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A review of the literature indicates that young males, who are unemployed with low levels of education, predominate in populations of pre-trial criminal offenders suspected of having a psychiatric illness, also known as “Observation Patients” according to the Criminal Procedures Act of 1977 in South Africa. Other contributory factors include a history of mental illness and non-compliance on psychiatric medication, a previous forensic history, co-morbid substance abuse and being intoxicated at the time of the offence. Dual diagnosis is considered a key contributor to criminal behaviour in this group of patients. The review of the literature also shows a significant proportion of co-morbid intellectual disability among offenders found to be psychiatrically ill at the time of the criminal event. A previous study conducted 20 years earlier, in 1986 at the Sterkfontein Forensic Psychiatric Unit by Vorster (1986) showed that the typical profile was a single, unemployed, poorly educated male in his twenties, usually with a history of psychiatric treatment. This typical profile confirmed the evidence in the literatures at the time of the study.

This article examines the socio-political intricacies of the United States Opiate Crisis. By first addressing the pharmaceutical origins of Oxycontin and its pain relief benefits within the United States, I construct a framework by which a conversation about substance abuse can move forward. Within the first chapter I provide background into the arguments for medicalization against personal responsibility as it relates to opiate withdrawal and seeking treatment for the prior. Furthermore, I include subheadings to further provide insight into Medically Assisted Treatment Centers and their function on the local level. I contrast these modern treatment models with the Reagan War on Drugs mentalities and illustrate a larger societal tonal shift towards increased medicalization. My second chapter addresses the bulk of my theoretical frameworks, including spatial and feminist theories to construct an argument about patriarchal dominance in relation to factors such as homelessness, race, and socioeconomic status. Finally, in my third chapter I examine the current debate regarding whether or not the U.S. Opiate Crisis can truly be considered a crisis. I address the arguments for why it could still be considered a widespread crisis, and end on the central argument for the crisis being a symptom of Disease of Despair.

This study sought to investigate fatal overdoses in Orange County, Florida during the years of 2019, 2020, and 2021. Data for this project was provided by the Orange County Medical Examiner's office. Each overdose death was coded for age, sex, race, and cause of death. The purpose of the study is to identify trends to inform policy reform. The results reveal that fentanyl overdose deaths are continuing to rise as heroin overdose deaths decrease. Additionally, there is greater upward trends in polysubstance opioid overdose deaths as compared to non-opioid polysubstance overdose deaths. Ultimately, a specific type of overdose death cannot be predicted by race or sex. The implications of this study are that awareness campaigns and treatment opportunities should highlight that an overdose death can happen to anyone.

While there is a substantial body of placed-based evaluations of drug enforcement strategies, little is known about the nature and effectiveness of the routine tactics used by local police to target individual drug offenders. This study used a mixed-method approach to build on existing research on the efficacy of drug enforcement by documenting the nature and consequences of street-level drug enforcement at the local level. First, a focus group of drug enforcement experts was conducted to identify the tactics used to generate arrests and various types of evidence believed to strengthen drug cases. Next, official data in the form of police reports and court records were coded from one year of proactive felony drug arrests in a large, urban police department. The relationship between offender-focused drug enforcement tactics and various court outcomes (e.g., felony prosecution, formal conviction, and incarceration) were examined through logistic regression analyses. Results indicate traffic stops were the most frequently used tactic to generate felony drug arrests. However, buy-walks were more effective than traffic stops at receiving felony prosecutions. In contrast, search warrants were significantly less likely to result in prosecution. Implications for research and policy are discussed.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine. Johannesburg 2019 / Background: The high level of co-morbid TB/HIV cases with severe organ failure on presentation in South Africa, results in an increased number of ICU admissions often with a poor prognosis at presentation. In this study, the aim was to identify patients admitted with HIV/TB co-infection and calculate the APACHE II scores and SOFA scores for each patient. Predicted percentage mortality was compared with actual mortality. Predictors of mortality were further identified, as well as the benefit of initiating ARV treatment in patients who are ARV naive upon admission to ICU. Methods: A retrospective audit of consecutive cases over a 24 month period was completed. Patient demographics; CD 4 count; ARV treatment status; ICU and 30 day mortality; the APACHE II Score; SOFA scores and correlating predicted percentage mortality were documented. The survival of patients was assessed using Kaplan Meier survival curves, and a univariate analysis was performed to identify risk factors for mortality. Calculated predicted mortality was compared with actual mortality to validate each scoring system and infer which was the better tool. Results: Of 75 patients admitted with pulmonary (43 cases) or extra-pulmonary (32 cases) TB, 23 died in the ICU (mortality 30,7%), and a further 10 died in the first 30 days of hospitalisation (30 day mortality 44%). A survival analysis established ARV treatment and CD 4 counts greater than 50 cells/mm3 were associated with a higher survival rate at any point of the analysis. In the entire study period, only 2 patients were initiated on ARV therapy during their ICU stay, 1 survived to discharge and 1 died in ICU. The APACHE II Predicted Mortality was within the 95% Confidence Intervals for all groups while the SOFA score was outside the upper bound limit of the 95% confidence intervals of actual mortality for those patients taking ARV treatment (52%, 95% CI 43,1% - 59,5% vs actual mortality 30%, 95% CI 17,7% - 46,1%), those with a CD 4 count of more than 50 (53,5% 95% CI 45,4% - 60,6% vs actual mortality 34%, 95% CI 22,1% - 48,4%) and female patients (51,2%, 95% CI 41,6% - 58,1% vs actual mortality 35,1%, 95% CI 21,4% - 50,4%). Conclusion: The study found that both the APACHE II and SOFA scoring systems were both statistically significant in prognosticating mortality in the study population. The APACHE II scoring system however showed a slightly improved prognostication in specific cohorts who had improved survival. It was also confirmed that patients with a CD 4 count of more than 50 cells/mm3, and those on ARV therapy had a statistically significant improved mortality. Further studies reviewing survival benefit of ARV initiation in ICU are warranted. ACKNOWLEDGEMENTS Supervisor: Prof GA Richards Co-Supervisor: Dr SHH Mohamadali Statistician: Mr MH Zondi Assistant - Data Collection: Ms S Madanlall / E.K. 2019

