Bakgrund: Antalet dödsfall relaterat till narkotikarelaterat substansbruk ökar. Personer med narkotikarelaterat substansbrukssyndrom utgör en marginaliserad och stigmatiserad grupp i samhället. Dessa personer löper förhöjd risk för ohälsa, inte minst till följd av deras substansbruk. Stigmatisering inom hälso- och sjukvården är särskilt allvarligt, då det drabbar människor i ett särdeles sårbart tillstånd. Mot bakgrund av detta föreligger ett behov av att sammanställa tidigare forskning som studerat erfarenheter hos personer med narkotikarelaterat substansbrukssyndrom av att vårdas på sjukhus.   Syfte: Syftet var att undersöka de erfarenheter personer med narkotikarelaterat substansbrukssyndrom har av att vårdas på sjukhus. Metod: En icke-systematisk litteraturöversikt med integrerad dataanalys genomfördes baserat på 16 vetenskapliga originalartiklar. Litteratursökningarna utfördes i databaserna PubMed och CINAHL utifrån MeSH-termer och CINAHL Subject Headings, samt ytterligare relevanta sökord. Samtliga artiklar som inkluderades i studien har genomgått en kvalitetsgranskning enligt Sophiahemmet Högskolas bedömningsmall.   Resultat: Tre huvudkategorier identifierades, vilka var Erfarenheter av ojämlik vård, Erfarenheter av bemötande och Erfarenheter av utebliven vård. Resultatet visade att personer med narkotikarelaterat substansbrukssyndrom hade erfarit bristande bemötande av vårdpersonal till följd av stigmatisering och diskriminering, vilket ledde till konsekvenser som fördröjd eller nekad vård. Det framkom att vårdpersonal saknade kunskap om substansbrukssyndrom och hur substansbruksrelaterade tillstånd behandlas. Vidare visade resultatet att substansbruk utgjorde ett hinder för att erhålla adekvat smärtlindring, då vårdpersonalen antog att denna patientgrupp enbart sökte vård för att få tillgång till narkotikaklassade substanser. Personer med substansbrukssyndrom avbröt inte sällan sin sjukhusvistelse mot medicinsk inrådan, främst till följd av abstinensbesvär och inadekvat smärtlindring. Slutsats: Denna litteraturöversikt kan bidra till att hos vårdpersonal medvetandegöra patientgruppens erfarenheter och användas till grund för vidareutbildning inom området. Då flera stigmatiserade grupper kan tänkas uppleva liknande bemötande när de söker vård, kan föreliggande litteraturöversikt också användas för att förstå de erfarenheter stigmatiserade grupper generellt kan antas ha av att söka vård. / Background: The number of deaths related to narcotics related substance use is increasing. People with narcotics related substance use syndrome constitute a marginalized and stigmatized group in society. These people run an increased risk of ill health, especially as a result of their substance use. Stigmatization in health care is particularly serious, as it affects people in a particularly vulnerable state. In light of this, there is a need to compile previous research that has studied experiences of people with narcotics related substance use disorder being cared for in hospital settings.   Aim: The aim of this study was to examine experiences of people with narcotics related substance use disorder who have received hospital care.   Method: A non-systematic literature review with integrated data analysis was conducted based on 16 original scientific articles. The literature searches were carried out in the databases PubMed and CINAHL based on MeSH terms and CINAHL Subject Headings as well as additional relevant keywords. All articles that were included in the study have undergone a quality review according to Sophiahemmet University's assessment template.  Results: Three main categories were identified, as follows: Experiences of unequal care, Experiences of encounters and Experiences of missed care. The results showed that people with narcotics related substance use disorder had experienced a lack of treatment by healthcare professionals as a result of stigmatization and discrimination, which led to consequences such as delayed or denied care. It emerged that healthcare staff lacked knowledge about substance use disorder and how substance use related conditions are treated. Furthermore, the results showed that substance use constituted an obstacle to obtaining adequate pain relief as the healthcare staff assumed that this patient group only sought care to gain access to narcotic-classified substances. People with substance use syndrome often terminated their hospital stay against medical advice, mainly as a result of withdrawal symptoms and inadequate pain relief.  Conclusions: This literature review can contribute to raising awareness of the patient group's experiences among health care professionals and be used as a basis for further education in the field. As several stigmatized groups can conceivably experience similar treatment when they seek care, the present literature review can also be used to understand the experiences stigmatized groups can generally be assumed to have from seeking care.

