Tesi: "Heroin dependence"

1

Scott, Anna Basich. "Initiation of intravenous heroin use : symbolic meaning of the first time /". Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/7232.

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2

Mills, Katherine Public Health &amp Community Medicine Faculty of Medicine UNSW. "Post traumatic stress disorder among people with heroin dependence". Awarded by:University of New South Wales. Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/23339.

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Comorbidity between substance use disorders and post traumatic stress disorder (PTSD) is common. Despite evidence to suggest that people with heroin dependence are at particular risk of PTSD, there is a dearth of research focussing on the interrelationship between these disorders. The present thesis aims to identify the prevalence of PTSD among people with heroin dependence, the correlates of this comorbidity, and its impact on treatment outcomes, the utilisation of treatment services, and treatment costs. Study 1 examines the epidemiology of PTSD and heroin dependence among 10,641 Australian adults who participated in the National Survey of Mental Health and Wellbeing. The prevalence of PTSD was highest among people with heroin or other opioid use disorders compared with any other drug class (33.2%). Comorbid PTSD was associated with poorer occupational functioning, and poorer physical and mental health. While general population studies provide crucial population estimates they do not allow for a detailed examination of the relationship between highly disabling but low prevalence disorders. The remaining studies were undertaken using a sample of 615 treatment seeking and non-treatment seeking dependent heroin users. Study 2 examines the prevalence and correlates of this comorbidity. PTSD was common (lifetime 41%; current 31%) and was associated with a more severe clinical profile. Studies 3 and 4 were based on follow-up data on this large cohort. Study 3 is the first study to examine the impact of PTSD on 2 year treatment outcomes for heroin dependence. Across the 2 year period, those with current PTSD at baseline performed more poorly in terms of their occupational functioning, physical and mental health. Study 4 found that this did not equate to the greater use of treatment services or an increased cost to the health care system among those with PTSD. It is concluded that PTSD and heroin dependence are highly comorbid conditions, and that this comorbidity is associated with poorer functioning and poorer treatment outcomes. Individuals entering treatment for heroin dependence should be assessed for PTSD so that they may receive appropriate treatment and referral. Further research is also needed to determine how best to treat this comorbidity.

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3

Shaw, Elizabeth H. "An exploration of the process of recovery from heroin dependence". Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:4910.

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This review aimed to collate information regarding the psychological and sociological factors that contribute to recovery from heroin dependence. Systematic searches (manual and electronic) using the databases PsychInfo, PsychArticles, Medline, CINAHL, Scopus and Web of Science were undertaken. Six themes were identified: the role of social factors in the engagement of heroin users with services, psycho-social factors associated with motivation to stop heroin use, the role of motivation in achieving abstinence from heroin, the role of confidence/self-efficacy in reduction of heroin consumption, coping strategies and heroin abstinence and the theme of how social factors aid the transition from addict to non-addict identity. The development of non-drug using relationships and coping strategies was associated with abstinence from heroin, identifying points for intervention by drug treatment services. Self-confidence for remaining abstinent from heroin at admission to treatment was found to be un-related to heroin use following treatment. Confidence surrounding cessation of heroin use was dependent on receiving substitution medication. Drug services may play an important role in increasing past heroin users‟ self-efficacy with regard to living without heroin and substitution treatment. Throughout the literature, „recovery‟ was viewed as engagement with services and abstinence from heroin use. It seemed that this conceptualization of recovery was inconsistent with that provided by the latest government policy and that more research is required to discover how people receiving MMT and people working in drug services view recovery from heroin dependence.

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4

Zarnegar, Parisa. "In vitro and postmortem studies of the brain opioid system: association to opiate dependence /". Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-904-1/.

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5

Leung, Wai-hing Frances, e 梁慧卿. "An exploratory study of factors leading to alcohol dependence among treated heroin addicts". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1993. http://hub.hku.hk/bib/B31249504.

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6

Leung, Wai-hing Frances. "An exploratory study of factors leading to alcohol dependence among treated heroin addicts /". [Hong Kong : University of Hong Kong], 1993. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13744707.

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7

Walmsley, Clarey J. "Factors associated with opiate dependence : an interaction of cognitive, genetic and psychosocial influences on acquisition and outcome /". St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17744.pdf.