This thesis attempts to document and illuminate the growing issue of prescription drug abuse among the elderly population. The average elder in the U.S. takes at least one prescription drug per day, depending upon their health status. Likewise, elders that suffer from multiple chronic conditions are more likely to take multiple prescription drugs. As the lifespan of humankind grows well into their 90's and older, even more elders will be placed on prescription drugs. As part of this study, a narrative literature review was conducted to summarize the topic of prescription drug abuse amongst the elderly. The findings suggest that elderly white women over the age of 80 years old are more likely to take prescription drugs that lead to a higher risk of bodily injuries and death. This study is critically important and essential since the current generation that meets the age requirement to be considered elderly is the "Baby Boomer" generation. The "Baby Boomer" generation, defined as individuals born between 1946 and 1964, is considered one of the largest generations recorded in modern times. This study will be useful for practitioners, residential care facilities, policymakers, and family members to have better oversight and communication with elders suffering from chronic conditions that take prescription drugs to cure their illnesses.

Pain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively recognize drug-seeking. This integrative literature review will identify the common behaviors that have been seen as indicators of drug-seeking in the ED. The evidence collected from articles published between 2001 and 2011 examined the use of assessment tools, drug screening, and prescription monitoring programs for distinguishing drug-seekers. The evidence did not identify a specific evaluation tool used to recognize drug-seekers; however, the research did suggested that using these techniques can help to identify drug-seeking behavior allowing emergency medical staff to effectively manage pain in the ED.

This thesis examines the possibilities of living an authentic life for an alcoholic, both in and out of Alcoholics Anonymous. Authenticity is explored using the existential models put forth by Jean-Paul Sartre and Soren Kierkegaard. Alcoholics Anonymous figures prominently in this analysis. It is suggested that A.A. acts inauthentically in its claims that it is not a religious organization. A.A. creates special problems for female alcoholics because of the sexist and masculinist nature of its primary literature. While A.A. claims that its message is the only way by which an alcoholic can recover, other treatment methods exist. Suggestions are made that A.A. revise its main texts, and two alternative organizations to A.A. are briefly discussed.

Twelve-Step programs of substance abuse recovery are the most popular and most used mutual-help model in the U.S. One of the pivotal aspects of Twelve-Step is the often controversial idea of powerlessness. While a few recent dissertations have been conducted to look at issues related to women in Twelve-Step, most of what has been published in the literature on powerlessness in Twelve-Step is hypothetical, anecdotal, and theoretical. There is debate about the usefulness of the concept of powerless, especially for women in recovery, though no research was found specifically exploring this issue. The current study examines the experiences of powerlessness among women who are using Twelve-Step substance abuse recovery. Because experiences of powerlessness are abstract and may be difficult to articulate, a data collection method called ZMET (Zaltman, 2004) was utilized. This method helped women discuss their thoughts and feelings about powerlessness through the use of images of representative metaphors and analogies. Participants were 13 women who were in various stages of recovery using Twelve-Step. In-depth interviews were used to understand women's experiences of powerlessness in their recovery while two surveys were used to determine women's levels of affiliation with Twelve Step programs and their level of agreement with the First Step of Twelve Step. Overall, women felt positively about powerlessness in their recovery and felt it provided a sense of relief. Eleven of the 13 women felt powerlessness was an important aspect of their recovery while two felt it was either not relevant or not something they fully embraced. In exploring the metaphors women had for their experiences of powerlessness, a number of themes emerged. Many of the metaphors indicated processes while some were static. Themes also included metaphors of current events, nature, and babies. Other themes were: Higher Power; a general sense of powerlessness over many things in life and; choosing not to share certain experiences in Twelve-Step meetings. Implications for women in recovery, clinicians, and future research are included as well as strengths and limitations of the study. / Ph. D.