Introduction: Breastfeeding offers the substance exposed mother and child potential short and long-term health benefits, with breast milk shown to alleviate the severity of Neonatal Abstinence Syndrome. Substance dependent women, however, have limited success establishing breastfeeding with physical, psychological and institutional factors cited as barriers. This study aimed to develop and test the feasibility of an evidence informed and theory based intervention to support continued breastfeeding for this group. Methods: The research was a two-phase feasibility study. Phase 1 informed intervention development using a mixed methodology approach which included (a) a comprehensive systematic literature review of breastfeeding support for women from disadvantaged groups (b) expert advisory group recommendations and (c) ‘think aloud’ verbal protocols with opioid dependent women. Phase 2 underpinned the evidence with the theoretical constructs of behaviour change, prior to testing the acceptability and implementation fidelity of the intervention in a feasibility study with an embedded small-scale randomised controlled trial. Results: Phase 1 identified the barriers to breastfeeding continuation as low maternal self-efficacy; neonatal feeding difficulties associated with withdrawal and unsupportive healthcare practices. Evidence and theory synthesis resulted in an integrated breastfeeding support model founded on practical, informational, psychological, person-centred and environmental components. Phase 2 demonstrated that the intervention was feasible to implement and acceptable to participants. The randomised controlled trial reported higher rates of continued breastfeeding and a greater level of maternal confidence in breastfeeding ability in the intervention group compared to the control group. Breastfed infants were less likely to require pharmacological management and had corresponding shorter durations of hospitalisation than formula fed infants. Conclusion: The research provided an original contribution to the development of a complex healthcare intervention which is meaningful to both existing research and clinical practice. The findings highlighted the potential of the intervention to support breastfeeding for the substance exposed mother and baby, which has wide ranging implications for the improved health and social equalities of this group.

Substance abuse and dependence causes many problems in our society. Attachment style may be useful in the etiology of this problem. Using archival data, this study hypothesizes men in a court-ordered facility will be more likely to have an insecure attachment style. The participants were 73 males ages 18-49. The Adult Attachment Scale (AAS) was used to measure adult romantic attachment style. Through cluster analysis and conversion of the subscales of the AAS, four attachment styles were measured. Men were more likely to have an insecure attachment style especially a Fearful style. The study concludes with limitations of the results and a discussion about possible interventions based on attachment style.

Considering the prevalence of addiction issues within the U.S., this study focused on the topic of recovery from drug and alcohol dependence in order to add to current literature. Prevention and recovery services are two of the most common ways of combating the addiction issue, and counselors are at the forefront of both movements. The bottoming out experience (BOE) and the turning point (TTP) are two common lay terms of factors within changing addictive behaviors, yet the connection of these constructs to recovery remains unstudied and unknown. The current study tested a model that levels of the BOE and the TTP are predictive of early recovery (ER). The data from this study was obtained from a national dataset previously collected from 230 grant-funded addiction treatment centers that utilize the Global Assessment of Individual Needs (GAIN) assessment instrument. A review of the literature gaps, coupled with available data, influenced decisions on research design and statistical analysis procedures. As clear definitions of the BOE, TTP, and ER have not been discovered through research, a descriptive, correlational research design was chosen in order to understand not only what constitutes a BOE, TTP, and ER, but also to discover the relationships between the BOE, TTP, and ER in their natural state. The purpose of correlational studies is to investigate the relationship between two or more variables without researcher manipulation and such designs are