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8

Metrebian, Nicola. "Influences on the prescribing of heroin for the treatment of opiate dependence in the United Kingdom". Thesis, Imperial College London, 2005. http://hdl.handle.net/10044/1/8267.

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9

Brooks, Victoria Louise. "The role of Injectable Opiate Treatment in the patient's journey of recovery from entrenched heroin dependence". Thesis, King's College London (University of London), 2016. https://kclpure.kcl.ac.uk/portal/en/theses/the-role-of-injectable-opiate-treatment-in-the-patients-journey-of-recovery-from-entrenched-heroin-dependence(a3f3b96b-26dc-4b23-ae65-8fe16916840b).html.

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Background: Supervised Injectable Opiate Treatment (IOT) is a complex, intensive treatment modality that has been effective in treating long-term, chronic, previously treatment refractory heroin users. The mechanisms that make it an effective treatment modality are little explored, and never in a UK context. Aims: In a UK supervised IOT context, this thesis set out to describe the long-term treatment trajectory of patients receiving IOT. Additional aims were to describe the experience of patients receiving IOT and ascertain the role of IOT in the patient’s overall journey of recovery. In so doing, the thesis contributes to the scientific understanding of IOT. Method: Quantitative measures are employed to describe treatment process and the effect of treatment duration on outcome. Qualitative measures are utilised to describe the following: patients’ drug use and treatment histories; goals for, motivations, and expectations of IOT; experience with IOT; satisfaction with IOT; views on the impact of IOT; and views of, and goals for, patients’ recovery. Results: Quantitative findings illustrate that some participants remained in IOT long-term, whereas others discharged or moved back on to oral treatment modalities. When long-term IOT was undertaken, initial gains made were sustained. Qualitative findings illustrate that patients conceive effective IOT as flexible, psychosocial, person-centred, and encompasses autonomous ongoing support. Recovery is perceived as an ongoing, individualised journey, and the need for support following both IOT and abstinence are identified. Discussion: Strengths and limitations of the research are discussed. IOT is best delivered as an individualised, time-limited, goal-driven, flexible treatment programme for those entrenched users with long-term, treatment refractory histories. Numerous findings have utility for policy and clinical practice and there is scope for examination of individually tailored treatment programmes through further research and, a systematic exploration of longitudinal outcomes.

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10

Williamson, Anna Public Health &amp Community Medicine Faculty of Medicine UNSW. "The effect of cocaine use on outcomes for the treatment of heroin dependence in Sydney, Australia". Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2005. http://handle.unsw.edu.au/1959.4/24973.

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This thesis explored the effect of cocaine use on treatment outcomes for heroin dependent individuals in Sydney, Australia. A naturalistic, longitudinal design was employed in order to examine the effects of cocaine on outcomes over a two year period. Study 1 assessed the prevalence and correlates of cocaine use among heroin dependent individuals. Cocaine use was found to be common among entrants to all three of the major treatment modalities in NSW. Heroin users who also used cocaine (CU) displayed a poorer clinical profile at baseline than non-cocaine users (NCU), reporting higher levels of drug use and dependence, and a greater prevalence of needle risk-taking and criminal behaviour. Study 2 examined outcomes three months post-study entry. CU and NCU were found to have been equally well retained in treatment. Despite significantly reduced levels of cocaine use amongst the cohort, however, CU continued to display the higher levels of drug-related harm that characterized them at baseline. In order to determine whether cocaine use itself was responsible for the greater levels of harm observed amongst CU, or whether instead CU were an inherently more dysfunctional group for whom cocaine use merely served as a marker, comparisons were made within groups on the basis of cocaine use patterns over the study period. The results of these analyses demonstrated that commencing cocaine use resulted in a clear decline in functioning, whereas cessation resulted in corresponding improvements. In Study 3 outcomes were examined twelve months post-study. Baseline cocaine use was again found to predict poorer outcome, despite a large scale reduction in cocaine use amongst the cohort. Importantly, CU were significantly less likely than NCU to be abstinent from heroin at twelve months and more likely to have been incarcerated since study entry. In addition, the effect of persistence of cocaine use was examined. Results indicated that the harms associated with cocaine use increased with increasing persistence of use. Outcomes at two years post-study entry were explored in Study 4. At this time CU and NCU recorded similar outcomes in most domains. Thus, it appeared that the harms caused by cocaine use may take a substantial period of time to diminish. Patterns of cocaine use and motivations for cessation and commencement were also examined. Responses suggested that cocaine use amongst the cohort was largely opportunistic, with participants ceasing use for a variety of reasons, including the financial and psychological problems caused by cocaine use. Past year prevalence of cocaine dependence was measured in this study, with the majority of those who had used cocaine in the past year meeting criteria for dependence. In Study 5, generalized estimating equations were used to measure the effect of baseline cocaine use on major outcome variables over the entire two year study period. Even after controlling for treatment variables, heroin use and other baseline polydrug use, the results of this study confirmed previous findings within the thesis by demonstrating the negative effect of baseline cocaine use on most outcome variables. Evidently, cocaine use among dependent heroin users has serious, long lasting, consequences. To date, however, there has been a stark lack of research examining the effect of cocaine use on treatment outcomes for heroin dependence. To that end, the results of this thesis are encouraging, suggesting that treatment for heroin dependence may also aid in reducing cocaine use among this group.

