This exploratory, quantitative study investigated the prevalence rate of people with cooccurring substance-related and psychiatric disorders (CODs). A treatment-seeking sample from Houghton House Addiction Recovery Centre in Johannesburg, South Africa was used. Details of the case histories of the clients were collected, coded and analysed using Statistical Analysis System (SAS). The results indicated that 57.1% of 419 clients had one or more co-occurring psychiatric disorder, along with a substance-related disorder. Of the 239 with a COD, 155 had a mood disorder, 40 had an anxiety disorder, 39 had ADHD, 35 had an eating disorder, 8 had a conduct disorder and 5 had schizophrenia. Statistically significant relationships were found for ADHD with cannabis-related disorders and polysubstance dependence; anxiety-related disorders with alcohol-related disorders; and mood disorders with cocaine-related disorders, possibly substance-induced disorders and substance-induced disorders. These results showed that there was large group of people who presented for substance abuse treatment who have one or more COD. Having a COD made the nature of their problems particularly complex. There is a need for greater awareness of this vulnerable group. This would serve to improve the treatment that people with CODs receive.

A number of theories have attempted to explicate mechanisms underpinning the transition from recreational drug use to substance dependence. A highly reliable correlate of dependence is the value ascribed to the drug. However, supernormal drug valuation may be insufficient to fully account for a subgroup of dependent individuals for whom the course of dependence is chronic and relapsing and who persist in drug use in the face of devastating costs. Three candidate secondary mechanisms for dependence are considered in this thesis: cue reactivity, cost discounting, and sensitivity to negative affect. Neither cue reactivity nor cost discounting were found to be significantly associated with severity of alcohol dependence in samples of young adult drinkers. By contrast, induced negative affect was found to be reliably associated with augmented alcohol motivation, and sensitivity to this effect was related to symptoms of depression and self-reported drinking to cope with negative affect: both risk factors for the development of dependence. These findings delineate a particular subset of dependent individuals for whom negative affect may represent a substantial trigger to continued drug use. There are a lack of brief interventions to abolish or limit negative affect driven drug motivation. This thesis trialled three potential interventions. A natural walk intervention in hazardous drinkers showed no evidence of limiting this effect in two experiments. Brief instruction in acceptance-based coping showed no evidence of limiting annoyance in response to an aversive noise induction procedure in an alcohol dependent population, and was therefore also eliminated as a potential intervention. However, engagement with pleasant environmental images, as a proxy for environmental enrichment, significantly reduced negative affect driven alcohol choice in student drinkers who reported a desire to visit the locations shown (high liking), compared to low-liking individuals and controls. This provides preliminary evidence for the efficacy of environmental enrichment type interventions, justifying further trials. In treatment of dependence more generally, interventions to increase access to healthy, non-drug sources of positive reinforcement may prove effective.

Evidence-Based Alternative Therapy to Reduce Anxiety in Ambulatory Mental Health Patients by Renee Denobrega MS, Widener University, 2013 BS, Alvernia University, 2007 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University January 2016

Substance dependency can affect a mother‘s health and her ability to parent. A cross sectional study was implemented to better understand resources of African American mothers in recovery from substance dependence. A convenience sample of 38 African American mothers at two drug treatment centers in Atlanta, Georgia completed the Michigan Screening Profile of Parents (Helfer, Hoffmeister, & Schneider, 1978). Results indicated that women who perceived that their emotional needs were being met were less likely to use maladaptive coping skills. Mothers who used less maladaptive coping skills were less likely to report negative interactions with their children. Results have implications for the needs of African Americans mothers in substance abuse treatment. Follow up studies may benefit from the use of longitudinal and qualitative research methods in order to comprehensively explain the impact of lifetime social supports on maladaptive coping and negative parenting behaviors for African American mothers in recovery.

