacts effective professional practice that is teaching and learning. The study concludes with recommendations to educate learners on substance abuse prevention in schools and how to assist learners that are already abusing drugs.