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11

Bain, Katherine Alison. "Chased by the dragon the experience of relapse in cocaine and heroin users /". Diss., Pretoria : [s.n.], 2004. http://upetd.up.ac.za/thesis/available/etd-10192004-100341.

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12

Wittchen, Hans-Ulrich, Sabine M. Apelt, Michael Soyka, Markus Gastpar, Markus Backmund, Jörg Gölz, Michael R. Kraus et al. "Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in 2694 patients". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-110756.

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Background: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs). Objectives: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings. Methods: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N= 2694 maintenance patients, recruited from a nationally representative sample of N= 223 substitution physicians. Results: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates. Conclusion: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.

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13

Soyka, Michael, Jens Strehle, Jürgen Rehm, Gerhard Bühringer e Hans-Ulrich Wittchen. "Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample". Karger, 2017. https://tud.qucosa.de/id/qucosa%3A71616.

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Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term studies have been performed, but little is known about long-term effects. Therefore, this study described over 6 years (1) mortality, retention and abstinence rates and (2) changes in concomitant drug use and somatic and mental health. Methods: A prevalence sample of n = 2,694 maintenance patients, recruited from a nationally representative sample of n = 223 substitution doctors, was evaluated in a 6-year prospectivelongitudinal naturalistic study. At 72 months, n = 1,624 patients were assessed for outcome; 1,147 had full outcome data, 346 primary outcome data and 131 had died; 660 individuals were lost to follow-up. Results: The 6-year retention rate was 76.6%; the average mortality rate was 1.1%. During follow-up, 9.4% of patients became “abstinent” and 1.9% were referred for drug-free addiction treatment. Concomitant drug use decreased and somatic health status and social parameters improved. Conclusions: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists. In the long term, the number of opioid-free patients is low and most patients are more or less continuously under opioid maintenance therapy. Further implications are discussed.

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14

Wittchen, Hans-Ulrich, Sabine M. Apelt, Michael Soyka, Markus Gastpar, Markus Backmund, Jörg Gölz, Michael R. Kraus et al. "Feasibility and outcome of substitution treatment of heroin-dependent patients in specialized substitution centers and primary care facilities in Germany: A naturalistic study in 2694 patients". Technische Universität Dresden, 2008. https://tud.qucosa.de/id/qucosa%3A26834.

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Abstract (sommario):

Background: In many countries, buprenorphine and methadone are licensed for the maintenance treatment (MT) of opioid dependence. Despite many short-term studies, little is known about the long-term (12-month) effects of these treatments in different settings, i.e. primary care-based (PMC) and specialized substitution centers (SSCs). Objectives: To describe over a period of 12 months: (1) mortality, retention and abstinence rates; (2) changes in concomitant drug use, somatic and mental health; and (3) to explore differences between different types of provider settings. Methods: 12-Month prospective-longitudinal naturalistic study with four waves of assessment in a prevalence sample of N= 2694 maintenance patients, recruited from a nationally representative sample of N= 223 substitution physicians. Results: The 12-month retention rate was 75%; the mortality rate 1.1%. 4.1% of patients became “abstinent” during follow-up. 7% were referred to drug-free addiction treatment. Concomitant drug use decreased and somatic health status improved. No significant improvements were observed for mental health and quality of life. When controlling for initial severity, small PMC settings revealed better retention, abstinence and concomitant drug use rates. Conclusion: The study underlines the overall 12-month effectiveness of various forms of agonist MT. Findings reveal relatively high retention rates, low mortality rates, and improvements in most 12-month outcome domains, except for mental health and quality of life. PMC settings appear to be a good additional option to improve access to MTs.

