Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

Adolescence is a time of experimentation and exploration. For many young people, a feature of this developmental period is the initiation of substance use. Whilst the majority of young people do not go on to develop substance use problems, any substance use has potential for danger. The current body of literature on the prevention of substance use problems suggests that in order to advance understanding, researchers must adopt a risk-focused approach. There is a wide range of indices that have been cited as risk factors for the development of substance use disorders. Chapter 2 explores some of the aetiological models and literature on risk factors with specific reference to psychological wellbeing, studies highlighting comorbid relationships between adolescent mental health and substance use problems, and the functional value of substances in relation to well-being. Although attention to psychological risk factors has received increased press in the literature, the number of controlled, longitudinal studies is relatively small. A review of recent studies (Chapter 3) indicates that the presence of anxiety, depression, low self-esteem or behavioural problems such as delinquency represent psychological risk factors for the development of later substance use problems, however findings are inconsistent and many studies do not examine differential predictive utility by substance or gender. Thus, Study 1 of this research aimed to add to this body of work by exploring the prediction of alcohol, cannabis and other illicit substance use at age fifteen from key indicators of psychological well-being taken at age thirteen. The data from a normative sample of high school students indicated subtle differences in trajectory for young males and females and effects specific to different drug categories. Delinquency emerged as the most consistent predictor in both males and females. Low self-esteem was also an important indicator for future female marijuana use and marijuana intoxication and both male and female other illicit substance use. The findings highlighted the need for a greater contextual understanding of the relationship between delinquency, self-esteem and substance use. The second study sought to provide a deeper understanding of these issues by examining the perceived functional value of substances in relation to psychological wellbeing, by means of a qualitative study of a group of young people who had experienced problems with their substance use. Chapter 4 explores the limited phenomenological research in this area, with a focus on studies which have used methods of measurement that highlight the perspective of young people. Using a Consensual Qualitative Research approach, Study 2 builds on the drug type and gender contrasts noted in Study 1, and explores the interface between substance use and psychological well-being in depth using a clinical population. A number of key functions are identified by young people, with evidence of both convergence and divergence across drug categories (alcohol, cannabis, other illicit substances). Interviewees reported six functions common to all substances; social connectedness, improve affect, positive self-transformation, better coping with problems, fun and laughter, and feeling intoxicated. Nine additional functions were identified in relation to cannabis and other illicit substances. Several gender differences were also noted, with males tending to report more positive reinforcement from alcohol and cannabis, and young females more frequently describing benefits related to use of other illicit substances. The concluding chapter (Chapter 5) reviews the main findings across both studies and their implications for theory, practice, and future research. Overall, the findings of the research provide support for both problem behaviour and adaptive models of adolescent substance use, and indicate that young people are capable of reflecting on their substance use experiences. Incorporating the wisdom of young people into risk frameworks may enhance prevention, education and intervention efforts.

This thesis documents research undertaken to understand the experience of families who have lived with domestic violence, substance misuse and subsequent child protection intervention. Initially a participatory methodology was adopted, which presented significant challenges. This thesis presents a critical reflection of using the participatory methodology with vulnerable and stigmatized families and the divergence that this research experienced from participatory ideals when operationalized in a real-world setting. A range of methods have been employed to capture these experiences through a series of ‘polyvocal’ stories that not only provide authentic research findings, but also gave participants the chance to speak collectively about issues that concern them. This is an opportunity rarely afforded to families involved in child protection. Specific issues raised include the difficulty of inhabiting dual status as victim or perpetrator of domestic violence and a parent, the complexity of assessing structural injustice as opposed to agency responsibility when researching traumatic events and how services responses of ‘kinship care’ arrangements have substantial flaws. The study also generated new insight into the experiences of men as fathers and how ‘risk’ is assumed to be cross-contextual. No easy solutions are proposed, but the participatory principles employed demonstrate the need to embrace a high level of reflexivity to address the challenges of power sharing with vulnerable people. The identity barriers to transformational relationships of families involved in child protection services also need to be reviewed. Only then will safe and ethical research and social work practice become possible.

