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Patients with Substance Use Disorders An investigation of Relapse, Substance Use and Recovery
Norwegian University of Science and Technology, Faculty of Social Sciences and Technology Management, Department of Psychology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main purpose of the present thesis was to investigate contextual and psychosocial factors with potential importance for relapse, substance use and perceptions of treatment and recovery processes among patients with substance addiction. The thesis is based on two different data materials. Studies I, II and III are based on a cross-sectional survey investigation carried out among a patient sample (N = 352) recruited from 16 treatment facilities for substance use disorders in Norway. Study IV is based on material established by semi-structured interviews of 13 patients recruited from six clinics in the central region of Norway. The included treatment facilities covered the majority of common specialised treatment approaches for substance use disorders in Norway. Most of the treatment facilities carried out psychosocial treatment for poly-substance use, and included short-term inpatient treatment lasting up to six months, long-term inpatient treatment exceeding six months, as well as open-ended outpatient treatment and Opioid Maintenance Treatment (OMT). The clinics have a broad approach to substance use disorders; they include interventions based on, for instance, cognitive therapy, motivational interviewing, family therapy, milieu therapy, methadone or buprenorphine maintenance and interventions in a therapeutic community. Several clinics also offered opportunities for physical activity and advice regarding economic issues and accommodation. Some clinics also collaborated with public services in the municipalities to establish work-related activities for their patients.

The theoretical framework for the studies was stress models for substance use (i.e. the self-medication hypothesis and the life stress model). These models assert that substance use could be caused by psychological symptoms and social problems (i.e. psychosocial factors). The self-medication hypothesis argues that substance addiction is caused by a need to relieve psychological distress induced by psychological disorders. According to the life stress model of substance use, the probability of such use is regulated by the levels of stress experienced by the individuals and the presence of potential moderators such as social networks, social competence and resources. The behavioural choice theory for substance use was also relevant for the work in the present thesis. This theory argues that substance use and relapse could be interpreted as an overall lack of alternative rewarding activities to substance use. The behavioural choice theory asserts that substance use could be reduced or avoided by establishing competing activities to substance use such as occupational activities and education. Therefore, the studies also focused on contextual variables with potential importance for the everyday functioning of the individuals. Such variables could, for example, be occupational activities and social and material resources that the patients have at their disposal. Demographic characteristics, such as gender and age, were also considered relevant in this line of enquiry. However, it should be noted that the thesis did not specifically aim to validate these comprehensive theories and models. These theories and models constituted the theoretical basis and established the rationale for the empirical work. The thesis considers substance use disorders in a broad community psychological perspective. It was expected that the results would have implications both for clinical practice, aftercare strategies and preventive interventions.

Study I examined the time interval from treatment discharge to potential relapses among the patients. Contextual and psychosocial factors related to a prolonged or reduced time interval after treatment to a relapse were also explored. The findings suggested that the relapse risk was very high during the first months after treatment. The results also showed that adolescents had higher probabilities of early relapses compared to older patients. Patients who experienced an early relapse after treatment were more likely to be unemployed and to use opioids or alcohol as their main substances. Patients who had been enrolled in several different treatment programmes that used various approaches had higher likelihood of early relapse compared to patients who had only been enrolled in one type of treatment programme. Inpatient treatment of long and short durability increased the time period from treatment discharge to relapse. Aftercare and treatment follow-up strategies should focus on the period of time of the early months after treatment discharge. An adequate countermeasure would be to facilitate work-related and educational activities for the patients before they have completed treatment. Focus on risk perception regarding substance use among adolescents could reduce the relapse risk among this specific demographic risk group. Clinicians could facilitate internal motivation for treatment among these patients. The higher relapse risk of adolescents also underlines the importance of early intervention for this group.