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Coping with relapse in the drug addiction treatment is a frequent problem. To accept and admit a possibility of a relapse in an individual, which has already a took part, and duly finished his residential treatment, is important for his future life in abstinence. Relapses must be seen as a natural part of the therapeutic process and its needed to prepare clients and their families to them, during the treatment. Relapses might lead client to a deeper self-knowledge and also to gain the ability to recognize and manage risk situations. Research work was aimed on clients, who underwent at least one or more attempts to addiction treatment, which, although they completed it in due time, they are unable to remain in longer abstinence of drugs, and are reaching back to fall into previous level of drug dosage. Aim of this work was to map into more detaile the factors stading in the backround of relapse in an individual client after each treatment, to examine the circumstances, motivation for abstinence, decisions, and mental states, which clients were aware before starting the relapse, by using semi - structured interviews and anamnestic data. The basic findings of this research include the changing causes which trigger relapses in the majority of clients who had repeated treatments. There was a lack of...

Bakgrund: Smärtupplevelsen är subjektiv och individuell som inte kan uppskattas av storleken på en skada. Sjuksköterskans uppgift är att främja livskvalitet, lindra lidande och reducera komplikationer. Inom sjukvården administreras ofta opioider mot smärta, som har en hög beroendepotential. Personer med ett substansberoende och smärta har lika rätt till en kvalitativ, evidensbaserad och värdig vård. Behandlingen ska präglas av ett personcentrerat förhållningssätt där smärtan respekteras, bekräftas och tros på med hänsyn till olika faktorer som kan påverka smärtupplevelsen. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att behandla smärta hos patienter med ett substansberoende. Metod: En litteraturöversikt som utgick från tio vetenskapliga originalartiklar, hämtade från databaserna PubMed och CINAHL complete. Sökorden i PubMed var följande, "nurs* experienc*", "nurs* attitude*", "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" och "pain". I CINAHL complete var sökorden, "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", "Pain",  "nurs* experienc*" och "nurs* attitude*". Av de utvalda artiklarna var åtta kvalitativa och två kvantitativa som kvalitetsgranskades samt analyserades efter Fribergs metodbeskrivning. Resultat: Resultatet visade att inadekvat vård förekommer i smärtbehandlingen av patienter med substansberoenden. Detta till följd av sjuksköterskors bristande kunskap och kommunikation, stigmatisering, osäkerheter och rädslor samt brister i standardiserade smärtskattningsinstrument och behandlingsriktlinjer. Sammanfattning: Att behandla smärta hos patienter med substansberoenden kräver bred kompetens inom området och berör fysiska, sociala och psykiska behov. Vården behöver integrera ett personcentrerat arbetssätt för att tillgodose detta. Genom att dela med sig av erfarenheter och kunskap kunde man minska stigmatisering och lättare hantera egna känslor. Även organisatoriska förändringar på politisk nivå krävs för förbättringar. / Background: Pain is a subjective and an individual experience which cannot be judge by the apperance of an injury. The role of a nurse is to improve quality of life, alleviate suffering and reduce the impact of pain. In healthcare, addictive opioids are mainly administered for pain. People with a substance dependence and pain have the same right to a qualitative evidence-based and dignified care. Pain management should be characterized by a person-centred approach in which pain is respected, acknowledged and believed in, considers the various factors that may influence the experience of pain. Aim: The aim was to describe nurses' experiences of managing pain in patients with substance dependence. Method: A general literature review based on ten original scholarly articles, taken from PubMed and CINAHL Complete databases was chosen for the study. The key words in PubMed was “nurs* experienc*”, “nurs* attitude*”, "Substance-Related Disorders", "Opioid-Related Disorders", "Pain Management", "care management" and “pain”. The following key words in Cinahl complete was "Substance Dependence", "Substance Use Disorders", "Pain Management", "care management", “Pain”, “nurs* experienc*” and “nurs* attitude*”. Of the selected articles were eight of qualitative design and two were quantitative. They were all quality reviewed and systematically analyzed according to Friberg's method description. Results: The findings show that inadequate care occurs as a result of nurses' perceived, as well as measurable, experiences of treating pain in patients with substance addictions. Based on lack of knowledge and communication, stigmatization, uncertainties and fears, as well as deficiencies in standardized pain assessment instruments and treatment guidelines. Summary: Managing pain in patients with substance dependence requires broad competence and affects physical, social and psychological needs. The healthcare have to integrate a person-centered way of working to accomplish those needs. Stigma and self-management of own feelings could be improved by sharing experiences and knowledge. Organizational changes at the political level are also required for improvements.

