This non-experimental field study examined the relationship between participant reported experiences of relational depth (RD) with their individual counselors in substance use disorder (SUD) treatment and participant reported motivation to change substance use. Participants in the study were clients enrolled in inpatient and outpatient levels of substance use disorder treatment. A total of 78 clients (aged 18-77, with mean age 35.97, 80.1% Caucasian, 11.5% African-American, 3.8% Hispanic, 1.3% Asian, 1.3% multiracial, 1.3% other) with SUDs participated in the study. Results demonstrated that treatment process variables explained approximately 42% of the variance in participant recognition scores. Specifically, substance abuse community support involvement (β = .598, rs2 = .908, p < .001) and relational depth (β = .184, rs2 = .178, p = .045) were found to be significant predictors of participant recognition of a substance use problem. From these results, one may tentatively conclude that community support and the development of relational depth in SUD treatment are valuable additions to standard SUD treatment. Extended results are described and summarized using text, tables, and figures. The study has practical and clinical implications for counselors working with clients in substance use disorder treatment particularly concerning the length of individual counseling.

Over the past three decades, the United States criminal justice system and mental health treatment providers have collaborated in ways to support more than 20.3 million individuals who are struggling with a substance use disorder (SUD), and who may also be facing drug-related offenses due to their ongoing challenges combatting addiction. Through collaborative efforts we have been fortunate to witness the establishment of adult drug treatment courts, as well as other problem-solving court processes. With more than 1,500 active adult drug treatment court programs in this country, there is a critical need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. Adult drug treatment court programs have been shown to have discrepant success outcomes (8% to 80%) in terms of reducing criminal recidivism; moreover, the existing literature examining the lived experiences of participants in these programs is both minimal and disheartening. This lack of empirical data is problematic for the counseling profession given that they serve as key change agents in this process. What we do know is that the process of creating treatment goal and modalities, which should be in the hands of the clients and their counselors, can be complicated by court-mandated requirements. This bi-level structure has the potential to create ruptures in the working alliance between clients and counselors providing SUD treatment to this population. Accordingly, additional research is needed to explore the client experience within the working alliance, and in so doing reveal the influences at play when working with clients who are mandated to receive SUD treatment. This qualitative study was guided by one central research question: How do clients experience the working alliance with counselors during drug court-mandated addictions treatment? Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients. / Doctor of Philosophy / With more than 1,500 active drug court programs throughout the United States, there is a pressing need to better understand the working alliance between counselors and clients who have been mandated to receive SUD treatment. While adult drug treatment court programs have been shown to have positive outcomes in terms of reducing criminal recidivism, the existing literature examining the participants' lived experiences receiving SUD treatment is minimal and disheartening. Due to the nature of the mandated treatment relationship, the confidentiality which has historically bound and secured the therapeutic working alliance is less defined than it is in fully voluntary treatment settings. This shift in understanding what creates a healthy working alliance for mandated clients to work through presenting treatment issues is something that has yet to be explored by current research. The current study sought to explore clients' experiences of the working alliance with counselors during drug court-mandated addictions treatment. Interview data from eight individuals in court-mandated SUD treatment led to the development of a constructivist grounded theory model: From compliance to alliance: A grounded theory of building rapport in mandated treatment. This model and it's components describe and define key factors when working with this population. More research is needed to understand counselors' perspectives of the working alliance with court-mandated clients.