Study II tested a hypothesised model where significant life events, interpersonal problems, psychological distress and self-efficacy predicted substance use. Differences in these associations according to gender were also examined. The results showed that both negative and positive life events had stronger relations to substance use behaviours among males. Psychological distress was strongly linked to substance use among both genders, but this relation was somewhat stronger among females. Interpersonal problems were associated with psychological distress, but a direct relation to substance use was not supported by the empirical data. The findings could justify the use of different clinical approaches when male and female patients are exposed to life stress. Male patients could benefit from learning adaptive behavioural coping strategies when they are confronted with major negative life events, whereas females could benefit from establishing or seeking out supportive social networks. The strong association between psychological distress and substance use implies that an increase in psychological competence of personnel in specialised treatment for substance use disorders could be beneficial.

The aim of study III was to examine whether patients with high or low consumption levels of illicit substances or alcohol differed on specific dimensions of psychosocial symptom load operationalised by the Symptom Checklist-90- Revised (SCL-90-R) and Inventory of Interpersonal Problems – Circumplex (IIPC). The findings showed that the prevalence of psychosocial symptom load was higher in the groups with high consumption levels of illicit substances or alcohol. Further, the results showed that these differences were stronger for those who manifested high consumption levels of illicit substances compared to those who mainly had high consumption levels of alcohol. Very few patients had a high consumption level of both alcohol and illicit substances; the reason could be that patients who have high consumption levels of illicit substances are subjected to more discrediting attitudes and attributes than patients who mainly manifest severe alcohol consumption. This partly stems from the legal status of alcohol and the fact that alcohol is often consumed in acceptable contexts by the general public (e.g. restaurant and pubs). There is also the fact that patients with high alcohol consumption had more available resources than patients who mainly used illicit substances to consider. Differences in psychosocial distress related to levels of alcohol consumption were stronger for anxiety disorders, whereas variations concerning illicit substances related to several heterogeneous psychosocial symptoms. This could indicate that the sedative effects of alcohol serve important functions for patients with anxiety disorders. Patients who use illicit substances may be more sensitive to a high variety of negative emotional symptoms. There were few differences related to interpersonal problems between the consumption groups. This underlines that the relation between interpersonal problems and substance use could be of an indirect character.

Study IV investigated contextual and psychosocial variables with potential relevance for how patients perceived processes related to treatment and recovery. Despite the fact that paper IV is located towards the end of the thesis, study IV was the first study conducted in the PhD project. Since this study indicated that contextual and psychosocial factors, such as therapeutic relations, social support and material resources, were important for patients' perceived recovery, the subsequent studies mainly focused on contextual and psychosocial variables in conjunction with relapse and substance use. Specifically, the results in paper IV showed that the patients focused on recovery in different domains related to psychological health, substance use, social functioning and the initiation of occupational activities. They also focused on the establishment of proper housing and economic improvements. The patients stressed the importance of therapeutic relationships and mutual support among patients in the clinics when they were asked about how they perceived processes related to treatment. They focused on the positive influences of trustful and respectful attitudes of the treatment personnel. According to the patients, treatment based in trust and respect between the caregivers and patients was important for the initiation of recovery processes. Both positive and negative influences of patient interactions were focused on by the patients. Patients reported that other patients at the clinics had convinced them to remain in the programmes when they were tempted to prematurely drop out or relapse to substance use. However, according to the patients who did not receive methadone or buprenorphine as part of their treatment, those who did receive methadone or buprenorphine had less motivation regarding the psychosocial components of the programme, and they felt that this negatively influenced the overall motivation in the whole group. Perhaps these patients should be treated separately.

