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

published_or_final_version / Social Service Management / Master / Master of Social Sciences

Low-income women, including women who receive welfare, are some of the most misunderstood citizens in the U.S. Low-income women often live in extreme situations that are complicated by poverty and multiple issues related to human capital, social support, mental health, and substance use. These factors make low-income women unique in that they contribute not only to the women’s current situations, but to their potential for future self-sufficiency. The majority of previous studies have described these factors as barriers to self-sufficiency. This study explored these factors differently by examining the extent to which human capital is associated with mental health problems and substance use problems and whether those associations are moderated by social support among low-income women. By exploring human capital among low-income women, this study closes a gap in the literature. Previous literature has examined human capital as an outcome of life choices and circumstances. This study is unique in that human capital is conceptualized as a combination of strengths that are employed in unique ways and that help determine whether life outcomes among low-income women will be related. This study examined secondary data collected from 11,495 low-income women who participated in the University of Kentucky’s Targeted Assessment Program (TAP) between July 2005 and July 2011 and is informed by theoretical literature on human capital, social support, and relationships, as well as empirical literature on study factors related to problems experienced by low-income women (i.e., mental health problems, substance use problems, and social support). Study hypotheses were developed to examine the relationships between human capital and mental health and substance use among low-income women and whether social support moderates those relationships. Results indicate that while some human capital factors are indicative of fewer mental health and substance use problems, perceived social support was a significant indicator of each of the mental health and substance use factors. Perceived social support was not found to moderate relationships between predictor and outcome variables.

The purpose of this study is four-fold: (1) to test delinquency theories in social settings that vary by their degree of religiousness; (2) to determine whether delinquency causal processes vary according to the nature of religious ecology; (3) to assess whether variation exists in the rates and types of adolescent offenses committed in these settings; and (4) whether these offenses are a response to unique influences in each context. Religious ecology is measured by tapping a dimension of school religious characteristics, including a school's level of religiousness and a school's religious group composition. Adolescent boys who are exposed to the confines of schools that are predominantly irreligious or disproportionately low in orthodoxy are significantly more likely to engage in delinquency than boys from more moral or highly orthodox schools. Experiences in fundamentalist reference groups also protects youngsters against engaging in substance use episodes, including harmful drugs such as cocaine. These patterns are independent of demographic characteristics such as race, gender, socioeconomic status, family size and community size. To account for religious ecological differences in problem behavior, strain and control theories of delinquency are tested. These testing procedures reveal little support for processes advocated by strain theorists. Not only is structural and interactionist induced strain not correlated with delinquency and substance use, but discrepancies between cultural expectations and perceived realization of these goals do not lead to psychosocial frustration and tension, as implied in many strain models. Control models more aptly account for delinquency and substance use variation in various religious climates, but the strength of religious, school, and family effects varies with the type of offense and the measure of religious ecology. If we measure religious ecology by the nature of denominational composition, religiosity has a uniform effect on delinquency. However, religiosity's effect in settings that vary by religious level is to more strongly inhibit chronic offending in secular disorganized communities. Involvement in delinquency and substance use is probabilistically less likely in moral and highly orthodox settings because religion's social expression is stronger, the broken home phenomenon is weaker and potentially harmful school behaviors and attitudes are unrelated to delinquency in these settings.

The goal of this research is to explore the relationship between coercion and crime amongst street youths in Mexico. This research relies on Mark Colvin’s (2000) Differential Coercion Theory (DCT). Through semi-structured interviews with street youths in Mexico City, this research explores: (1) the various personal and structural factors that lead youths to the street; (2) the strategies of income generation used by the youths; (3) the youths experiences of victimization, substance use, criminal involvement and institutionalization; and finally, (4) the personal and structural reasons that contribute to youths’ inability to leave the street. Results indicate that in most cases youths experience some form of physical, sexual, verbal, and/or psychological abuse that prompts them to leave home. In other cases, youths simply witnessed the abuse of a significant other or become subject to neglect. Some youths are thrown out of the home due to familial conflict. Results also indicate that on the street, youths are encouraged to display violent behaviours to avoid victimization. Further, youths face a number of needs and are compelled to engage in legitimate or illegitimate sustenance practices. On the street, youths are subject to theft, as well as physical and sexual victimization from peers and police officers. The results also suggest that youths are dependent on various substances as a way to cope with difficult situations. Results also indicate that as a result of crime or drug use, youths are likely to experience institutionalization where physical, verbal, and psychological victimization is experienced. Finally, youths attribute the freedom provided by the street and substance dependency as reasons to stay on the streets. Overall, the results suggest that Mexican street youths experience coercion in various settings. However, to explain the relationship between coercion and crime more research is needed on other explanatory factors. / Thesis (Master, Sociology) -- Queen's University, 2013-10-28 16:29:18.922

Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later. Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis. Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline. Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31). Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.