common in the counseling and counselor education research field (Heppner, et al., 2008). Because correlational research is exploratory in nature, structural equation modeling (SEM) was utilized to understand the components of each construct and was used to test the hypothesis of the relationships iv between the BOE, TTP and ER. Although SEM is a confirmatory technique, it is frequently used in an exploratory manner because it combines elements of confirmatory factor analysis and multiple regressions and allows for various possibilities of the relationships between constructs and variables (Schrieber, et al., 2006). The literature on ER, BOE, and TTP provides enough evidence to test a theoretical model, which is the purpose of SEM. The hypothesized model assessed data at intake for the BOE, TTP and ER. Once constructs were delineated through measurement models/CFA, SEM path analysis was used to understand how the constructs related to one another. The first three hypotheses were rejected in the study, and measurement model modifications were conducted, which yielded good fit indices. Results from Hypothesis One indicated that hypothesized factors did not load on the BOE, and instead, the BOE at the intake level was a measurement of mental health severity. Results from Hypothesis Two indicated that hypothesized factors did not load on TTP; however, TTP did resulting factor structure created through model modification contained factors of awareness, motivation, and support. Results from Hypothesis Three also indicated that hypothesized indicators did not load into ER; however the resulting factor structure contained indicators of abstinence and environmental support. Lastly, Hypothesis Four yielded three resulting models, all of which had good fit indices. Therefore, hypothesis four was accepted. It is noteworthy that direct effects were not all significant, and the p value in all final models was significant. There was not a significant relationship between the BOE and ER at the intake level; however, there was a significant relationship between the BOE and TTP, as well as TTP and ER at the intake level. The direct v effects between the BOE and ER may have had a role in the significant p values, as well as the large sample size. Within the three resulting models, the BOE had significant relationships with TTP, spiritual support, and motivation. Both spiritual support and motivation also had significant relationships with ER. Therefore, the results from the current study support that there are existing relationships between the BOE and TTP; however, the relationship between the BOE and ER at the intake level was not significant.

Made available in DSpace on 2016-04-28T20:40:18Z (GMT). No. of bitstreams: 1 Leda Fleury Monastero.pdf: 2249700 bytes, checksum: 87351c40e32696ffd77122a69254423c (MD5) Previous issue date: 2010-05-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / International and national studies point to substance dependence as one of the most frequent psychiatric disorders of our time that extends far beyond the individual self, but their families are also affected. Today, it is commonly agreed that the concept of a family has been changing, but its function of being a place of care and safety, in several knowledge fields, continues being recognized by scholars and families. Researches on drug addiction include several lines of study addressing from genetic and neurobiological factors to psychological reasons and motivation behind addiction, and they clearly state how harmful they can be to any instance in social, occupational and familiar life. However, studies on addiction recovery and on how arduous it is to addicts to sustain abstinence and prevent relapsing are still rare. This study aimed to develop a social-intervention model towards drug addicts that enables them to re-mean the narratives of their lives lived within family dynamics. Through social and educational monthly meetings, we sought to build a communication channel between the Casa Diar s resident addicts and their families and people interested in the community. This activity was done during this period when addicts struggle to beat their addiction and avoid behavior and attitudes of substance dependents. Topics such as family and group definition, communication, values, beliefs inside a family, differences between behaving and acting among many others were addressed giving room to deconstruct myths and restrictive, negative and repetitive telling about drug addiction and familiar relationships. From these participants