In summary, the findings supported that both contextual and psychosocial variables relate to relapse, substance use and perceptions of treatment and recovery among patients who have manifested substance use disorders. A practical implication is that many of the interventions needed to facilitate recovery among patients with substance use disorders could take place at the community level rather than be solely conducted within the context of specialised treatment facilities. Because relapse after treatment discharge is common among these patients, programme developers and decision-makers should focus on measuresthat could reduce the relapse risk among these patients. In line with the behavioural choice theory, Community Reinforcement Approaches (CRA) aimed at facilitating alternative competing activities (e.g. work, education and physical activity) to substance use could reduce the relapse risk after treatment. In addition, clinicians could teach patients how to identify relapse-preceding cues based on the relapse prevention model (e.g. intra-psychological negative affect or substance using individuals from the patients’ social environment). Moreover, the present thesis hasidentified patterns in the time intervals from treatment discharge to relapse. Some of the specific risk groups for relapse were also identified and countermeasures to reduce the relapse rates within these groups have been suggested. Previous researchhas tended to focus on the importance of psychiatric diagnoses for relapsNotwithstanding the potential importance of such diagnoses, further research couldalso take contextual and psychosocial variables into account. The present work contributed to the current literature in that it also focused on variables related tsocial and material resources in relation to relapse, substance use and perceptionsof treatment and recovery processes. Moreover, the results supported potential gender differences in the life stress models of substance use, as negative life events solely predicted substance use among males. Future research should gearlongitudinal studies to investigate gender differences in the relations between lifeevents, psychosocial distress, self-efficacy and substance use over time. Suchstudies could provide further insights into the dynamics of relapse and recoveryprocesses of this patient group. The results also showed that the social relationshipsestablished in the treatment programmes are important for the patients. The study based on semi-structured interviews suggests that these relationships are an integral part of patients' motivation and persistence in treatment. Research in the future could focus on the social conditions within the clinics and relate these variables topatient outcomes.

Abstract [no]

Hovedformålet med denne avhandlingen var å undersøke psykososiale og kontekstuelle faktorer med potensiell betydning for tilbakefall, rusmiddelbruk og oppfatninger av behandlings- og bedringsprosesser hos pasienter med rusavhengighet. Avhandlingen er basert på to ulike datamaterialer. Studie I, II og III er basert på en tverrsnittsundersøkelse gjennomført blant et pasientutvalg (N =352) som ble rekruttert fra 16 behandlingsenheter for rusavhengighet i Norge. Studie IV er basert på et materiale etablert gjennom semi-strukturerte intervju av 13 pasienter som ble rekruttert fra seks behandlingsenheter i Midt-Norge. De inkluderte klinikkene dekket de fleste spesialiserte tverrfaglige behandlingstiltak for rusmisbruk i Norge. De fleste av disse klinikkene gjennomførte psykososiale behandlingstiltak for blandingsmisbruk og dekket korttidsbehandling i institusjon (inntil seks måneder), langtidsbehandling i institusjon (utover seks måneder), poliklinisk behandling og legemiddelassistert rehabilitering (LAR). Disse behandlingsenhetene benyttet en rekke ulike behandlingsmetoder som blant annet omfatter intervensjoner basert på kognitiv terapi, motiverende intervju, familieterapi, miljøterapi, vedlikeholdsbehandling og intervensjoner i terapeutiske samfunn. Flere av klinikkene tilbydde også rådgivning i forbindelse med økonomi og etablering av bolig. I tillegg jobbet flere av enhetene aktivt med kommunalt hjelpeapparat for å etablere arbeidsaktiviteter for pasientene etter behandling.

Det teoretiske rammeverket for undersøkelsene var stressmodeller utviklet for prediksjon av rusmiddelbruk. Blant disse er selv-medisineringshypotesen og livsstress-modellen sentrale bidrag. Disse modellene argumenterte for at rusbruk kan forstås som tiltak for å håndtere psykologiske symptomer og mellommenneskelige problemer (psykososiale faktorer). Selvmedisineringshypotesen argumenterte for at rusavhengighet forårsakes av behov for å lindre psykologisk stress som igjen blir forårsaket av underliggende psykiske lidelser. I følge livsstress-modellen blir sannsynligheten for rusbruk regulert av stressnivået til individene og eventuell tilstedværelse av modererende faktorer som for eksempel sosial støtte, sosial kompetanse og ressurser.