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15

LaForge, Karl Steven. "Preproenkephalin Gene and mRNA : Studies of Structure, Function, Cocaine Responses in an Animal Model, and Genetic Association with Human Opiate Addiction". Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4013.

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16

Frick, Ulrich, Jürgen Rehm, Daniele Zullino, Manrique Fernando, Gerhard Wiesbeck, Jeannine Ammann e Ambros Uchtenhagen. "Long-Term Follow-Up of Orally Administered Diacetylmorphine Substitution Treatment". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-133129.

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Background: To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Design: Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. Results: Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. Conclusions: Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

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17

Frick, Ulrich, Jürgen Rehm, Daniele Zullino, Manrique Fernando, Gerhard Wiesbeck, Jeannine Ammann e Ambros Uchtenhagen. "Long-Term Follow-Up of Orally Administered Diacetylmorphine Substitution Treatment". Karger, 2010. https://tud.qucosa.de/id/qucosa%3A27490.

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Abstract (sommario):

Background: To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. Design: Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. Results: Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. Conclusions: Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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18

Woods, Sally C. "Heroin and methadone substitution treatments : harm reduction and the effectiveness of 'flexible' prescribing for the treatment of opioid dependency". Thesis, Liverpool John Moores University, 2005. http://researchonline.ljmu.ac.uk/5852/.

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In the mid 1990's the UK government began to focus on problem heroin use mainly as a drug related crime issue, and so attracting and retaining clients became a treatment priority. The concept of flexible prescribing, matching individual clients to treatment programmes appropriate to their drug using history and circumstances, began to gain support amongst politicians and clinicians. As part of this shift in emphasis, prescribing heroin to heroin addicts re-emerged as a treatment option. Injectable (and smokable) diamorphine (pharmaceutical heroin) began to be prescribed in a small number of drug dependency units under the direction of local psychiatrists, including two in North West England. One hundred and thirty three registered drug users were interviewed between August 1995 and February 1997 using a structured questionnaire. Three key areas and their association with heroin substitution prescribing were addressed; levels of criminal activity, levels of illicit drug use, and a range of client held perceptions and attributions regarding coping/quality of life. The mean age of the sample was 30 years, and 75% were male. 61% had used illicit heroin in the past month, spending on average £638, on a habit of 4g per week. Clients were subdivided on a number of variables and comparisons were made between groups according to (IV) prescription type (which drug), and form (injectable/smokable/oral mixture). Significant differences were found across each of three key variables, including differing levels of illicit drug use according to prescription form, and differing levels of specific criminal activity according to prescription type. Significant effects included; Clients on prescriptions which included ampoules were significantly more likely to report being able to cope with life, and spent significantly less time on drug taking activities, than those clients receiving other prescriptions. Clients on prescriptions which included `reefers' (smokable) reported significantly less shop lifting than clients receiving other prescriptions. It was concluded that the available empirical evidence regarding heroin prescribing is limited, and although some clinicians are yet to be convinced, it seems heroin does have its merits as a viable treatment option. Issues of cost and possible dispersion remain, and are discussed in relation to the continuing development of substitution treatment policy in the UK.

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19

Magrath, Steven Matt. "Medication Assisted Treatment and the Three Legged Stool: Medical Providers, Chemical Dependency Professionals, and Clients". Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1472903728.

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20

Dagher, Hoda. "La dépendance à l'héroïne dans ses dimensions générationnelles et transgénérationnelles". Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE2014/document.