Introduction: Substance abuse syndrome is common in society. According to the Patient Act, each individual is always entitled to adapted care, according to maturity, age, experience, ethnicity and other individual aspects. Previous studies have shown that healthcare professionals feel insecure meeting patients with substance abuse syndrome, so it will be interesting to investigate how patients experience the response from healthcare professionals and what consequences leads to. Aim: The aim was to compile current research on how people with previous or ongoing substance use syndrome experience the treatment from healthcare professionals. As well as their views on the significance of the treatment for the impact on the care they receive. Method: The method used is a literature review with a qualitative approach. The data collection was done via the database PubMed, where 11 scientific studies were found and reviewed via SBU's review template. Results: Three main categories were identified and followed by subcategories. The main categories that were used were treatment, stigma and pain treatment. It demonstrated a need for healthcare professionals to become aware of the stigma and differences in power that arise at healthcare meetings with patients. This review of the literature showed that patients did not experience a satisfactory treatment, it also emerged that the patients experienced a better treatment from specialist trained staff in the subject of substance use syndrome. The consequences for the patients when the treatment from the care staff was not perceived as satisfactory was an inadequate pain relief, delayed care, premature discharge, self-medication and the patients completely refraining from seeking care. In the long run, the consequences became a longer and more difficult suffering for the patient. Conclusion: The nurse's previous experience and competence were decisive for how the patient experienced the treatment in the care search. A non-judgmental attitude created an increased sense of security for patients, to dare to open up and not use strategies to hide their substance use syndrome. Keywords: “substance use disorder”, “experience”, “nurses”, “stigmatization”, “patient experience”and “substance dependence”. / Introduktion: Substansbrukssyndrom är vanligt förekommande i samhället. Enligt patientlagen har alltid varje enskild individ rätt till en anpassad vård, efter mognad, ålder, erfarenhet, etnicitet och andra individuella aspekter. Tidigare studier har visat att sjukvårdspersonal känner sig osäkra inför mötet med patienter med substansbrukssyndrom, därför blir det intressant att undersöka hur patienterna upplever bemötandet från sjukvårdspersonalen och vad det kan ha för upplevda konsekvenser.  Syfte: Syftet var att sammanställa aktuell forskning om hur personer med tidigare eller pågående substansbrukssyndrom upplever bemötandet från vårdpersonal. Samt deras åsikter om bemötandets betydelse för inverkan på den vård de får.  Metod: Metoden som använts är en litteraturöversikt med kvalitativ ansats. Datainsamlingen gjordes via databasen PubMed, där 11 vetenskapliga studier hittades och granskades via SBU:s granskningsmall.  Resultat: Tre Huvudkategorier identifierades och följdes av underkategorier. Huvudkategorierna som togs fram var bemötande, stigmatisering och smärtbehandling. Det påvisade ett behov hos vårdpersonal att bli medvetna om stigmatisering och maktskillnader som uppstår vid vårdmötet med patienterna. Denna litteraturöversikt visade att patienter inte upplevde ett tillfredsställande bemötande, det framkom även att patienterna upplevde ett bättre bemötande från specialistutbildad personal inom ämnet substansbrukssyndrom. Konsekvenserna för patienterna när bemötandet från vårdpersonalen inte upplevdes som tillfredsställande var en icke adekvat smärtlindring, försenat vårdförlopp, för tidiga utskrivningar, självmedicinering och att patienterna helt avstod från att söka vård. I förlängningen blev konsekvenserna ett längre och svårare lidande för patienten.  Slutsats: Sjuksköterskans tidigare erfarenhet och kompetens var avgörande för hur patienten upplevde bemötandet i vårdsökandet. En icke dömande attityd skapade en ökad trygghetskänsla för patienterna, att våga öppna upp och inte använda strategier för att dölja sitt substansbrukssyndrom.  2 Nyckelord: missbruksrelaterade sjukdomar, upplevelser, sjuksköterskor, stigmatisering, patientens upplevelse, substansberoende