Teori knyttet til atferdsvalg og rusbruk var også relevante for undersøkelsene. Denne teorien fokuserte på at rusbruk og tilbakefall til rusbruk kan forstås som en mangel på alternative arenaer for mestring og belønning. Teorien argumenterer for at rusbruk kan reduseres eller unngås gjennom å etablere konkurrerende aktiviteter til rusbruk som for eksempel arbeids eller utdanningsaktiviteter. Studiene fokuserte derfor også på kontekstuelle variabler som kan være viktig for den daglige fungering for disse pasientene. Slike variabler kan for eksempel være yrkesrelaterte aktiviteter og materielle ressurser som pasientene har til rådighet. Demografiske variabler som kjønn og alder ble også vurdert som relevant innenfor dette rammeverket. Det er imidlertid viktig å notere seg at avhandlingen ikke hadde som formål å validere disse omfattende teoriene og modellene. Imidlertid utgjorde disse teoriene og modellene det teoretiske grunnlaget for det empiriske arbeidet. Avhandlingen anser rusavhengighet som en samfunnspsykologisk utfordring. Det var forventet at resultatene fra undersøkelsene ville ha implikasjoner både for klinisk praksis, ettervernsstrategier og tidlig intervensjon.

Studie I undersøkte tidsintervallet fra avsluttet behandling til tilbakefall blant pasientene. Kontekstuelle og psykososiale faktorer som økte eller reduserte dette tidsintervallet ble også utforsket. Funnene indikerte at risikoen for tilbakefall var svært høy i de første månedene etter behandling. I tillegg viste resultatene at ungdom hadde høyere sannsynlighet for tidlige tilbakefall sammenlignet med eldre pasienter. Pasienter som opplevde tidlige tilbakefall hadde høyere sannsynlighet for å være arbeidsledige, og høyere sannsynlighet for å bruke opioider eller alkohol som sine hovedrusmiddel. Pasienter som hadde en komplisert behandlingshistorikk med deltagelse i en rekke forskjellige behandlingsprogrammer tenderte til å ha tidligere tilbakefall enn pasienter som kun hadde deltatt i en type behandlingsprogram. Både kort- og langtids døgnbehandling var assosiert med en økt periode fra utskrivning til tilbakefall. Ettervernsstrategier og behandlingsoppfølging kan fokuseres spesielt inn mot de første månedene etter behandling. Et godt mottiltak kan være å initiere arbeids- og utdanningsrelaterte aktiviteter for pasientene før de forlater behandlingsenhetene. Økt fokus på risikopersepsjon knyttet til rusmiddelbruk kan redusere risikoen for tilbakefall blant ungdom. Klinikere kan forsøke å forsterke den indre motivasjonen for behandling hos disse pasientene. Den økte risikoen for tidlige tilbakefall blant yngre pasienter tyder også på at det kan være viktig med forbyggende virksomhet i kommunene.

Studie II undersøkte en teoretisk modell hvor signifikante livshendelser, mellommenneskelig og psykologisk stress og mestring (self-efficacy) predikerte rusbruk. Det ble også gjennomført undergruppeanalyser av disse sammenhengene blant menn og kvinner. Resultatene viste at både negative og positive livshendelser hadde sterkere relasjon til rusmiddelbruk blant menn. Psykiske plager var sterkt knyttet til rusmiddelbruk blant begge kjønn, men denne relasjonen var noe sterkere blant kvinnene i undersøkelsen. Mellommenneskelig stress var assosiert med psykiske plager, men en direkte relasjon til rusmiddelbruk ble ikke støttet av de empiriske data. Funnene kan rettferdiggjøre at det benyttes ulike kliniske tilnærminger når menn og kvinner med rusavhengighet blir konfrontert med stressende livshendelser. Mannlige pasienter kan ha nytte av å lære mer adaptive mestringsstrategier enn rusbruk når de blir eksponert for slike hendelser, mens kvinner kan dra større nytte av å etablere og oppsøke støttende sosiale nettverk. Den sterke relasjonen mellom psykologisk stress og rusbruk indikerer også et behov for å øke den psykologiske kompetansen i tverrfaglig spesialisert rusbehandling.