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La dépendance à l’héroïne pose des problèmes graves, vu sa propagation parmi les jeunes et son lien avec l’autodestruction, la transgression et la délinquance. Depuis des années, les perspectives psychanalytiques et systémiques, malgré leurs différences conceptuelles, se rejoignent sur l’importance des facteurs familiaux chez les jeunes qui développent des conduites de dépendance à une substance, notamment l’héroïne. La dépendance à l’héroïne semble comporter une prévalence de familles dysfonctionnelles avec des mandats familiaux destructurants, des carences ou des excès dans les fonctions maternelles, des défaillances majeures des fonctions paternelles, ainsi que des conflits familiaux et parentaux, dont les causes dépassent le présent et trouvent leurs racines dans des transmissions transgénérationnelles. Les comportements de dépendance perçus sous l’angle du générationnel et du transgénérationnel n’ont pas été étudiés dans l’expérience libanaise. Il nous semble que les jeunes libanais dépendants à l’héroïne tentent de résoudre, à travers des prises de drogue, une dépendance qui les relie à un passé envahissant et reflète par leur dépendance des histoires familiales, non résolues, qui se répètent d'une génération à une autre. De ce fait, discerner les problématiques de la dépendance à l’héroïne au Liban, étudier le rôle central des relations précoces que vivent les héroïnomanes et mettre en évidence les caractéristiques transgénérationnelles du génogramme familial, peuvent fournir des pistes importantes dans le discernement des pathologies de l’addiction et permettent aussi de mieux viser les interventions thérapeutiques
Addiction to Heroin poses serious problems, given its spread among the youth and its relationship to self-destruction, transgression and crime.For years, and despite their conceptual differences, psychoanalytic and systemic perspectives concur on the importance of family related factors in young people who develop addictive behaviors to substances, including Heroin.Addiction to Heroin appears to be prevalent in dysfunctional families where parenting roles are destructive, the maternal functions being deficient or excessive and the paternal functions showing major failures, as well as familial and parental conflicts that can be traced to causes that are beyond the present and rooted in transgenerational transmission.Addictive behaviors seen under the generational and transgenerational angles have not been studied in the Lebanese experience. It seems to us that the Lebanese youth addicted to Heroin are trying to resolve, through their drug intake, a dependency that is connected to a pervasive past and is reflective of an unresolved family history which repeats itself from one generation to another.Thereby discerning the problematics of Heroin addiction in Lebanon, examining the central role of early relationships experienced by heroin addicts, and highlighting the generational characteristics of the family genogram can provide important clues in understanding the addiction’s pathologies and also allow a better targeting of therapeutic interventions

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21

Fonseca, Casals Francina. "Pharmacogenomic study of oppioid addicts in methadone treatment / Francina Fonseca Casals". Doctoral thesis, Universitat Pompeu Fabra, 2010. http://hdl.handle.net/10803/7234.

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Abstract (sommario):

Although the well established efficacy of methadone maintenance treatment (MMT) in the opioid dependence disorder, there is a group of patients that are poor responders. The study of the influence of methadone pharmacodynamics and pharmacokinetics in dose requirements and program outcome remains still controversial. The aim of this dissertation is to study the pharmacodynamic and pharmacokinetic factors involved in the methadone maintenance treatment efficacy.
The study recruited opioid dependence patients (DSM-IV criteria) from a MMT community program. Patients were clinically assessed and blood samples were obtained in order to evaluate methadone plasma concentrations of (R,S)-, (R) and (S)- methadone. Allelic variants of genes encoding the following proteins were assessed: BDNF, OPRM1, MYOCD, mGluR6, mGluR8, CRY1, NR4A2, 1q31.2 (rs965972), 2q21.2 (rs1867898), CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19 and P-glycoprotein. Responders and non-responders were defined by means of illicit opioid consumption detected in random urinalyses.
Differences in response status were found depending on different single nucleotide polymorphisms (SNPs of genes encoding for BDNF, MYOCD and GRM6. The CYP2D6 metabolizing phenotype was associated with response to MMT, and also with methadone dosage requirement and methadone plasma concentrations.
Els programes de manteniment amb metadona (PMM) han demostrat eficàcia en el tractament del trastorn per dependència d'opiacis malgrat la persistència de pacients amb mala resposta al tractament. L'estudi dels factors farmacodinàmics i farmacocinètics implicats en la resposta terapèutica ofereix resultats controvertits. L'objectiu de la tesi doctoral que es presenta és estudiar els factors farmacodinàmics i farmacocinètics de la metadona que poden estar implicats en l'eficàcia del tractament. S'han inclòs pacients ambulatoris diagnosticats de trastorn per dependència d'opiacis (segons criteris DSM-IV) en PMM. Els pacients s'han avaluat a nivell clínic i s'han obtingut mostres de sang per a l'estudi de les concentracions plasmàtiques de (R,S)-, (R) i (S)- metadona. S'han estudiat també les variants al·lèliques dels gens que codifiquen per: BDNF, OPRM1, MYOCD, mGluR6, mGluR8, CRY1, NR4A2, 1q31.2 (rs965972), 2q21.2 (rs1867898), CYP3A5, CYP2D6, CYP2B6, CYP2C9, CYP2C19 i P-glicoproteïna. La mostra s'ha dividit en responedors i no responedors en funció del nombre de controls d'orina positius per a heroïna en analítiques realitzades de forma aleatòria.
Es van detectar diferències en resposta al tractament segons les variants dels gens codificants per a BDNF, MYOCD i GRM6. També es va detectar una associació entre el fenotip de CYP2D6, la resposta al tractament, la dosi requerida de metadona i les concentracions plasmàtiques.