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The aim of this thesis is to explore how men in recovery from substance use conceptualize challenges and use their inherent strengths to navigate them. Estimates of substance use prevalence rates in Canada suggest that approximately one-in-five Canadians will meet the diagnostic criteria for substance use disorder throughout their lifetime (Pearson, Janz & Ali, 2013). These prevalence estimates represent a significant cause for concern as addiction is a significant phenomenon in contemporary Canadian society. A scoping literature review was conducted on nineteen research studies to investigate the state of current research. Although there is a wealth of studies on addiction, research frequently utilizes pathologizing approaches. These approaches are commonly focused on addiction in the context of a social or individual issue ripe with problematizing discourses. Six qualitative semi-structured interviews were conducted on men living in recovery-based supportive housing for this research to explore their experiences from the onset of substance use into substance use and recovery efforts. A strength-based perspective was adopted for analysis purposes in order to more accurately reflect on the inherent strengths of the participants. The men provided in-depth accounts of their experiences, conceptualized challenges to their recovery and contrary to many contemporary research discourses, demonstrated an affluence of strengths while articulating challenge navigation. The men were also proactive in their ability to anticipate future challenges and conceive methods of effective challenge navigation. Findings of this study are analyzed and discussed in the context of recognizing the magnitude of the challenges facing the men in recovery and the incredible strengths that they demonstrate in challenge navigation. The implications for current social work practice are outlined and several suggestions are tabled with the goal of improving current practice methods. Finally, suggestions for future strength-based addiction research are offered with the intention of seeking overall improvements to the research field and addressing existing gaps within the literature. / Thesis / Master of Social Work (MSW)

The study aims to uncover social workers understandings of substance use (SU) among people with intellectual disabilities (ID) and ways in which social work with this group should be carried out.  Previous research has asserted that people with ID use drugs to a lesser extent, and therefore experience less drug related issues in general compared to the general popuation. However, people with ID experience more severe consequences from SU than others. Evidence for specific methods for working with this group is scarce.  The theoretical framework for this thesis is first based in the social model of disability. This enables the use of Goffmans symbolic interactionism with an emphesis on his theories of social roles. The last piece to the theoretical framework is cooperation theory which assists in analysing the themes of issues in cooperation that professionals express.  The thesis is carried out through semi-structured interviews with 6 interviewees, chosen through a combination of strategic- and snowball selection methods. The results are analysed thematically. Three main themes emerge from the empirical data: social factors, matters of cooperation between professionals and their organizations and communication styles between professionals and people with ID.  The main findings of the thesis is first: that Swedish research on the topic is practically non-exictent. Second: that effective methods are developed by professionals such as writing and drawing to enhance communication and that this knowledge is not transferred and expanded upon. Third: that professionals view SU among people with ID as caused by a need for social inclusion which they get from SU. / Undersökningen syftar till att ådagalägga socialarbetares förståelse av drogbruk bland personer med intellektuellt funktionshinder (IF) och hur socialt arbete med denna målgrupp bör utföras.  Tidigare forskning har visat att personer med IF använder droger i lägre grad, och därför erfar mindre drogrelaterade problem än befolkningen i övrigt. Personer med IF erfar dock allvarligare konsekvenser av sitt drogbruk än andra. Forskningsunderlaget för behandlingsmetoder är tunnsått.  Uppsatsens teoretiska utgångspunkter börjar i det sociala funktionshinderbegreppet som möjliggör användandet av Goffmans symboliska interaktionism med fokus på hans teori om sociala roller och masker. Slutligen används samverkansteori för att analysera samverkansrelaterade problem som framkommer i socialarbetares utsagor.  Undersökningen utförs som semistrukturerade intervjuer med 6 intervjupersoner som valts i kombinerad strategisk urvalsprocess och snöbollsurval. Empirin analyseras sedan tematiskt.  Tre huvudsakliga teman framkommer i empirin: sociala faktorer, samverkan mellan organisationer och professionella och kommunikation mellan professionella och personer med IF. Uppsatsen kommer fram till tre slutsatser. 1: Att svesnk forskning på ämnet saknas. 2: Att effektiva metoder för att arbeta med målgruppen så som att ritprata utvecklas i verksamheter men att denna kunskap inte förs vidare i organisationer över tid eller mellan organisationer och att denna kunskap behöver tas till vara och vidareutvecklas till arbetsmetoder. 3: Att socialarbetare ser drogbruk bland personer med IF som en konsekevens av ett behov av social tillhörighet.