Formålet med studie III var å undersøke om pasienter med høyt eller lavt forbruk av illegale rusmidler eller alkohol rapporterte ulik symptombelastning på dimensjoner av psykososialt stress operasjonalisert i Symptom Checklist-90- Revised (SCL-90-R) og Inventory of Interpersonal Problems – Circumplex (IIP-C). Resultatene viste høyere forekomst av slik symptombelastning i gruppene som hadde høyt forbruk av slike rusmidler. I tillegg viste funnene at den overordnede forskjellen i symptomtrykk var sterkere for illegale rusmidler sammenlignet med pasienter som hovedsakelig hadde høyt forbruk av alkohol. Svært få pasienter hadde høyt forbruk av både illegale rusmidler og alkohol. En mulig årsak til disse resultatene kan være at pasienter som har et høyt forbruk av illegale rusmidler blir mer stigmatisert enn pasienter som primært har et høyt alkoholkonsum. En mulig årsak til dette er at alkohol er et legalt rusmiddel, og blir ofte konsumert i akseptable sammenhenger (for eksempel på restauranter og puber) blant den generelle befolkningen. Dette kan også henge sammen med at pasienter med høyere alkoholforbruk hadde mer kontekstuelle ressurser tilgjengelig enn pasienter som hovedsakelig hadde høyt forbruk av illegale rusmidler. Forskjellene i psykologiske symptomer knyttet til alkoholforbruk var sterkest for angstlidelser, mens forskjellene vedrørende illegale rusmidler var distribuert utover en rekke ulike symptomer. Dette kan tyde på at de beroligende effektene av alkohol har en viktig funksjon for pasienter med angstsymptomer. Pasienter som bruker illegale rusmidler synes å være sårbar for en rekke ulike emosjonelle symptomer. Det var få gruppeforskjeller knyttet til mellommenneskelige problemer, noe som styrker en antagelse om at mellommenneskelige vansker har en indirekte relasjon til rusbruk.

Studie IV undersøkte psykososiale og kontekstuelle faktorer knyttet til hvordan pasientene opplevde prosesser tilknyttet behandling av rusavhengighet. Det ble også fokusert på kontekstuelle og psykososiale faktorer knyttet til pasientenes bedringsprosesser. Selv om studie IV er plassert mot slutten av avhandlingen, så var dette den første studien som ble gjennomført i sammenheng med doktorgradsavhandlingen. Ettersom denne studien indikerte at kontekstuelle og psykososiale variabler, som for eksempel terapeutiske relasjoner, sosial støtte og tilgjengelige materielle ressurser, var viktig for pasientenes rehabilitering fokuserte de påfølgende studiene primært på kontekstuelle og psykososiale variabler i sammenheng med tilbakefall og rusbruk. Spesifikt viste resultatene at pasientene fokuserte på forbedringer innenfor en rekke problemområder som for eksempel psykisk helse, konsum av rusmidler og sosial fungering. Pasientene fokuserte også på å etablere arbeidsrelaterte aktiviteter, bolig og bedring av egen privatøkonomi. Den terapeutiske relasjon og den gjensidige støtten blant pasientene på behandlingsenhetene ble gjentatte ganger løftet fram når pasientene fortalte om hvilke kontekstuelle og psykososiale faktorer som var viktige under behandlingen. Pasientene hadde både positive og negative erfaringer med hvordan disse relasjonene påvirket deres behandlingsmotivasjon. På den ene siden fokuserte pasientene på de positive aspektene ved å bli møtt med en tillitsfull og respektfull holdning fra klinisk personell. I følge pasientene var dette endringsfremmende i seg selv. Pasientene rapporterte også at medpasienter hadde overtalt dem til å forbli i behandlingsopplegget når de ble fristet til tilbakefall eller til å avslutte behandlingen før den var fullført. På den andre side var det et sterkere negativt fokus blant pasienter som var i behandling sammen med personer som fikk metadon eller buprenorfin som en del av behandlingsopplegget. Pasienter som ikke mottok opiatsubstitutter fortalte at pasienter som mottok slike substitutter hadde mindre motivasjon for å delta i de psykososiale komponentene i behandlingsprogrammene. I følge pasientene som ikke mottok opiatsubstitutter påvirket dette den generelle motivasjonen og stemningen på klinikken i en negativ retning. En kan stille spørsmål om det å behandle disse pasientene innenfor samme system er en god strategi.