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22

Santos, Monika Maria Lucia Freitas dos. "Defeating the dragon: Heroin dependence recovery". Thesis, 2006. http://hdl.handle.net/10500/2369.

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Abstract (sommario):

Heroin dependence, which is escalating within South Africa, has become a symbol of the social disorder of the times - associated with materialism, poverty, crime, the problems of a society in transition, the disadvantaged, and the inner cities. However, that is not to say that all those who misuse heroin develop a problem or become dependent. In reality, only a small minority of heroin users develop a dependence, but for those who do it can result in unpleasant and potentially terrifying experiences/consequences, that can often be extremely difficult to escape from. That is not to say that recovery from dependence to heroin is not possible. Indeed, contrary to the beliefs of many people, the reality is that many people do eventually recover. Despite the vast sums of money devoted to treatment intervention of heroin dependants in the South Africa and worldwide, the processes by which recovery occur remain fairly unclear. Moreover, relatively little is known about the contribution of interventions and processes in facilitating such recovery. The statistical and content analysis of the data revealed that one of the most important factors identified in allowing successful behaviour modification and promoting recovery was psychosocial and pharmacological intervention, which seemed to produce a range of positive effects that facilitated natural healing processes. However, a range of other factors alongside intervention were also important in promoting behaviour modification. This study has provided important information, from forty recovering heroin dependants themselves, on the many factors that are important in achieving abstinence, in allowing recovery to be maintained in the longer term, and in potentially allowing an eventual exit from heroin dependence. A number of difficulties encountered in intervention were also identified. The statistical findings of the study support the `maturing out' hypothesis of heroin dependence (c² = 16.841; r = 0.001; df = 3). Ethnicity, highest level of education, employment status, marital status, biological parents' marital status or whether biological parents were deceased or not did not relate to any of the identified behavioural indices associated with heroin dependence recovery. A framework for the development of a contextual heroin dependence recovery model is also discussed.
Psychology
(M.A.(Psychology))

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23

"Prediction of heroin dependence and its treatment outcome by receptor gene polymorphisms and cold-pressor test: a case/control association study". 2006. http://library.cuhk.edu.hk/record=b5892888.

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Abstract (sommario):