telling, this reconstruction could be done through new and re-meant narratives which were born from dialogues and involvement kept during the meetings / Estudos nacionais e internacionais apontam a dependência química como um dos transtornos psiquiátricos mais freqüentes da atualidade que atinge além do individuo, também seu sistema familiar. É consenso hoje, que o conceito de família vem mudando, mas a função de ser um lugar de cuidado e de segurança continua sendo reconhecida nas várias áreas do conhecimento, tanto pelos estudiosos como pelas famílias. As pesquisas sobre dependência de drogas incluem várias linhas de estudo que abordam desde os fatores genéticos e neurobiológicos até as causas e motivações psicológicas para o abuso, além de deixarem claros os prejuízos nas várias áreas da vida social, ocupacional e familiar. Entretanto, estudos sobre o período de recuperação e sobre a árdua tarefa que é a da manutenção da abstinência e prevenção de recaídas, para o dependente, ainda são escassos. Este estudo teve como objetivo principal desenvolver um modelo de intervenção social com dependentes de drogas, que possibilite a ressignificação da narrativa de suas histórias, vividas na dinâmica familiar. Por meio de reuniões sócio-educativas mensais buscou-se a construção de um canal de comunicação entre os dependentes residentes da Casa Diart´s, seus familiares e pessoas interessadas da comunidade, durante esse período em que buscam se recuperar da dependência das drogas e dos comportamentos e atitudes de dependente. Temas como a definição de família e de grupo, comunicação, valores e crenças dentro da família, diferença entre comportamento e atitude, entre outros, foram discutidos abrindo um espaço para desconstruir mitos e relatos restritivos, negativos e repetitivos sobre dependência de drogas e relações familiares. A partir de relatos dos participantes, essa reconstrução pode ser feita por novas narrativas, ressignificadas, advindas do diálogo e do envolvimento que aconteceu durante as reuniões

Made available in DSpace on 2014-12-17T15:38:52Z (GMT). No. of bitstreams: 1 HanniaRRPR_DISSERT.pdf: 2137181 bytes, checksum: ae4af965fe56dad2f3f8c2d06548931d (MD5) Previous issue date: 2011-05-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Millon describes the normal personality by means of adaptation styles that are effective in normal environments and personality disorders such as unadapted operating styles. To operacionalize his theoretical model, Millon has built several instruments, including the Millon Clinical Multiaxial Inventory III (MCMI-III), wich consists of a self report inventory composed by 175 true or false response items, containing four verification scales, and others scales wich evaluates 14 personality patterns and 10 clinical syndromes. The Substance Dependence scale (T) is placed along with Clinical Syndromes scales. This research is justified by the lack of a Brazilian instrument to assess personality psychopathological aspects, and aims to translate and semantically adapt the MCMI-III to the Brazilian context, checking validity elements of the Substance Dependence scale, and developing a computer application for assisting the evaluation of assessment results. To this intent, 2.588 individuals data was collected, male and female, aged between 18 and 85 years, characterized as belonging to a clinical or non-clinical group, who took part in the survey via the internet or in person. Respondents completed the MCMI-III, a socio-demographic questionnaire and a subgroup also answered to the Goldberg General Health Questionnaire (GHQ). Besides descriptive statistics, we performed the analysis using the Student t test, principal components analysis and internal consistency. Despite difficulties related to translating very specific English terms, the assessment by judges, experts on Millon?s theory, and the back translation, attested the adequacy of the Brazilian version. Factorial analysis indicated the grouping of translated T scale items into three factors (social activities prejudice, lack of impulse control, and oppositional behavior), by presenting a single item on a fourth factor (apparently related to seeking pleasurable stimuli). The Cronbach alpha for this set of items was 0,82, indicating an acceptable scale reliability. The data analysis resulted in distinction of scores between clinical and non-clinical groups and between men and women; the relationship between high scores on the scale T and the other scales; scores of drug users according to the declared used