Oppsummert så understøttet funnene at både psykososiale og kontekstuelle variabler er relatert til tilbakefall, rusmiddelbruk og oppfatninger av behandlings og bedringsprosesser blant pasientene. En praktisk implikasjon er at intervensjoner som sikter mot å bedre pasientenes mestring av rusavhengighet også bør foregå i kommunene på samfunnsnivå, og ikke bare innenfor konteksten av spesialiserte kliniske enheter for rusmisbruk. Ettersom tilbakefall er vanlig blant denne pasientgruppen kan programutviklere og tilknyttet administrasjon se nærmere på tiltak som kan redusere risikoen for tilbakefall. I tråd med teorier om atferdsvalg så kan CRA-tilnærminger som sikter mot å etablere alternative konkurrerende aktiviteter til rusbruk (for eksempel arbeid og fysisk aktivitet) redusere risikoen for tilbakefall etter behandling. I tillegg kan klinikere forsøke å lære pasientene å identifisere både interne og eksterne signaler som kan øke sannsynligheten for tilbakefall i tråd med modeller for tilbakefallsprevensjon. Slike signaler kan for eksempel være negativ intra-psykologisk affekt eller spesielle personer i pasientens sosiale miljø. I tillegg har den foreliggende avhandlingen bidratt til å identifisere mønster i tidsintervallene fra utskrivning til tilbakefall blant pasientene, og noen av risikogruppene for tilbakefall er identifisert. Konkrete tiltak for å redusere tilbakefall blant disse risikogruppene er foreslått. Tidligere forskning har hatt en tendens til å overfokusere på betydningen av psykiatriske diagnoser for tilbakefall. Selv om disse diagnosene kan være sentrale for tilbakefall, bør videre forskning også ta i betraktning variabler tilknyttet konteksten som pasientene befinner seg i. Et annet bidrag til dette forskningsområdet er derfor at sosiale og materielle ressurser blant pasientene ble tatt i betraktning i tillegg til variabler knyttet til psykologisk og sosial fungering. Videre pekte resultatene i retning av at det kan foreligge kjønnsforskjeller i stressmodellene for rusbruk ettersom negative livshendelser kun predikerte rusbruk blant menn. Følgelig bør det initieres longitudinelle studier som undersøker kjønnsforskjeller i relasjonene mellom livshendelser, psykososialt stress, mestring og rusbruk over tid. Slike studier kan også gi bedre forståelse for dynamikken i tilbakefall og bedringsprosessene blant denne pasientgruppen. Resultatene viste også at de sosiale relasjonene innad i behandlingsprogrammene er viktige for pasientene. Resultatene fra studien som var basert på semi-strukturerte intervju tydet på at disse relasjonene er relevante for pasientenes behandlingsmotivasjon og persistens til å bli i behandlingsprogrammene. Videre forskning kan fokusere på variabler knyttet til sosiale forhold innad i klinikkene og knytte dette mot behandlingsutfall blant pasientene.

Place, publisher, year, edition, pages
Trondheim: NTNU , 2011.
Doctoral theses at NTNU, ISSN 1503-8181 ; 2011:166
URN: urn:nbn:no:ntnu:diva-13128ISBN: 978-82-471-2879-4OAI: diva2:438799
Public defence
2011-06-10, 00:00
Available from: 2011-09-05 Created: 2011-08-10 Last updated: 2011-09-05Bibliographically approved
List of papers
1. Relapse patterns among patients with substance use disorders
Open this publication in new window or tab >>Relapse patterns among patients with substance use disorders
2011 (English)In: Journal of Substance Use, ISSN 1465-9891, Vol. 16, no 4, 313-329 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to examine the time interval from treatment to relapse among patients with substance addiction. Some of the risk factors related to this interval were investigated. The sample (n = 352) was recruited from 16 substance addiction treatment facilities in four Norwegian counties. The respondents replied to a questionnaire either at waiting lists, when starting treatment, upon treatment completion or 3-12 months after treatment. Among these respondents, 160 patients had experienced a relapse after their prior treatment. Cox regression models showed that the relapse risk peaked during the first months after treatment. Older and employed patients had lower probabilities of early relapses. Patients who had an addiction pattern dominated by stimulants or cannabis had lower probabilities of early relapses compared with those who used opiates or alcohol. Inpatient treatment of short and long durability was associated with a longer time interval from treatment to relapse. Aftercare should be intensified during the first months after treatment. Treatment follow-up should be individually differentiated and target patients with higher risk of relapse. Interventions could aim to target adolescents and facilitate occupational activities for the patients before they leave the facilities.