Drop out for clients with addiction has an adverse effect on their abstinence - the probability of relapse is very high (Kalina, 2003). By contrast, treatment completion is associated with abstinence, lower criminal activity, fewer relapses and a higher employment rate (Brorson et al., 2013). For effective addiction treatment is crucial to minimize the number of drop outs. Risk factors appear not only on the client side, but also on the side of the service. The study focused on clients who planned to drop out, but at last they decided to stay. Anamnestic data and interviews with clients helped to identify common client traits and answer the questions about the client thinking process during the crisis, what they emphasize, how they evaluate their decision not to drop out and what motivational influences they identify. Frequent common traits of clients who overcame drop out tendencies were a higher age (90 %), criminal record (74 %), contact with psychiatry (84 %) and repeated addiction treatment (74 %). Interpersonal conflicts with staff and clients (50 %) and craving (22 %) were the most frequent reasons to drop out. Nearly 2/3 of clients appreciated the improved mental and physical health. The support from the others was the main reason for retention in treatment (31 % from relatives, 26 % from...

Made available in DSpace on 2016-04-28T20:40:19Z (GMT). No. of bitstreams: 1 Jair Lourenco da Silva.pdf: 1752349 bytes, checksum: 8b0165463550a9060827180bb1ece90d (MD5) Previous issue date: 2010-06-18 / The purpose of this study is to propose an intervention in family systems with an addicted member. An intervention that may be applied by non-psychotherapist caretakers, i.e., substance dependence advisors, working in therapeutic communities, who will participate in this research. Therapeutic communities for substance addicts are important resources, described by the Brazilian National Anti-Drug Department, in the drug-fighting network, however, as most of the substance dependence services, they require interventions in the family level. Due to this need and the complexity of the phenomenon, substance dependence experts have oriented approaches in this scope. By means of a qualitative research, we will seek to investigate, among the caretakers involved in this research (former substance addicts recovered for at least one year), the functioning patterns of their family systems in the generational and transgenerational levels. We will seek to develop along with the participants the understanding of the relationship patterns in their original and current families, with the purpose of valuing the competences and rescuing the resilient aspects of these caretaker families systems. Therefore, our purpose is to create, together with these caretakers, an intervention instrument, easily applicable by non-psychotherapists working with families involved with the problems of substance addiction, to empower them to fight the drug-addiction cycle / O presente estudo tem como objetivo apresentar uma proposta de intervenção nos sistemas familiares com membro adicto. Uma intervenção que possa ser aplicada por cuidadores não-psicoterapeutas, ou seja, conselheiros em dependência química, que trabalhem em comunidades terapêuticas, os quais serão os participantes desta pesquisa. As comunidades terapêuticas para dependentes químicos são importantes recursos, descritos pela Secretária Nacional Antidrogas, na rede de atenção ao enfrentamento das drogas, porém, assim como a maioria dos serviços para dependência química, carecem de intervenções em nível familiar. Em virtude dessa carência e da complexidade do fenômeno é que especialistas em dependência química têm orientado abordagens neste âmbito. Por meio de uma pesquisa qualitativa, procuraremos investigar, entre os cuidadores envolvidos nesta pesquisa (ex-dependentes químicos recuperados há pelo menos um ano), os padrões de funcionamento de seus sistemas familiares no plano geracional e transgeracional. Buscaremos desenvolver, junto aos participantes, a compreensão dos padrões de relacionamento em sua família de origem e atual, com o intuito de valorizar as competências e resgatar os aspectos resilientes dos sistemas familiares destes cuidadores. Nosso objetivo, então, é criar, junto com estes cuidadores, um instrumento de intervenção, facilmente aplicável por não-psicoterapeutas que trabalhem com famílias envolvidas com a problemática da dependência química, para o empoderamento destas no enfrentamento do ciclo da drogadicção