substance; and the relationship between high scores on T and the verification of disorder or risk on GHQ mental health factor, indicating the instrument?s adequate sensistivity in identifying psychopathologies and the relationship between the different disorders or psychopathological personality patterns. Although further studies are necessary to develop the scores transformation factors, the computerized correction tool was adequate. / Millon descreve a personalidade normal em termos de estilos de adapta??o que s?o eficazes em meios normais e transtornos de personalidade como os estilos de funcionamento desadaptados. Para operacionalizar seu modelo te?rico, Millon construiu diversos instrumentos, entre eles o Millon Clinical Multiaxial Inventory III (MCMI-III), que consiste num invent?rio de auto-relato de 175 itens com resposta falso ou verdadeiro, que avalia 14 padr?es de personalidade e 10 s?ndromes cl?nicas, al?m de conter 4 escalas de verifica??o. Entre as escalas de S?ndromes Cl?nicas encontra-se a escala de Depend?ncia de Subst?ncia (T). A presente pesquisa justifica-se pela inexist?ncia de instrumentos no pa?s que avaliem os aspectos psicopatol?gicos da personalidade, e tem como objetivos traduzir e adaptar semanticamente o MCMI-III para o Brasil, verificando elementos de validade da escala de Depend?ncia de Subst?ncias, e elaborar um aplicativo informatizado que assessore a avalia??o dos resultados desse instrumento. Para tal, foram coletados dados junto a 2.588 pessoas, dos sexos masculino e feminino, com idades entre 18 e 85 anos, caracterizados como pertencentes a um grupo cl?nico ou n?o-cl?nico, que participaram da pesquisa presencialmente ou via internet. Os participantes responderam ao MCMI-III, a um question?rio s?cio-demogr?fico e um subgrupo tamb?m respondeu ao Question?rio de Sa?de Geral de Goldberg (QSG). Al?m das estat?sticas descritivas, foram efetuadas an?lises por meio do teste t de Student, an?lises de componentes principais e de consist?ncia interna. Apesar de dificuldades relacionadas ? tradu??o de termos muito espec?ficos da l?ngua inglesa, a avalia??o por ju?zes conhecedores da teoria de Millon e o procedimento de back translation atestaram a adequa??o da vers?o brasileira. A an?lise fatorial indicou o agrupamento dos itens da escala T em 3 fatores (comprometimento das atividades sociais, aus?ncia de controle dos impulsos e condutas opositivas), com a apresenta??o de um item isolado em um quarto fator (aparentemente relacionado ? busca de est?mulos prazerosos). O alfa de Cronbach para este grupo de itens foi de 0,82, indicando aceit?vel confiabilidade da escala. A an?lise dos dados obtidos resultou em diferencia??o nas pontua??es de grupos cl?nico e n?o cl?nico e entre homens e mulheres; rela??o entre pontua??es altas na escala T com as demais escalas do instrumento; diferencia??o nas pontua??es dos usu?rios de drogas de acordo com a subst?ncia declarada como utilizada; e rela??o entre as altas pontua??es em T e a verifica??o de dist?rbio ou risco no fator Sa?de Geral do QSG, indicando adequada sensibilidade do instrumento na identifica??o de quadros psicopatol?gicos e na rela??o entre os diferentes transtornos ou padr?es psicopatol?gicos de personalidade. O aplicativo de corre??o informatizado se mostrou adequado, embora ainda sejam necess?rios estudos para o desenvolvimento dos fatores de transforma??o dos escores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Destaca-se a necessária tarefa da diaconia de produzir um movimento de mediação entre o polo da presença de Cristo na comunidade de seus servos e o polo da sua presença no sofrimento do mundo. O verdadeiro culto ao Deus encarnado é provado nas ações concretas de amor. Ações que constituem a ética pessoal e comunitária daqueles e daquelas que afirmam ser discípulos e discípulas do Kyrios-Diácono, através da hospitalidade que acolhe na comunhão e pela visitação que acode e caminha com a pessoa sofredora. São ações que protegem e promovem a vida e corroboram para que esta seja tão digna quanto possível. Assim, a diaconia se mantém em estreita relação com os demais serviços da comunidade de fé e evita que estes se tornem alienados da vida real, encarnando-os. Trata-se do olhar diaconia vida: responde a pergunta pelo fazer da diaconia pela vida. É a ética vivenciada. Através da fenomenologia da Vida de Michel Henry (1922-2002), tem-se um olhar complementar: a Vida que se apresenta na vida pela textura do sofrimento e do prazer. É o olhar que parte da perspectiva da Vida com suas implicações para a diaconia: Vida