Ho Man Choi.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (leaves 178-215).
Abstracts and appendices in English and Chinese.
ACKNOWLEDGEMENT --- p.ii
ABSTRACT --- p.iii
研究摘要 --- p.vi
Chapter CHAPTER 1 --- INTRODUCTION
Chapter 1.1. --- Heroin --- p.1
Chapter 1.1.1. --- Manufacture --- p.1
Chapter 1.1.2. --- Administration --- p.2
Chapter 1.1.3. --- Physical and Psychological Effects --- p.4
Chapter 1.1.4. --- Heroin Metabolism --- p.5
Chapter 1.1.5. --- Treatments for Heroin Dependence --- p.6
Chapter 1.2. --- Opioids and Analgesia --- p.8
Chapter 1.2.1. --- Pain Transmission --- p.8
Chapter 1.2.2. --- Pain Modulation and Endogenous Opioid System --- p.9
Chapter 1.2.3. --- Clinical Application of Opiates in Pain Management --- p.11
Chapter 1.2.4. --- Narcotics and Pain --- p.11
Chapter 1.3. --- Biological Basis of Drug Addiction --- p.12
Chapter 1.3.1. --- Mesocorticolimbic Reward System --- p.13
Chapter 1.3.2. --- Molecular Neurobiology of Drug Addiction --- p.16
Chapter 1.3.2.1. --- "Cyclic Adenosine-3',5'-Monophosphate and Protein Kinase A" --- p.16
Chapter 1.3.2.2. --- Transcription Factors: cAMP-Response Element Binding Protein and Delta-Fos B --- p.18
Chapter 1.3.2.3. --- Neurotrophic Factors --- p.23
Chapter 1.4. --- Biological Basis of Relapse --- p.25
Chapter 1.4.1. --- Environmental Stimuli --- p.26
Chapter 1.4.2. --- Drug Re-exposure/Priming --- p.26
Chapter 1.4.3. --- Acute Stress Exposure --- p.27
Chapter 1.5. --- Gene Polymorphisms and Opioid Dependence --- p.30
Chapter 1.5.1. --- Opioidergic System --- p.31
Chapter 1.5.2. --- Dopaminergic System --- p.36
Chapter 1.5.3. --- Serotoninergic System --- p.41
Chapter 1.5.4. --- Noradrenergic System --- p.43
Chapter 1.5.5. --- GABAergic System --- p.44
Chapter 1.6. --- Aim of Research --- p.45
Chapter CHAPTER 2 --- METHODS OF STUDY
Chapter 2.1. --- Subject Recruitment and Demographic Data Collection --- p.49
Chapter 2.1.1. --- Heroin-dependent Subjects --- p.49
Chapter 2.1.1.1. --- Phenotype Assessment --- p.49
Chapter 2.1.1.2. --- Socio-demographics Data and Substance Use History --- p.50
Chapter 2.1.1.3. --- Addiction Severity Index (ASI) --- p.51
Chapter 2.1.1.4. --- History of Detoxifications and Relapse --- p.51
Chapter 2.1.2. --- Control Subjects --- p.51
Chapter 2.2. --- Pain Response Assessment using Cold-Pressor Test (CPT) --- p.52
Chapter 2.3. --- Personality Trait Assessment --- p.53
Chapter 2.4. --- Genotype Analysis --- p.55
Chapter 2.4.1. --- DNA Extraction --- p.55
Chapter 2.4.2. --- Genotyping --- p.56
Chapter 2.4.2.1. --- MORA118G --- p.56
Chapter 2.4.2.2. --- DOR T921C --- p.56
Chapter 2.4.2.3. --- COMTVal108/158Met --- p.57
Chapter 2.4.2.4. --- Prodynorphin 68bp-VNTR --- p.58
Chapter 2.4.2.5. --- DRD2 TaqI A --- p.59
Chapter 2.4.2.6. --- DRD4 -521C/T --- p.59
Chapter 2.4.2.7. --- 5HT1B G861C --- p.60
Chapter 2.5. --- Saliva Collection and Salivary Cortisol Measurement --- p.61
Chapter 2.6. --- Statistical Analysis --- p.62
Chapter CHAPTER 3 --- RESULTS
Chapter 3.1. --- Demographics --- p.64
Chapter 3.1.1. --- Age --- p.64
Chapter 3.1.2. --- Ethnicity --- p.64
Chapter 3.1.3. --- District of Residence and Type of Housing --- p.64
Chapter 3.1.4. --- "Education, Employment and Income" --- p.68
Chapter 3.1.5. --- ASI Scores --- p.71
Chapter 3.1.5.1. --- Family/Social Relationship --- p.71
Chapter 3.1.5.2. --- Employment and Support Status --- p.73
Chapter 3.1.5.3. --- Medical Status --- p.73
Chapter 3.1.5.4. --- Legal Status --- p.75
Chapter 3.1.5.5. --- Psychiatric Status --- p.75
Chapter 3.1.5.6. --- Drug Use Status --- p.76
Chapter 3.1.5.7. --- Alcohol Use Status --- p.79
Chapter 3.1.6. --- Tranquillizer Use Status --- p.79
Chapter 3.1.7. --- Smoking Status --- p.81