Context – The prevalence of problem substance use is a global concern, particularly for adolescents due to their ongoing developmental changes. Amongst other contributory factors, parenting styles adopted by parents and caregivers can either; increase the risks of their children developing substance misuse problems or prevent its onset. Knowledge about the needs and experiences of the caregivers of adolescents who misuse substances is limited and greatly under-researched. Brief interventions (BIs) have been identified as an effective means of tackling this problem-type behaviour among adolescents, including ‘Teen Intervene', which was developed in the US. This evidence-based intervention included a parent component which has been found to further enhance the interventions' positive outcomes. Rationale – In light of the unique caregiver structures in South Africa, the general neglect of their needs in the South African literature with regards to interventions and the high prevalence of adolescent substance misuse in the Western Cape, exploring these needs within the country's context is warranted and necessary. Design and data collection – This was a qualitative study and data for the study was collected in two main phases: through focus group discussions to identify caregivers needs and to explore perceptions of the intervention; and post-intervention interviews with caregivers and adolescents at a 1-month follow-up session. Findings – Template analysis revealed six main themes: 1) Access to knowledge about substance misuse; 2) Parenting skills; 3) Sources of emotional support; 4) Empowerment for female caregivers; 5) Financial concerns; and 6) Alternative solutions to adolescent's involvement in the justice system. Caregivers also reported various feelings that are a direct result of their experiences. Discussion – Caregivers have distinct needs that require designated responses, however, some of these needs can be addressed through their inclusion in treatment interventions for adolescents who misuse substances.

The region of Appalachia in the United States is a diverse region that is full of beauty, mountains, art, and culture. Due to a history of abuse from large corporations, the impact of the decline in coal mining and generational poverty, the region is currently on a road toward recovery. Substance misuse rates are disproportionality high, and there are limited resources available to address the issue. Literature suggests that church leaders may be a potential resource. The goal of the study was to provide a better understanding of the substance misuse epidemic through the eyes of church leaders. Interpretative Phenomenological Analysis guided this qualitative study. Church leaders (n = 10) were interviewed and four significant themes emerged: narratives used to describe their experiences with substance misuse, the stigma associated with substance misuse, the community impact that substance misuse has on Appalachia, and the lack of understanding and need for training on substance misuse for church leaders and healthcare practitioners. The results of the study are discussed and connected to discussions of the implications for clinical practice, recommendations for further research, and limitations of the study. / Doctor of Philosophy / Appalachia is a mountain range located in the eastern portion of the United States. It is a diverse region that is full of beauty, mountains, art, and culture. Due to a history of abuse from large corporations, the impact of the decline in coal mining and generational poverty, the region is currently on a road toward recovery. Substance misuse rates are disproportionality high, and there are limited healthcare resources available to address the issue. The goal of the presented study was to provide a better understanding of the substance misuse epidemic through the experiences of church leaders, which are abundant in the region. Church leaders, a sample of 10, were interviewed and four significant topics emerged from their stories shared: narratives used to describe their experiences with substance misuse, the stigma associated with substance misuse, the community impact that substance misuse has on Appalachia, and the lack of understanding and need for training on substance misuse for church leaders and healthcare practitioners. The results of this study suggest that church leaders may be used as a resource to help lower the impact of substance misuse. The experiences of the church leaders gained from this study can help provide training to church leaders and healthcare providers on ways to work together and lower substance misuse in Appalachia.

Indiana University-Purdue University Indianapolis (IUPUI) / Deaths due to prescription painkillers and heroin have quickly become national, state, and local public health concerns. Studies using data from Medical Examiners or Coroner Offices throughout the United States have been conducted and are contributing to the understanding of this epidemic. However, the analysis of these fatalities are specific to the communities where the study was conducted and cannot be assumed that the decedents in one community are similar to decedents in another community. Many local governments and agencies throughout the U.S. are aware that this problem exists in their communities, but are not prepared to adequately respond to and intervene in these fatalities as an analysis of those who have died has rarely been conducted. This dissertation is a replication study of longitudinal epidemiological analyses of opiate related fatalities that was implemented in a location where an analysis of opiate-related fatalities had not been conducted, Marion County, Indiana. The purpose of the dissertation was twofold: (1) to describe the demographic characteristics of the decedents using publicly available data from the Marion County Coroner’s Office to be used in informing future preventative efforts to decrease opiate-related fatalities in Marion County and (2) to inform other communities on how to conduct a similar analysis in their own community. This dissertation describes the methods of the replication study, provides descriptive results of the people who died from opiate-related overdoses, and: (a) Report the types of opiates identified in blood toxicology reports and (b) Present the histories of opiate-related decedents as reported in the Deputy Coroner Field Officer’s Reports (DCFOR). Additionally, analysis was conducted to determine if decedent characteristics deferred depending on the type of opiate fatality based on the toxicology in 1) heroin alone, 2) painkillers alone, and 3) heroin and painkillers combined.

No description available.