diaconia. A diaconia não se limita apenas a ações para a vida. É-o também ação da Vida na vida. Cuida no e ensina a viver o sofrimento. Dos sofrimentos, a investigação direciona o olhar para a problemática da dependência de substâncias psicoativas. Apresenta o desenvolvimento conceitual da dependência, importante para vencer os preconceitos. Aponta as principais características da pessoa dependente e do processo motivacional, para subsidiar uma proposta terapêutica. Analisa a proposta das Comunidades Terapêuticas, instituições de acolhimento terapêutico, com seus diferentes modelos. Os aportes da diaconia e da fenomenologia da Vida enriquecem a oferta destas instituições e apontam para a continuidade que se dá no acolhimento diaconal nas comunidades de fé. O quadro desta investigação diaconia fenomenologia da vida dependência Comunidades Terapêuticas recebe um colorido especial, através da leitura de relatos vivos de pessoas reais que vivenciaram de diferentes formas esta textura da Vida. A diaconia vivenciada pela fruição da Vida, torna-se terapêutica. / The necessary task of diakonia to produce a mediation movement between the center of the presence of Christ in the community of his servants and the center of his presence in the suffering of the world is highlighted. The true worship of the incarnated God is proved in concrete actions of love - actions which constitute the personal and community ethics of those who affirm that they are disciples of the Kyrios-Deacon, through the hospitality which welcomes into communion and through visitation which succors and walks with the suffering person. These are actions which protect and promote life and corroborate so that this life might be as dignified as possible. Thus, diakonia maintains a strict relation with other services of the faith community and avoids that these become alienated from the real life by incarnating them. It is about the diakonia-life perspective: it answers the question about diakonia for life. It is lived ethics. Through Michel Henrys phenomenology (1922-2002), one has a complementary perspective: The Life which presents itself in life through the weaving of suffering and pleasure. It is a look that stems from the perspective of Life with its implications for diakonia: Life-diakonia. Diakonia is not limited only to actions for life. It is also the action of the Life in life. It gives care and teaches to live in suffering. From the sufferings, the investigation directs its look to the problem of psychoactive substance dependence. It presents the conceptual development of dependence, which is important to overcome pre-judgments. It points out the main characteristics of a dependent person and of the motivational process, to substantiate a therapeutic proposal. It analyzes the proposal of the Therapeutic Communities, institutions of therapeutic welcoming in with their different models. The contributions of diakonia and of the phenomenology of Life enrich the offer of these institutions and point to the continuity which is propitiated by the diaconal welcoming in the faith communities. The framework of this investigation diakonia-phenomenology of life dependence Therapeutic Communities acquires a special coloring through the reading of live reports of real people who have experienced in different ways this weaving of Life. The diakonia experienced because of the fruition of Life becomes therapeutic.

Made available in DSpace on 2015-07-22T20:50:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30. Added 1 bitstream(s) on 2015-08-11T03:26:11Z : No. of bitstreams: 1 Publico-12803.pdf: 1327527 bytes, checksum: 4fb071f9df6c6a7299fea37a3cbfb20a (MD5) / As orexinas são dois neuropeptídeos, orexina-A e orexina-B, derivados do mesmo gene precursor (pré-pro-orexina), produzidos em alguns milhares de neurônios localizados na área perifornicial do Hipotálamo lateral. Apesar de ter uma produção restrita ao hipotálamo, os neurônios orexinérgicos projetam-se amplamente para todo o cérebro regulando uma série de funções endócrinas e homeostáticas. Evidências recentes, no entanto, mostram o envolvimento do sistema da orexina no circuito de recompensa. Neste estudo avaliamos o envolvimento do sistema da orexina na sensibilização comportamental induzida por etanol. No experimento 1 foi utilizado o modelo de sensibilização comportamental e os animais do grupo salina, agudo (uma administração de EtOH) e crônico (7 administrações de EtOH) foram tratados durante 14 dias para verificar o desenvolvimento de sensibilização comportamental; após o término