Relapse pattern, psychological, Norwegian, substance addiction, patients
urn:nbn:no:ntnu:diva-13138 (URN)10.3109/14659890903580482 (DOI)000292839800007 ()
Available from: 2011-08-10 Created: 2011-08-10 Last updated: 2011-09-05Bibliographically approved
2. Interrelations Between Patients' Personal Life Events, Psychosocial Distress, and Substance Use
Open this publication in new window or tab >>Interrelations Between Patients' Personal Life Events, Psychosocial Distress, and Substance Use
2010 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 45, no 7-8, 1161-1179 p.Article in journal (Refereed) Published
Abstract [en]

This study investigated interrelations between life events, psychosocial distress, self-efficacy, and substance use among patients manifesting substance use disorders. Gender differences in these interrelations were also explored. Patients (N = 352) were recruited during 2008 and 2009 from 16 Norwegian facilities. These patients completed a questionnaire with validated measurement instruments. Interrelations were investigated by SEM analysis. The results suggested that negative life events facilitated substance use and psychological distress. Positive life events were associated with self-efficacy, but weakly related to substance use. The results supported the notion that males are more prone to use substances when faced upon negative life events.</.

life events, interpersonal problems, psychological distress, self-efficacy, gender, substance addiction
urn:nbn:no:ntnu:diva-13134 (URN)10.3109/10826080903567863 (DOI)000277307200010 ()
Available from: 2011-08-10 Created: 2011-08-10 Last updated: 2011-09-05Bibliographically approved
3. Do severity levels of substance use relate to self-reported variations in psychosocial distress?
Open this publication in new window or tab >>Do severity levels of substance use relate to self-reported variations in psychosocial distress?
2011 (English)In: Journal of Substance Use, ISSN 1465-9891, Vol. 16, no 6, 422-438 p.Article in journal (Refereed) Published
urn:nbn:no:ntnu:diva-13139 (URN)10.3109/14659891.2010.495444 (DOI)
Available from: 2011-08-10 Created: 2011-08-10 Last updated: 2012-02-03Bibliographically approved
4. Treatment and recovery as perceived by patients with substance addiction.
Open this publication in new window or tab >>Treatment and recovery as perceived by patients with substance addiction.
2010 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 17, no 1, 46-64 p.Article in journal (Refereed) Published
Abstract [en]

Social relations to therapists and other patients in treatment are important for positive and negative experiences among patients with substance addiction. * Improvements in mental health and substance use were considered as the more important areas of recovery among these patients. * One of the core reasons for premature dropout could be a failure to establish positive social relations and temptations to relapse to substance use. Abstract Research concerning patients with substance addiction and how they perceive their treatment remains scant. The objective of this study was therefore to examine positive and negative perceptions of treatment and recovery from the perspectives of these patients. Data were collected with semi-structured interviews among seven patients who completed treatment and six patients who prematurely dropped out from their programme (n= 13). Patients were strategically sampled from five inpatient facilities and one outpatient opioid maintenance treatment clinic located in two Norwegian counties. All interviews were transcribed and thereafter analysed with contextual content analysis aided by the qsr nvivo 8.0 software. This was carried out to obtain information about the manifest positive and negative content in the interviews. The results showed that the therapeutic alliance and mutual influences among patients were important for perceptions of treatment. Frequent staff turnover also related to these perceptions. The more important domains of recovery were psychosocial functioning and substance use. The implications of the results were discussed in relation to clinical practice and further research.

urn:nbn:no:ntnu:diva-13131 (URN)10.1111/j.1365-2850.2009.01477.x (DOI)20100306 (PubMedID)
Available from: 2011-08-10 Created: 2011-08-10 Last updated: 2011-09-05Bibliographically approved

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