Doctor of Philosophy / School of Family Studies and Human Services / Jared Anderson / This meta-analysis used data from 285 studies (yielding 983 effect sizes and a combined sample size of 627,726) to quantitatively evaluate the link between substance use and physical intimate partner violence (IPV) perpetration and victimization. Results indicated that overall substance use, alcohol use, and drug use were significantly related to both IPV perpetration and victimization, with mean effect sizes ranging from r =.18 to .23. Moderator analyses also compared males and females for overall substance use, alcohol use, and drug use; subcategories of alcohol use and drug use; and different types of drugs, for males and females, and for IPV perpetration and for victimization. This is the first meta-analysis to compare alcohol versus drug use for IPV perpetration and IPV victimization. The analyses revealed drug use to be a significantly stronger risk marker for victimization, and a non-significantly stronger risk marker for perpetration, compared to alcohol use. Alcohol consequence measures (i.e., abuse and dependence) were significantly stronger risk markers than consumption measures for IPV victimization, but non-significantly different for IPV perpetration. Furthermore, more frequent alcohol use (few times a week, almost daily, and daily) was a significantly stronger risk marker for perpetration compared to other alcohol frequency measures. Drug consequence measures (abuse/dependence) were significantly stronger risk markers for perpetration than simply drug use measures. There were no significant differences between different drug types, and no significant difference between stimulants versus non-stimulants for IPV perpetration and victimization (though these smaller comparisons may have been underpowered, and thus unable to detect differences). The findings of this study are important because they provide the most comprehensive and detailed analysis of the link between substance use and IPV to date.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: The aim of this study was to explore the dynamics between spiritual fitness and women in recovery from substance-problems. The phenomenological method of enquiry, and within this context, the qualitative approach, was followed. Interviews with five women, four of whom received treatment at Stepping Stones Addiction Centre, constituted the empirical data on which this research was based. These interviews revealed remarkable experiences in the lives of these women. The findings of the research indicate that women in recovery with substanceproblems benefit tremendously from interaction with the dimension of spirituality. Spirituality was understood in terms of the experience of intervention or support by a power greater than themselves – an experience which gave meaning to the lives of these women, which is manifested in their way of being and way of acting. This includes a new sense of responsibility and self-respect which empower them to become co-creators of their lives, and to contribute compassionately to the well-being of others. The continuous and disciplined application of “spiritual tools”, practices and guidelines constitute a growing dynamics of spiritual fitness which forms part of a holistic approach to treatment and recovery. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die dinamiek tussen spirituele fiksheid en vroue met substansie-probleme in die herstelproses, te verken. Die fenomenologiese metode van ondersoek, en binne hierdie konteks die kwalitatiewe benadering, is gebruik. Onderhoude met vyf vroue, van wie vier behandeling ontvang het by Stepping Stones Addiction Centre, het die empiriese data waarop hierdie navorsing gebaseer is, gekonstitueer. Hierdie onderhoude het merkwaardige ondervindings in die lewens van die vroue blootgelê. Die bevindings van die navorsing toon dat vroue met substansie- probleme in die herstelproses geweldig by die interaksie met die spirituele dimensie gebaat het. Spiritualiteit is verstaan in terme van die belewenis van intervensie of ondersteuning deur ‘n mag groter as hulself – ‘n ervaring wat betekenis gegee het aan die lewens van hierdie vroue, wat gemanifesteer het in hul wyse van bestaan en wyse van handel. Dit sluit ‘n nuwe begrip van verantwoordelikheid en selfrespek in, wat hul bemagtig om mede-skeppers van hul lewens te word, en op ‘n deernisvolle en empatiese wyse tot die welsyn van ander by te dra. Die voortgaande en gedissiplineerde toepassing van spirituele toerusting, gebruike en riglyne lei tot ‘n toenemende dinamiek van spirituele fiksheid wat deel vorm van ‘n holistiese benadering tot behandeling en die herstelproses.