do tratamento os animais foram perfundidos e a imunorreatividade de duplas marcações para orexina e c-Fos foi avaliada pela técnica de imunohistoquímica. No experimento 2 foi utilizado o modelo de sensibilização comportamental para verificar se o antagonista de receptor do tipo 1 da orexina, SB 334867, bloqueia esse fenômeno. No primeiro experimento não houve diferença estatística entre os grupos salina, agudo e crônico quanto à ORX+c-Fos-IR; porém os animais tratados cronicamente com EtOH apresentaram uma tendência de aumento da dupla marcação de neurônios orexinérgicos indicando que o desenvolvimento da sensibilização comportamental produz ativação desses neurônios; além disso, os animais tratados cronicamente com etanol desenvolveram a sensibilização comportamental. No segundo experimento, o SB 334867 bloqueou a expressão deste fenômeno, indicando que o sistema orexinérgico parece influenciar de maneira importante o processo de sensibilização comportamental, já que a administração sistêmica do SB334867 bloqueou a expressão da sensibilização comportamental aos efeitos estimulantes do etanol em camundongos machos. / Orexins are two neuropeptides, orexin-A and orexin-B, derived from the same precursor gene (pre-pro-orexin) produced by a few thousand neurons located in the perifornical area of the lateral hypothalamus. Despite having a restricted production, orexinergic neurons project widely to brain structures that regulate a number of endocrine and homeostatic functions. Recent evidence suggests the involvement of the orexin system in the reward circuit. We evaluated the role of this system in ethanol-induced behavioral sensitization. In Experiment 1 was used the behavioral sensitization model (development), in which animals were chronically treated for 14 days with saline, acute ethanol after saline treatment or with ethanol (seven administration) to induce behavioral sensitization; at the end of the treatment animals were perfused and immunohistochemistry technique was used to determine double staining for orexin and c-Fos (ORX+c-Fos-IR). In Experiment 2 behavioral sensitization was induced and SB 334867, an orexin-1 receptor antagonist, was used to examine whether it could block the expression of this phenomenon. The results of Experiment 1 showed no statistical difference among the groups (saline, acute and chronic) as to ORX+c-Fos-IR, although animals chronically treated with EtOH exhibited an trend to more double staining of orexin neurons indicating that this treatment regimen activates this neuropeptide system. In the second experiment, SB 334867 blocked the expression of this phenomenon. The orexin system seems to influence the process of behavioral sensitization, since systemic administration of SB 334867 blocked the expression of this phenomenon induced by a stimulant dose of ethanol in male mice. / TEDE / BV UNIFESP: Teses e dissertações

The purpose of this study is to describe the subjective psychological experience of relapse in cocaine/crack and heroin users with the aim of identifying the significant cognitive, emotional and social themes involved in relapse. A better understanding of relapse may aid in providing more effective treatment for substance users. Both the intra- and interpsychic factors involved in relapse that emerge from the study are viewed from within a broad systems theory approach. In this study, not only the whole system is of relevance, but also the subsystems. Various sub systems are also identified to allow for the recognition of patterns, functions and recursive feedback loops that maintain substance-using behaviour. Due to the qualitative nature of the study, the context surrounding substance abuse and the substance users assumes vital importance. The interrelationships between the various intrapsychic structures, the family unit, the social contexts, the drugs themselves and the physiological aspects of substance abuse are identified. A qualitative research design was applied. In-depth semi-structured interviews were used to gather data from the eight participants, who were crack and heroin users who attended the in-patient rehabilitation programme at Phoenix House. Seven of the participants were still in the in-patient rehabilitation programme at the time of the interview, while one participant was in the aftercare programme. All have been through a rehabilitation process before and were at Phoenix House due to a relapse. A thematic analysis was conducted and the process of analysis settled on eight overall themes. Extensive descriptions of these themes