Yes / Background: The use of digital technology in health and social care is developing rapidly. It is promoted in UK policy and research which suggests varied results surrounding its implementation and outcomes. Introduction: This article aimed to test the implementation and outcomes of a short messaging service sent to a dedicated phone. The target cohort were drug treatment clients in two sites in Northern England. Materials and methods: Through staff focus groups and interviews with a small cohort of clients, the implementation and perceptions of the system were examined. Results: Nineteen participants were recruited to site 1 (15 male, 4 female, average age=37.7 years) and 12 participants were recruited to site 2 (9 male, 3 female, average age=40.3 years). One outcome that was of interest was well-being in treatment which, in this study, was described as an overall sense of feeling better rather than just focusing on the rehabilitation aspect of the programme. Other outcomes included: the successful completion of treatment and any relapse or associated reported drug use. Discussion: The system shows some evidence of its ‘social actor’ role; however, its implementation was hindered by staff citing that it called for increased resources. For future implementation the use of client’s own phones may be considered which may help to embed the system more fully in recovery planning and targeting clients at a different treatment stage. Conclusions: Despite some indications of positive results for clients and a perception that the system may have value as an addition to existing clinical interventions, more evaluation is required to determine whether this system can be implemented in a drug treatment setting.

The current study set out to explore the affect and significance of differing parental conditions on the experiences commonly reported by young carers. Previous studies on young caring have reflected on the impacts of caring for parents with particular `types' of conditions (normally physical disability or mental health problems) or a specific diagnosis. However, these have not contrasted or discriminated young carers' experiences according to different parental conditions. To address this gap in knowledge, the current study considered the experiences of young carers supporting parents with different `types' of conditions, namely physical disability, mental health problems and substance misuse. The participants discussed the impact of caring on a range of areas such as their education, social life, health, spatial transitions, relationships and role reversals. Additionally, definitional issues were considered. This included young carers own understanding and subscription to the term `young carer' and the significance of this to their identification. In terms of methodology, the study was firmly grounded within the qualitative domain and influenced by a constructive-interpretive paradigm, specifically symbolic interactionism. Within this, the grounded theory approach was used insofar as it provided a method to conduct the study. A range of data-collection techniques were employed. Semi-structured interviewing was the principal method used, with additional data gathered through a self-esteem tool, observations and diaries. The sample consisted of 30 young carers. The results showed firstly that the participants did not necessarily comprehend the term `young carer' or apply it to their own caring roles at home. Arguably, this contributed to their `hidden-ness' (i. e. invisibility) and as a result their needs were overlooked. The need for a new definition which embraces their understandings, together with appropriate awareness-raising programmes within schools and for key social care and health professionals was evidenced and called for. Secondly, whilst the participants shared common experiences regardless of the nature of the parental condition, other issues reported were specific to particular situations. Those most adversely affected were caring in the contexts of parental substance misuse or parental mental health problems. Such young carers were dually disadvantaged, as they experienced the most extreme difficulties, yet their caring roles and needs were least likely to be addressed. The experiential differences reported by young carers in different caring contexts have important practice implications. Nevertheless, the extent to which the experiences reported could be wholly attributed to the caring role, rather than other structural and socio-economic factors was questionable.

This research addresses the question ‘How does transformative change occur in rehabilitation programmes, and how is it facilitated or constrained by contextual factors?’ The study, carried out in three community-based intensive rehabilitation projects for alcohol and drug dependent people, is designed to specify and explain change mechanisms, understood as the processes through which programme resources influence the intentional actions of participants. A critical realist theoretical frame is used, drawing on the work of Margaret Archer and John Greenwood. The study consisted of two phases: in Phase 1, fourteen client interviews and eight counsellor interviews were carried out in two treatment programmes, and these were analysed abductively to produce a set of tentative contexts, mechanisms and outcomes. Phase 2 consisted of ten theory-driven interviews (Pawson 1996) with clients in a third programme, designed to elaborate the emerging theory. An explanatory model was produced, in contexts-mechanisms-outcomes form. This showed that the institutional context of active warmth and acceptance, combined with a clear, predictable and transparent structure, allowed participants to build trust, bond with the peer group and become ready to accept and process respectful challenges to their perspective or their interpersonal behaviour. This facilitated a change in the clients’ internal conversation (Archer 2000), permitting new emotional responses and the formation of new attachments, values and commitments. The programme was seen as a place which facilitated the development of a revised personal and social identity. The study contributes to the understanding of these programmes by clarifying how participants change or fail to change. It responds to recent calls for more useful forms of evidence, to complement the sparse and equivocal experimental evidence base. The study findings have the potential to improve counsellor training and programme development.