The purpose of this research is to examine the barriers to food security for single adults with mental illness and/or problematic substance use living in supported housing on Vancouver Island. The objectives are: (a) to examine the difference in the level of food security for tenants of supported housing neighbourhoods located in urban versus a rural community; (b) to examine the barriers to food access experienced by the tenants; and (c) to examine which barriers have the greatest effect on the tenants. Using an explanatory case study design, I employ a community-based research method with a social justice perspective as the framework. I have used an explanatory matrix to illustrate the tenant identified barriers to food security and the social structures that affect these barriers. As well, I have made recommendations for integrating food security services and programs into supported housing projects. I have argued that food security is a matter of public health and an integrative approach is needed. I am suggesting a shift on a larger policy scale, to promote the health and well-being of tenants in supported housing. An adequate holistic perspective with an integrated, long-term strategy linking all the determinants of health would result in health-in-all policies. This strategy could reduce the existing health inequities that the tenants in supported housing experience. / Graduate / judy@nahs.ca

Pathological gambling is a maladaptive behaviour associated with diminished self-control over persistent compulsive gambling behaviour despite negative consequences. A significant revision to the clinical perspective of pathological gambling is underway, and the disorder will likely be recognized as a behavioural addiction in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the neurobiological, cognitive and behavioural processes that drive a ‘behavioural addiction’ are unclear. A series of five studies were conducted to investigate cognitive mechanisms associated with neural and behavioural substrates of addictive processes in disordered gambling. Studies 1 through 3 investigated neurobiological correlates of addiction in individuals with pathological gambling as compared to individuals with cocaine dependence, and as compared to non-addicted healthy controls. Study 1 investigated brain activity associated with anticipatory and consummatory reward processing during slot-machine gambling. Study 2 investigated executive control processes by examining functional brain networks associated with loss-chasing behaviour. Study 3 employed voxel-based morphometry (VBM) to explore alterations in grey-matter volumes in individuals with addictive disorders. Studies 4 and 5 investigated the behavioural substrates of addiction in regular gamblers utilizing emerging and novel research techniques. Study 4 examined continuous hand motion trajectories to explore approach biases and implicit processing. Study 5 employed an adaptive testing methodology to explore the influence of gaming machine preferences on cognitive processes and gambling behaviour. Research identified neurobiological and behavioural substrates of gambling-related beliefs and biases that indicate significant contributions of cognitive mechanisms to the development and persistence of a behavioural addiction. Results suggest addictive disorders may share some common features of anticipatory reward processing and brain structure (Studies 1 and 3), while neural signals associated losing outcomes and decision-making during gambling may be specific to disordered gambling (Studies 1 and 2). Furthermore, cognitive distortions in regular gamblers may influence reinforcement and executive control processes (Study 4), and individual preferences for gaming speed may influence cognitions and behaviour during machine gambling. As additional psychological disorders are being considered for classification as behavioural addictions, and clinicians will be faced with the challenges of treating individuals with these non-substance-related addictive disorders, a better understanding of behavioural addictions, through the study of disordered gambling, will be essential under the new diagnostic framework.