are provided. The discussion highlights the role of relapse in the cycle of self-destruction that constitutes substance abuse, in addition to the role relapse plays in the process of recovery. Connection seems to be the key to breaking the cycle of alienation that users experience. Falling into the trap of rejecting users without looking beyond their behaviour allows them to continue functioning in a way that confirms their view of themselves as unlovable, which, in turn, maintains their behaviour. Although systems theory is an independent approach in its own right, the nature of its view allows for the incorporation of other approaches. Where possible and relevant, other theories are incorporated into the discussion of the results, with the aim of gaining an integrated understanding of the findings of the study within the broader field of substance abuse. / Dissertation (MA (Clinical Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Why is it that only some people who use drugs actually become addicted? In fact, addiction depends on a complicated process involving a confluence of risk factors related to biology, cognition, behaviour, and personality. Notably, all addictive drugs act on a neural system for reinforcement learning called the midbrain dopamine system, which projects to and regulates the brain's system for cognitive control, called frontal cortex and basal ganglia. Further, the development and expression of the dopamine system is determined in part by genetic factors that vary across individuals such that dopamine related genes are partly responsible for addiction-proneness. Taken together, these observations suggest that the cognitive and behavioral impairments associated with substance abuse result from the impact of disrupted dopamine signals on frontal brain areas involved in cognitive control: By acting on the abnormal reinforcement learning system of the genetically vulnerable, addictive drugs hijack the control system to reinforce maladaptive drug-taking behaviors. The goal of this research was to investigate this hypothesis by conducting a series of experiments that assayed the integrity of the dopamine system and its neural targets involved in cognitive control and decision making in young adults using a combination of electrophysiological, behavioral, and genetic assays together with surveys of substance use and personality. First, this research demonstrated that substance dependent individuals produce an abnormal Reward-positivity, an electrophysiological measure of a cortical mechanism for dopamine-dependent reward processing and cognitive control, and behaved abnormally on a decision making task that is diagnostic of dopamine dysfunction. Second, several dopamine-related neural pathways underlying individual differences in substance dependence were identified and modeled, providing a theoretical framework for bridging the gap between genes and behavior in drug addiction. Third, the neural mechanisms that underlie individual differences in decision making function and dysfunction were identified, revealing possible risk factors in the decision making system. In sum, these results illustrate how future interventions might be individually tailored for specific genetic, cognitive and personality profiles. / Graduate

Abstract This dissertation investigates the treatment of alcoholism and its related codependences using the Minnesota model, which defines alcoholism as a disease. This study seeks to recognize the stages of alcoholism, from the rise and deepening of alcoholism and its codependences through recovery, and to determine the keys to this recovery as viewed by patients and their family members. Based on experiential and transformative learning theories, a new learning model for explaining this recovery is suggested. A content analysis of empirical survey data obtained from a Minnesota-model-based treatment home over 10 years is carried out. The survey respondents are 173 patients and 125 of their family members. In this survey, the respondents describe their problems with substance dependence and codependence, explain their attempts to resolve these problems, characterize their recovery (or lack thereof) and provide their views on the treatment’s success factors. The results suggest that it is essential for patients and family members to obtain knowledge and adopt a new perception of substance dependence and codependences. The starting point, to consider alcoholism as a disease, opens up a new avenue of thinking, which liberates an alcoholic from agony and enables