Substance use disorders (SUD) are among the most significant worldwide public health challenges. Isolation and separation are some of the more common indicators of SUD. Even though various music therapy interventions are used to address clinical goals when working with clients with SUD, voicework, specifically, has not been abundantly researched with this client group. Research has shown that the use of the voice has the ability to turn isolation into connection. This qualitative study therefore examined whether voicework with this client group could facilitate connection. Seven clients participated in six group music therapy sessions held at a halfway house over three weeks. The sessions as well as the one focus group were transcribed, and thick descriptions were written of musical excerpts; all were then analysed thematically. From the data, the following four themes were developed: (1) multiple forms of connection were afforded through voicework in music therapy; (2) music therapy offered multiple opportunities for facilitating connection; (3) particular techniques were useful for enhancing connection; (4) a music therapy process, centred around voicework, offered participants an experience in which they could reflect on connection and disconnection. The findings suggest that voicework can be a useful intervention within music therapy to create opportunities for connection to both the self and other. / Dissertation (MMus (Music Therapy))--University of Pretoria, 2021. / Music / MMus (Music Therapy) / Unrestricted

Exercise training for clients at out-patient drug rehabilitation centers likely helps with coping skills. However, a better examination of the mechanisms producing changes may help identify effective interventions. PURPOSE: To test the effect of a vigorous exercise prescription on drug abstinence in voluntary rehabilitation patients. METHODS: 25 surveyed participants in a male drug treatment program underwent a 12-week minimum training program. The program included moderate-rigorous exercise and psychotherapy. Three days per week all subjects participated in EP for 90 minutes. Subjects also participated in ABIT 3 days per week where each session lasted 2 hours. Subjects also participated in ESM which ran for 90 minutes 5 days per week. Within each week, program participants also completed between 2-3 hours of psychotherapy (individual and/or group) per day, varying depending on level of care and phase of the treatment process. Exercise performance and adherence, sobriety and relapse rates, and emotional coping skills were collected. RESULTS: Subjects experienced frequent relapse (5±8 occurrences) prior to admission; however, 84% were currently sober on completion of the program, 8% relapsed during treatment, and 36% relapsed after treatment. The longest duration of sobriety a subject achieved was 273±111 days. Post-treatment survey results indicate 84% of subjects still exercised regularly, 68% continued to practice yoga or meditation, and 60% followed a diet that required disciplined awareness. Bench press max improved significantly throughout the program (39%; p<.001), as did squat (55% improvement; p<0.001) and deadlift (69.8%; p<0.001). On completion of the survey 91% of patients who exercised regularly were sober; 50% of patients who did not engage in regular exercise were sober on completion of the program (P=0.043). Owing to a small sample of patients who relapsed during treatment (N=2), the difference in exercisers who relapsed during treatment (5%) and non-exercisers who relapsed (25%) was not significant (P=0.171). Twenty-nine percent of exercisers relapsed after treatment; 75% of non-exercisers relapsed after treatment (P=0.076). The odds of managing adverse emotional states when they arose increased 20-fold among subjects who reported regular participation in exercise (Nagelkerke R2=0.333; P=0.036). Similarly, each additional day per week that a patient practiced yoga predicted a 20-day increase in duration of sobriety (R2=0.227; P=0.016). CONCLUSION: Exercise training exerts a statistically significant positive effect for sobriety and coping skills within a population that previously struggled with perpetual relapse.

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Background: Sedatives and hypnotics are substances to calm or relieve anxiety and to induce sleep. Long term prescription of benzodiazepines/Z-drugs may lead to the development of tolerance and the need to increase the dose. It is important to be aware of the risks of uncontrolled use of these drugs, such as harmful interactions with other substances, side effects and potential for abuse or addiction. Aim: The aim of this research was to describe abuse of sedatives and hypnotics from the user's perspective, to focus on circumstances leading to drug abuse, to describe beginning and course of the use of these drugs and self-awareness of the problem. The aim was also to describe the current state of users and their needs. Sample: The research sample consisted of 6 participants, of which 4 women and 2 men currently or recently using sedatives and hypnotics (specifically benzodiazepines/Z-drugs). Methods: Data were collected through a qualitative approach using a semi-structured interview. Interviews were conducted, rewritten into protocol summary, further analysed using thematic analysis, modified using open and axial coding and categorization methods. Results: Respondents may have misused sedatives and hypnotics to self-medicate symptoms. These drugs were prescribed for the first time with...