Överkonsumtion av alkohol är ett globalt problem som ökar risken för insjuknandet i flera sjukdomar, därmed kommer personer med substansbrukssyndrom i kontakt med många delar av hälso- och sjukvården. Patienter med substansbrukssyndrom upplever att de inte erhåller vård på samma villkor som andra. Syftet med litteraturstudien var att utforska sjuksköterskors inställningar vid vårdandet av personer med substansbrukssyndrom utanför specialiserad beroendevård. En systematisk litteraturstudie med beskrivande design användes som metod för att besvara syftet.  Resultatet består av två kategorier: “Sjuksköterskors inställningar till att vårda patienter med substansbrukssyndrom” och “Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom”. Kategorin ”Sjuksköterskors känslomässiga reaktioner av att vårda patienter med substansbrukssyndrom” bygger på fyra subkategorier: negativa aspekter, positiva aspekter, bristande kunskap och samtal om alkohol. Inställningen till att vårda patienter med substansbrukssyndrom var övervägande negativ. En förbättring av sjuksköterskors kunskaper om omvårdnad vid substansbrukssyndrom skulle kunna bidra till en bättre vårdupplevelse för både sjuksköterska och patient. / Overconsumption of alcohol is a global health issue that increases the risk for several physical and mental health conditions. People who suffer from alcohol dependence will therefore often come in contact with different instances within the health care system. Patients suffering from substance dependence might experience that they don’t receive equal care compared with other patients. The aim of the study was therefore to explore how nurses in general healthcare experience caring for patients suffering from substance dependence in general healthcare, outside of specialized care. A systematic literature review was used to answer the aim of the study. The result consists of two categories: "Nurses' experiences of caring for patients with substance use disorder" and "Nurses' emotional reactions of caring for patients with substance use disorder". The category "Nurses' emotional reactions of caring for patients with substance use disorder" is based on four subcategories: negative aspects, positive aspects, lack of knowledge and discussion about alcohol. Attitudes of caring for patients with substance dependence were predominantly negative. An improvement in nurses' knowledge could contribute to a better care experience for both nurse and patient.

Bakgrund: Sjuksköterskor möter personer med substansberoende inom alla vårdformer. Detta är en stigmatiserad patientgrupp som inte alltid upplever att de får vård på lika villkor som andra. En negativ inställning till denna patientgrupp är inte i enlighet med sjuksköterskans etiska kod och utgör ett hinder för god omvårdnad. Syfte: Syftet med litteraturstudien var att belysa sjuksköterskors upplevelser av att i sin professionella roll möta personer med substansberoende. Metod: En systematisk litteraturstudie av 10 studier med kvalitativ ansats. Sökningen genomfördes i databaserna PubMed, Cinahl samt PsycINFO. De kvalitetsgranskades och sammanställdes med inspiration av en modell för syntesprocess. Resultat: Fyra huvudteman framkom: a) misstro och negativ inställning till personer med substansberoende, b) kunskapsbrist och organisatoriska brister, c) hinder för god omvårdnad samt d) sympati och vilja att upprätta en god relation. Konklusion: Litteraturstudien visar att sjuksköterskor upplever flera brister och hinder inom omvårdnaden av personer med substansberoende. Det bidrar till att vård inte kan utföras i enlighet med etiska riktlinjer. Det finns behov av mer utbildning, kunskap och stöd i sjuksköterskornas yrkesroll samt vidare forskning för att kunna hitta förbättringsåtgärder som stödjer sjuksköterskan och kan förbättra vården för personer med substansberoende. Nyckelord: substansberoende, sjuköterskor, upplevelse, attityder, stigmatisering / Background: Nurses meet patients with substance use disorders in all forms of care settings. This is a stigmatized group that does not always receive care on equal terms as others. Negative attitudes towards this group are not in accordance with nurses ethical code and is a barrier for good nursing care. Aim: The aim of this systematic review was to illuminate nurses’ experiences of in their professional role encountering patients with substance use disorders. Method: A systematic review of 10 qualitative studies was performed. The search was made in the databases PubMed, Cinahl and PsycINFO. The studies were scrutinized for quality and compiled with inspiration of a model for synthesis. Results: Four major themes emerged; a) distrust and negative attitudes towards patients with substance use disorders, b) lack of knowledge and organizational deficiency, c) barriers for good nursing care, and d) sympathy and will to establish a good relationship. Conclusion: The systematic review shows that nurses experience many barriers in caring for patients with substance use disorders. This leads to inability to provide care according to the ethical guidelines. There is a need for more education, knowledge and role-support as well as further research to find improvements that support nurses’ and could improve the care for patients with substance use disorders. Keywords: substance use disorder, nurses, experience, attitudes, stigma