them to utilize previous life experiences as a bridge to move from only knowing the phenomenon to the active path of recovery. A key prerequisite for recovery is an analytical walkthrough of one’s own experiences from the drinking period based on this new understanding. Peer support provided by therapists and other patients who have been freed from alcohol dependence is also found to be essential for patients. The treatment’s special characteristics, which are close encounters with family members and a carefully planned one-year follow-up treatment, are also found to be very important. A new conceptual model is suggested to explain the results. The model is an experiential and transformative learning process model with theoretical roots in learning theories from Mezirow and Kolb. The birth and deepening of substance dependence and codependences is known as ‘capturing learning’ and, correspondingly, the recovery is known as ‘liberating learning’. This explanatory model emphasizes simultaneous collaboration- and peer-support-based recovery for family members and patients. Building upon the work of Jellinek, a new recovery curve, which is characteristically spiral and non-symmetric, is presented for both groups as an integral part of the model. This research has significant practical implications. The results of this study suggest that in addition to traditional approaches to treat alcoholism, which emphasize psychiatry, psychology and other mental health aspects, it is feasible to adopt the new learning-based treatment paradigm suggested here. / Tiivistelmä Tutkimus tarkastelee alkoholismin ja siihen liittyvän läheisriippuvuuden hoitoa Minnesota-mallin sairauskäsitteen pohjalta. Tavoitteena on kuvata kehityskulku alkoholismin ja läheisriippuvuuden synnystä ja syvenemisestä toipumiseen asti etsimällä alkoholistien ja heidän läheistensä itse määrittelemiä toipumiseen vaikuttavia tekijöitä. Molempien ryhmien toipumisprosesseja tulkitaan oppimisteoreettisesti ja tältä pohjalta kuvataan kokemukselliseen ja uudistavaan oppimiseen perustuva alkoholismista ja läheisriippuvuudesta toipumista selittävä malli. Empiirinen aineisto kerättiin survey-tutkimuksella Lapualla toimivaan Minnesota-hoitoon osallistuneilta 173 potilaalta ja näiden 125 läheiseltä. Aineisto on ajanjaksolta 1993–2003 ja se käsittää kyseisen hoidon potilaat ja näiden läheiset sen 10 ensimmäisen toimintavuoden ajalta. Vastaajat kuvasivat tätä tutkimusta varten suunnitelluilla kyselylomakkeilla juomisajan ongelmia, niiden ratkaisuyrityksiä, toipumisprosessin luonnetta ja omia näkemyksiään hoidon keskeisimmistä onnistumistekijöistä. Aineisto analysoitiin ja kuvattiin sisällönanalyysimenetelmällä. Saatujen tulosten perusteella toipuminen edellyttää aiemman päihteiden käyttöajan kokemusten analysoivaa läpikäymistä. Toipumisen ytimen niin potilaille kuin läheisillekin muodostavat päihde- ja läheisriippuvuuteen liittyvä uusi tieto ja oivallukset. Alkoholismin tarkastelu lähtökohtaisesti sairautena antoi juovan ajan kokemuksille uuden tuskaisuudesta vapauttavan tulkinnan ja omat kokemukset toimivat siltana tietämisestä toipumiseen. Tärkeänä osana potilaiden toipumisprosessia oli omasta riippuvuudestaan toipuneiden terapeuttien ja toisten potilaiden tarjoama vertaistuki. Keskeisiksi nousivat myös hoidon sisältämä läheiskohtaaminen ja hyvin suunniteltu vuoden pituinen jatkohoito. Tutkimuksen empiirisiä tuloksia selittävässä osuudessa potilaiden ja läheisten toipumisprosesseja tarkasteltiin Mezirowin uudistavan oppimisen ja Kolbin kokemuksellisen oppimisen teorioiden pohjalta. Toipuminen kuvataan erityisesti kokemuksellisena ja uudistavana oppimisprosessina, joka on luonteeltaan vertaistuellista ja yhteistoiminnallista. Päihde- ja läheisriippuvuuden synnystä ja syvenemisestä käytetään nimitystä vangitseva oppiminen ja toipumista kutsutaan vastaavasti vapauttavaksi oppimiseksi. Tutkimuksessa esitetään uusi toipumista kuvaava selitysmalli, joka korostaa läheisen ja potilaan samanaikaisen yhteistoiminnallisen ja vertaistuellisen toipumisen merkitystä. Tärkeä osa selitysmallia on uusi toipumiskäyrä, joka on ns. Jellinekin käyrää muistuttava, mutta kuitenkin epäsymmetrinen ja spiraalimainen. Uutta on myös se, että vastaava käyrä kuvataan samalla tavalla läheisille. Tutkimuksen kontribuutio myös käytännölle on merkittävä. Tutkimuksen perusteella näyttää jopa siltä, että perinteisten alkoholismin hoitoon liittyvien psykiatrian, psykologian ja mielenterveystyön lähestymistapojen rinnalle on mahdollista ottaa käyttöön uusi oppimiseen pohjautuva hoitoparadigma.