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Despite the fact that more men are diagnosed with substance use disorder, women escalate their drug consumption faster, exhibit higher craving during withdrawal, and have poorer treatment outcomes. Furthermore, as our cultural expectations of men and women have changed, there has been an increase in drug use in women and this increase is likely to persist. Preclinically, female rodents show stronger behavioral responses to drugs of abuse during initiation, escalation, and reinstatement of drug seeking. These behavioral differences are accompanied by alterations in structural plasticity within the mesocorticolimbic reward system. However, little is known about what functional sex differences exist in glutamate transmission in these circuits. The goal of these experiments was to determine functional sex differences in reward circuitry that may underlie behavioral sex differences in substance use disorder. We found heightened glutamate transmission in both the medial prefrontal cortex and nucleus accumbens in females compared to males. These findings corresponded with the nucleus accumbens being less plastic in females. We then investigated the role of PKMζ, a glutamatergic AMPA receptor trafficking protein, in plasticity and opioid-taking. We found PKMζ plays a role in synaptic plasticity within the nucleus accumbens and it works to blunt oxycodone-taking and motivation in a dose-dependent manner. Taken together these findings suggest there are functional sex differences at many levels within the reward system and gaining a better understanding of these differences could provide insight into improved treatments for substance use disorder. / Psychology

The U.S. Department of Health and Human Services has declared the misuse of opioid prescription drugs as a public health emergency. The Affordable Care Act’s Medicaid expansion expanded the number of people with insurance and increased the demand for services related to substance abuse treatment. In the first part of this study, the researcher examines whether the Medicaid expansion reduced the likelihood of treatment delay. The second part of this study explores whether the length of stay for opioid use disorder treatment is significantly different in states that adopted Medicaid expansion versus states that did not. In both studies, the researcher analyzes administrative data from the Substance Abuse and Mental Health Services Administration to discover any treatment delays associated with the opioid treatments for the states that adopted the expansion versus the states that did not, and to determine whether there was a difference in the length of stay in the states that adopted the Medicaid versus the states that did not. A difference-in-difference approach is used in both studies to compare the states which adopted an optional Medicaid expansion to those non-adoption states. The evidence suggests that demand for opioid treatment services increased in expansion states as there is a decreased probability of obtaining treatment on the first day for initial requests for outpatient treatment. In addition, evidence suggests that Medicaid expansion increased the likelihood of staying longer in outpatient facilities, but not inpatient facilities. / Business Administration/Risk Management and Insurance

Bakgrund: Substansbrukssyndrom är en sjukdom som påverkar flera miljoner individer i världen idag, varav sjuksköterskor är en särskilt utsatt grupp. Detta bland annat på grund av tillgängligheten till narkotika på arbetsplatserna. Trots detta råder det stor kunskapsbrist kring ämnet. Det medför att omvårdnadsarbetet kan påverkas negativt, och patienter, kollegor och den missbrukande sjuksköterskan själv kan utsättas för risker. Syfte: Att beskriva sjuksköterskans upplevelse av personligt substansmissbruk och missbruksrehabilitering. Metod: Litteraturstudien baserades på åtta kvalitativa studier inhämtade genom databassökningar i CINAHL och PubMed. Analyserades med Fribergs femstegsmodell.Resultat: Fyra huvudkategorier framkom ur analysen: ”Orsaker till missbruket”, “missbrukets konsekvenser”, “Att konfrontera missbruket” samt “rehabilitering”. Huvudkategorierna delades upp i 8 underkategorier. Konklusion: Missbruk leder till sociala och ekonomiska konsekvenser för sjuksköterskan samt kan negativt påverka kvaliteten på patientens vård. Det finns effektiva interventioner men upplevelsen av dessa varierar och är beroende av flera faktorer. Det finns ett kunskapsgap och det behövs mer forskning kring frågan. / Background: Substance use disorder is a disease that afflicts millions of individuals worldwide today, of which nurses are vulnerable as a group because of the easy access to narcotics amongst other reasons. Despite this, there is a great lack of knowledge about the subject. This affects the nursing care negatively, and patients, colleagues and the substance abusing nurse themselves can be put at risk. Aim: To describe the nurses’ experience of personal substance abuse and rehabilitation. Methods: This literature study is based on eight qualitative studies acquired through database-searches in CINAHL and PubMed, the analysis was conducted using Friberg`s five step model. Results: Four main categories were found through the analysis: “Causes for substance abuse”, “consequences of substance abuse”, “Confronting the substance abuse” and “rehabilitation”. The main categories were divided into 8 subcategories. Conclusion: Substance abuse leads to social and economic consequences for the nurse and can negatively affect the quality of the patient's care. There are effective interventions but the experiences of these vary and are dependent on multiple variables. There is a lack of research on the subject, and more is needed.