Title: Has youth participation in organized extracurricular activities and future expectation relevance for antisocial behavior?   Zetterberg, E. (2015). Has youth participation in organized extracurricular activities and future expectation relevance for antisocial behavior? Bachelor thesis in Public Health science. Department of work- and public health science. The academy of health and working life. University of Gävle, Sweden. Adolescent drug use is a threat to public health. Therefore it is important to identify how different factors interact in order to develop successful preventive interventions against youth drug use. The purpose of this study is to investigate the association of participation in organized extracurricular activity, future expectation and drug use. Method: The study is cross-section designed and based on the data material from the last survey, Life and Health Young in 2013 in Uppsala County. The study included 1648 high school students residing in the municipalities of Uppsala, Enköping and Älvkarleby (response rate of 60 %). The data were analyzed by bivariate and multivariate methods. Results: The results indicate that there is an association between participation in organized sports-related extracurricular activity, future expectation and drug use. Young people who have a positive expectation about their future have used less drugs (16%) compared with adolescents who have a negative future expectation (27%). Positive future expectation was also strongly associated with participation in organized sports-related extracurricular activity (both p< 0.001). Conclusions: Being involved in organized extracurricular activity appears to be a determinant of a positive future expectation as well as a positive future expectation seems to be a determining factor for decreased drug use among adolescents. / Ungdomars narkotikaanvändning är ett hot mot folkhälsan. Därför är det viktigt att kartlägga hur olika faktorer samvarierar för att kunna utveckla framgångsrika preventiva insatser mot ungdomars narkotikaanvändning. Syftet med den här studien är att undersöka associationen mellan deltagande i organiserad fritidsaktivitet, framtidstro och narkotikaanvändning. Metod: Studien är av tvärsnittsdesign och bygger på datamaterial från den senaste enkätundersökningen Liv och Hälsa Ung 2013 i Uppsala län. I studien ingick 1648 gymnasieungdomar bosatta i kommunerna Uppsala, Enköping och Älvkarleby (svarsfrekvens på 60 procent). Datamaterialet har analyserats med bivariata och multivariata metoder. Resultat: Resultatet indikerar att det finns en association mellan deltagande i organiserad idrottsrelaterad fritidsaktivitet, framtidstro och narkotikaanvändning. Ungdomar som har en positiv framtidstro har i mindre utsträckning använt narkotika (16%) jämfört med ungdomar som har en negativ framtidstro (27%). Positiv framtidstro var även starkt associerat med deltagande i organiserad idrottsrelaterad fritidsaktivitet (båda p<0.001). Slutsats: Att delta i organiserad fritidsaktivitet tycks vara en bestämningsfaktor för positiv framtidstro liksom att positiv framtidstro tycks vara en bestämningsfaktor för minskad narkotikaanvändning bland ungdomar.

This study was designed to collect data that would provide evidence as to what students' expectations of the environment were along with whether these expectations were actually being experienced by students living in the substance-free environment. A systematic sample of 139 students were surveyed who lived in the Students Uniting to Remain Free (SURF) substance-free living environment at Ball State University during the Fall semester of 2001 academic year. Data collection consisted of a survey instrument that had eight three-part questions, 10 demographic characteristic questions, and six student involvement questions.The data revealed that new and returning students living in the SURF hall were very satisfied with their residential experience. The majority of their expectations matched the majority of their experiences. Statistically significant differences between the expectations of new and returning students existed with the following variables: drinking and using drugs outside of the SURF hall, expecting that they would not have to deal with noise and disruptions caused by alcohol usage, living with students who had similar religious ideals and values, expecting the SURF hall to be a quiet study area and expecting and experiencing wellness and healthy lifestyle programs.The growing interest in substance-free housing environments is an area that many Chief Housing Officers and Student Affairs Administrators may want to consider investing more time researching in addition to allocating additional institutional resources in the creation of increased levels of this living environment option. Current expansion of this lifestyle option on campuses across the nation may dictate that for institutions to stay competitive and to meet the needs of the various populations living on their campuses the offering of this lifestyle option may need to increase. Additional research into the academic benefits and long-term retention benefits may be necessary for the development of new programs. / Department of Educational Leadership