Drug use, overdose, and addiction has skyrocketed in the past twenty years (Centers for Disease Control and Prevention, 2020). Negative stigma towards addiction, or otherwise known as substance use disorder (SUD), has only increased since President Nixon declared the "war on drugs" in 1971 (National Public Radio, 2007). Negative public stigma of SUD creates barriers for treatment for those who are suffering, continuing to exacerbate the stigma surrounding SUD. To understand ways to reduce stigma surrounding SUD, this study will look at narrative persuasion through transportation theory to better understand the power of stories and stories of recovery as a method to reduce stigma surrounding SUD among community members. In addition to examining narrative persuasion literature, 21 semi-structured interviews from community stakeholder groups in Virginia's Department of Behavioral Health and Developmental Services region 3, were conducted. To further understand the content in the stakeholder interviews, a qualitative thematic analysis using inductive themes was conducted to determine common themes surrounding substance use disorder, stigma, and ways to reduce stigma surrounding substance use disorder through narrative persuasion. Based on participant interviews, community stakeholders hold negative perceptions of those with SUD based on personal and professional experiences but believe that positive personal narratives of SUD and recovery can reduce public stigma towards those who suffer from the disorder. / Master of Arts / Drug use, overdose, and addiction has skyrocketed in the past twenty years (Centers for Disease Control and Prevention, 2020). Negative stigma towards addiction, or otherwise known as substance use disorder (SUD), has risen since President Nixon declared the "war on drugs" in 1971 (National Public Radio, 2007). Negative public stigma of SUD creates barriers for treatment for those who are suffering, continuing to worsen the stigma surrounding SUD. To understand ways to reduce stigma surrounding SUD, this study will look at persuasive storytelling through transportation theory to better understand the power of stories and stories of recovery as a method to reduce stigma surrounding SUD among community members. In addition to examining narrative persuasion literature, 21 interviews from various community members in region 3 of Virginia were conducted. To further understand the content in the participant interviews, a thematic analysis was conducted to determine common themes and patterns surrounding substance use disorder, stigma, and ways to reduce stigma surrounding substance use disorder through persuasive storytelling. Based on participant interviews, community stakeholders hold negative perceptions of those with SUD through personal and professional experiences but believe that positive personal narratives of SUD and recovery can reduce public stigma towards those who suffer from the disorder.

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations between DD, RF, and remission from SUDs. Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an Adjusting Amount Delay Discounting Task. T-tests were used to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship between DD, RF, and remission status. Remitted individuals (n=82) had significantly lower DD rates (p<0.001) and higher context sensitivity (p<0.001) and coping flexibility (p<0.001). There were significant negative associations between DD and context sensitivity (p=0.008), coping flexibility (p=0.002), and emotion regulation flexibility (p<0.001). Finally, context sensitivity (p=0.023) and coping flexibility (p=0.007) mediated the relationship between DD and SUD remission. Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes. / M.S. / Preference for immediate gratification (also called delay discounting), and self-regulation (the ability to control one’s emotions) are related to addiction outcomes. Regulatory flexibility - a self-regulation process by which individuals select and adapt their coping strategies based on their situation - is related to improved mental health outcomes. However, research studies have yet to examine the relationship between regulatory flexibility and delay discounting in individuals with a history of drug and/or alcohol dependence. Using a sample from an online addiction recovery research and support community called the International Quit and Recovery Registry, the current thesis examined the relationship between delay discounting and regulatory flexibility grouped by substance use disorder clinical diagnoses amongst 148 individuals. Group comparisons suggested that individuals in remission (i.e., no longer meet criteria for clinical diagnosis of addiction) were better able to delay gratification and were better able to flexibly regulate their emotions compared to individuals who relapsed. When examining the relationship between delay discounting and regulatory flexibility, we found that individuals’ who preferred delayed rewards over immediate rewards were better able to flexibly self-regulate, suggesting that being able to delay gratification is an important component of effective coping, together contributing to improved addiction recovery outcomes.

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.

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

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.

ABSTRACT Professors repeatedly warn students against burnout throughout the years of schooling that is required to earn a credential or license to work with persons who suffer from a substance use disorder. Despite these many warnings, burnout amongst practitioners continues to occur. There has been considerable research done over the years on the phenomenon of practitioner burnout, its causes and how to prevent it. Substance use disorder practitioners’ challenges often include high caseloads, difficult cases and lack of self-care. The data collected through an electronic server Survey Monkey allowed for a quantitative cross-sectional analysis which focused on participants’ perceptions of the causes of burnout and methods used for self-care. Respondents were recruited from two substance use disorder treatment programs, participation was voluntary. The analysis highlighted that the survey participants (n=30) view self-care as an appropriate intervention against burnout. These findings present: underlying causes of burnout; effective self-care practices for practitioners who are suffering from burnout; and how practitioners with higher education viewed self-care differently. Among the goals of the research done in this project was to bring awareness to; underlying causes of burnout; solutions to prevent burnout and effective techniques currently being used by practitioners that contributes additional knowledge to social work’s knowledge on burnout and self-care methods for practitioners experiencing burnout symptoms.