Introduktion: Substansmissbruk är ett stort folkhälsoproblem samt en global humanitär kris. Personer med substansmissbruk är en sårbar patientgrupp då de lider av både fysisk och psykisk samsjuklighet vilket leder till behov av både somatisk och psykiatrisk och vård.  Substansbrukssyndromet bidrar till att vårdpersonal inom sjukvården upplever denna patientgrupp som komplex och svårbehandlad.  Syfte: Syftet var att studera vilka erfarenheter personer med substansmissbruk hade av bemötandet i somatisk vård. Metodbeskrivning: En litteraturstudie med deskriptiv design och kvalitativ ansats, där 13 original studier inkluderades i tematisk analys. Resultat: Resultatet visade på att personer med substansmissbruk upplevde brister i bemötande inom vården. Dessa upplevelser beskrevs som stigmatisering, fördomar samt bristande vård. Resultatet visade även att personer med substansmissbruk uppskattar ett professionellt bemötande där vårdpersonal var engagerad, empatisk, tog sig tid att lyssna samt var icke-dömande.Slutsats: Bemötande är en viktig del av omvårdnad då upplevelser av bemötande påverkar patientens vårdupplevelse samt hur de hanterar sin ohälsa. Genom en bättre förståelse för denna patientgrupps upplevelser av bemötande samt hur bemötandet brister kan förutsättningar skapas för att personer med substansmissbruk ska erhålla en god, trygg och jämnlikvård. / Introduction: Substance abuse is a significant public health problem and global humanitarian crisis. People who suffer from substance use disorder are a vulnerable patient group as they suffer from both physical and mental co-morbidities that lead them to seek somatic and psychiatric care. Substance use disorder contributes to health professionals perceiving this patient group as complex and challenging. Purpose: The purpose was to study what experiences people with substance abuse had of interactions and treatment in somatic care. Method description: A literature review with a descriptive design including 13 qualitative studies in the thematic analysis. Results: The results showed that people with substance use disorder had negative treatment and interactions experiences in health care. The result describes experiences of stigmatization, prejudice, and neglect. The results also showed that people with substance use disorder appreciate a professional approach where the healthcare staff is committed, empathetic, takes the time to listen and is non-judgmental.Conclusion: Interaction is essential to nursing, as perceptions of interaction affect the patient's care experience and how they deal with their illness. A better understanding of this patient group's experiences in treatment and how it is lacking creates an environment for healthcare professionals to provide good, safe, and equal care; healthcare professionals must know the specific needs of this patient group.

Bakgrund Patienter med substansbrukssyndrom har ofta behov av sjukhusvård på grund av trauma, psykisk problematik eller fysiska skador som uppkommit på grund av substansbruk. Sjukdomen skapar ett sjukdomslidande för patienten som är svår att ta sig ut. Utöver sjukdom upplever patienterna sig ofta stigmatiserade både från samhället, sig själva samt vårdare vilket bidrar till livslidande såväl som vårdlidande. Sjuksköterskan har ett ansvar att vårda sina patienter personcentrerat med respekt. Syfte  Syftet är att beskriva mötet mellan patienten med substansbrukssyndrom och hälso-och sjukvårdspersonal. Metod Studien byggs på en icke-systematisk litteraturstudie baserad på 16 vetenskapliga originalartiklar. Inkluderade artiklar är av kvalitativ design. Datat är insamlad under hösten 2021 från databaserna PubMed och CINAHL, sökningarna genomfördes med booleska sökkombinationer. Alla inkluderade artiklar är kvalitetsgranskade utifrån Sophiahemmets Högskolas bedömningsinstrument. En integrerad dataanalys står till grund för teman i studiens resultat. Resultat Patienter såväl som sjuksköterskor uppvisar beteende och attityder påverkade av stigma. Den stigmatiserade patienter upplever förminskande samt diskrimination i mötet med hälso-och sjukvårdspersonal vilket gör patientgruppen mindre benägen att söka vård. Hälso-och sjukvårdspersonal som stigmatiserar patienten har svårt att vårda patienten utifrån ett personcentrerat synsätt och upplever svårigheter att se hela patienten i mötet. Hälso-och sjukvårdspersonal med specialistkompetens inom området visar att mer kunskap är av hjälp i mötet med patienter, samt att kunskap leder till avstigmatisering. Mötet med specialister leder till trygghet för patienten som i sin tur vågar vara sig själv. Slutsats Mer kunskap om substansbrukssyndrom behövs hos grundutbildad hälso-och sjukvårdspersonal för att kunna möta patienten utifrån ett personcentrerat synsätt, fritt från stigma. / Background Patients suffering from substance use disorders tend to hold a high frequency of hospitalizations, due to trauma, psychiatric instability or physical damage associated with substance use. The patient often experiences stigmatization, from the community, nurses and other ward personne. The nurse holds responsibility to treat their patients with respect as well as exercise a person-centered ward to ensure the best possible care for their patients.  Aim The aim is to describe the encounter of patients suffering from substance use disorder and healthcare personnel.  Method The study was implemented with a non-systematic literature study, based on 15 scientific articles. The included articles are based on qualitative design. The data was collected during the autumn of 2021 from the databases PubMed and CINAHL, the search was made with boolean search combinations. The included articles have been quality reviewed according to the Sophiahemmet assessment instrument. Data Analysis was made with an integrated data analysis, which contributed to the themes presented in the result of the study. Results Patients as well as nurses exhibit behaviour and attitudes affected by stigma. The stigmatized patient experiences diminishing behaviour together with dicrimination when they meet healht-care providers, which makes them less prone to approach hospital care. Health-care providers, who stigmatize patients, experience difficulties in the exercise ward of a patient centered point of view. Professions with specialist competens, within substance use disorders, shows that more knowledge leads to destigmatizing. Conclusions Better knowledge about substance use disorders is needed within healthcare-providers to be able to provide care out of a person centered point of view, free from stigma, in the meet with patients suffering from substance use disorder.