Bakgrund: Patienter med substansbruksyndrom ökar i vården och därmed sjukvårdspersonalens kontakt med denna patientgrupp. Sjukvårdpersonal har ansvar för att ge vård till patienter på lika villkor samt ha ett gott bemötande.  Sjukvårdpersonalens attityder inverkar på patientens upplevelse av bemötande och vårdkvaliteten vilket i sin tur påverkar deras tillit till sjukvården.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Syfte: Syftet med studien var att undersöka vårdpersonals erfarenheter av att vårda samt attityder till patienter med substansbruksyndrom på avdelningar där inte endast missbruksvård bedrivs. Metod: En litteraturstudie genomfördes och inkluderade 10 artiklar med kvalitativ ansats. Dessa har granskats, analyserats och sammanställts med hjälp en integrativ litteraturöversikt. Sökningarna utfördes i databaserna Cinahl, PsychInfo och Pubmed. Resultat: Tre huvudkategorier och sju subkategorier identifierades. De tre huvudkategorierna innefattade: Synen på och erfarenheter av patienter med missbruksproblematik, Synen på att vårda patienter med missbruk, och Synen på uppkomst och ansvar över missbruk.  Slutsats: Vårdpersonals attityder till patienter med missbruk varierar, dock visar studien på att det förekommer negativa attityder till dessa patienter. Det resulterar i att vården ofta blir mer uppgiftsorienterad och mindre individorienterad. Litteraturstudien visar även att vårdpersonal med erfarenhet och utbildning inom missbruk generellt har en mer positiv attityd till patienter med missbruksproblematik. Det tyder på att det behövs mer utbildning av vårdpersonal för att negativa attityder gentemot patienter med missbruksproblematik ska undvikas. / Background:The number of patients with substance use disorder are increasing within the healthcare system, therefore is also the contact between this patient group and the healthcare personnel becoming more frequent. It is the healthcare personnel’s responsibility to give equal care to all patients, including a respectful treatment. The attitude of the healthcare personnel will influence the patient’s experiences of how they are approached and the quality of the care they receive, which in turn affects the patients trust in the healthcare system.  Aim:The Aim of this study was to explore healthcare personnel’s experience of caring for patients with substance use disorder and their attitudes towards this patient group, in non-specialist settings.  Method:A literature study was conducted including 10 articles with a qualitative approach. These articles have been reviewed, analysed and compiled with help of an integrative literature review. Database searches have been executed in Cinahl, PsychInfo and Pubmed. Result:Three major categories and seven subcategories were identified. The three major categories included: The view and experiences of patients with substance misuse, The view on care for patients with substance misuse, and The view on responsibility and origin of misuse. Conclusion:Attitude towards patients with substance use disorder varies among healthcare personnel, however this study indicates that the attitudes are predominantly negative. This results in a care that are often more task oriented, and less orientated toward the individual. Furthermore, the literature study also demonstrates that more educated and experienced healthcare personnel usually express a more positive attitude toward this group of patients. This indicates that there is a need to educate healthcare personnel to avoid negative attitudes towards patients with substance use disorder.

Bakgrund: I Sverige uppskattas att 29500 personer utvecklat ett problematiskt narkotikabruk. Droger påverkar hjärnans delar som är kopplade till känslor av lust och välbehag. Narkotika är beroendeframkallande, hälsofarligt och påverkar hela människan. I samhället förekommer fördomar mot personer som har substansmissbruk vilket kan leda till utanförskap, mindervärdeskänslor och minskad benägenhet att uppsöka sjukhusvård. Syfte: Syftet var att beskriva sjuksköterskors attityder och erfarenheter av att möta personer som har ett substansmissbruk samt att beskriva de valda artiklarnas datainsamlingsmetod. Metod: Litteraturstudie med deskriptiv design. Elva artiklar inkluderades i studien, 4 med enkäter, 1 enkät med öppen fråga och 6 intervjuer. Artikelsökning genomfördes i databaserna Cinahl och Pubmed. Huvudresultat: Sjuksköterskor hade olika uppfattningar om orsaken till missbruk, där det ansågs bero på antingen brist på eget ansvar eller livsomständigheter. Sjuksköterskor beskrev personer som har ett substansmissbruk som manipulativa, våldsamma och krävande vilket byggde på tidigare erfarenheter. Andra sjuksköterskor hade ett holistiskt synsätt och såg människan bakom missbruket. Viktiga faktorer för en god relation var att vara ärlig och rak. Vidare beskrevs också att utbildning och erfarenhet hade betydelse för sjuksköterskans attityder och erfarenhet av personer som har ett substansmissbruk. Slutsats: I mötet spelar erfarenhet av missbruk, människosyn och utbildning stor roll för interaktionen mellan sjuksköterskan och personen som har ett missbruk. Där det råder brist på utbildning och erfarenhet finns känslor av misstro och frustration som leder till avståndstagande. Positiva attityder sammankopplas med sjuksköterskans förmåga att ha en helhetssyn och öppenhet mot personer som har ett missbruk. / Background: In Sweden it´s estimated that 29,500 people have developed a problematic drug abuse. Drugs affect the parts of the brain that affect feelings of desire and pleasure. Drugs are addictive, harmful to health and affects the whole person. The society’s stigma against people who have substance abuse can lead to alienation, inferiority and reduced tendency to seek hospital treatment. Aim: The aim of this literature review were to describe nurses' attitudes and their experience of meeting people who have a substance use disorder and to describe the selected articles method of data collection. Method: A literature study with descriptive design. Eleven articles was included in the study, 4 questionnaire, 1 questionnaire with an open question and 6 interviews. The search of the articles were carried out in the databases Cinahl and Pubmed. Findings: Nurses have different attitudes about the cause of substance use, some considered it to be because of lack of responsibility and others because of life circumstances. Nurses described people who have a substance use disorder as manipulative, violent and demanding, which was based on previous experiences. Other nurses had a more holistic approach and saw the person behind the substance use. Honesty and straightforwardness were important factors in meeting people with substance use disorder. Education and previous experience were important to the nurse's attitudes and experience. Conclusion: Experience, humanity and education played a major part in the interaction between the nurse and the person who has a substance use disorder. Where there is lack of education and experience feelings of distrust and frustration lead to rejection. Positive attitudes were linked to the nurse's ability to have a holistic approach and openness toward people who have a substance use disorder.