Chapter 3.1.8. --- Detoxification and Relapse --- p.83
Chapter 3.2. --- Cold-Pressor Test (CPT) --- p.88
Chapter 3.3. --- Personality Traits --- p.90
Chapter 3.3.1. --- NEO PI-R --- p.90
Chapter 3.3.2. --- BIS/BAS --- p.93
Chapter 3.3.3. --- SSS-V --- p.93
Chapter 3.4. --- Salivary Cortisol Levels --- p.93
Chapter 3.5. --- Genotype and Allele Frequencies of Gene Polymorphisms --- p.96
Chapter 3.5.1. --- MOR A118G Polymorphism --- p.96
Chapter 3.5.2. --- DOR T921C Polymorphism --- p.96
Chapter 3.5.3. --- COMT Val108/158Met Polymorphism --- p.99
Chapter 3.5.4. --- Prodynorphin 68bp-VNTR --- p.99
Chapter 3.5.5. --- DRD2 TαqI A Polymorphism --- p.102
Chapter 3.5.6. --- DRD4 -521C/T Polymorphism --- p.102
Chapter 3.5.7. --- 5HT1B G861C Polymorphism --- p.105
Chapter 3.6. --- "Association of Gene Polymorphisms, Personality Traits and CPT" --- p.105
Chapter 3.7. --- Association of Gene Polymorphisms and CPT --- p.108
Chapter 3.7.1. --- COMT Val108/158Met Polymorphism --- p.108
Chapter 3.7.2. --- DRD4 -521C/T Polymorphism --- p.108
Chapter CHAPTER 4 --- DISCUSSIONS AND CONCLUSIONS
Chapter 4.1. --- Demographics and Potential Environmental Factors of Relapse --- p.111
Chapter 4.1.1. --- Medical and Psychological Status --- p.114
Chapter 4.1.2. --- Substance Use Status --- p.116
Chapter 4.1.3. --- Detoxification and Relapse --- p.118
Chapter 4.2. --- Cold-Pressor Test (CPT) --- p.121
Chapter 4.3. --- Personality Traits --- p.123
Chapter 4.4. --- Salivary Cortisol --- p.125
Chapter 4.5. --- "Association of Gene Polymorphisms, Personality Traits and Cold-Pressor Test" --- p.127
Chapter 4.5.1. --- MORA118G Polymorphism --- p.127
Chapter 4.5.2. --- DOR T921C Polymorphism --- p.129
Chapter 4.5.3. --- COMT Val108/158Met --- p.130
Chapter 4.5.4. --- Prodynorphin (ProDYN) 68bp-VNTR --- p.133
Chapter 4.5.5. --- DRD2 A Polymorphism --- p.134
Chapter 4.5.6. --- DRD4 -521C/T Polymorphism --- p.138
Chapter 4.5.7. --- 5HTlB G861C Polymorphism --- p.141
Chapter 4.5.8. --- Personality Traits --- p.142
Chapter 4.6. --- Limitations --- p.144
Chapter 4.7. --- Potential Clinical Application --- p.145
Chapter 4.8. --- Conclusion --- p.146
APPENDIXES --- p.148
APPENDIX 1 Addiction Severity Index (ASI) with Additional Questions for Heroin Users
APPENDIX 2 Detoxification and Relapse History Questionnaire
APPENDIX 3A Questionnaire for Control Subjects (Chinese version)
APPENDIX 3B Questionnaire for Control Subjects (English version)
APPENDIX 4A NEO PI-R (Chinese version)
APPENDIX 4B NEO PI-R (English version)
APPENDIX 5A BIS/BAS (Chinese version)
APPENDIX 5B BIS/BAS (English version)
APPENDIX 6A SSS- V (Chinese version)
APPENDIX 6B SSS- V (English version)
REFERENCES --- p.178

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24

Mills, Katherine. "Post traumatic stress disorder among people with heroin dependence". 2005. http://www.library.unsw.edu.au/~thesis/adt-NUN/uploads/approved/adt-NUN20060407.101436/public/02whole.pdf.

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25

Cheng, Yi-Ling, e 鄭伊伶. "The association between personality and intimacy in heroin dependence subjects". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/13203039067343648404.

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Abstract (sommario):

碩士
樹德科技大學
人類性學研究所
100
Aim: The study sought to understand and compare the demographic distribution, personality, parenting, and mental health of heroin abusers and poly-substance abusers who receive methadone replacement treatment, and whether this treatment impacts satisfaction from intimate relationships of the subjects. Methods: This study implemented descriptive research methods through purposive sampling and comparative cases studies. These methods included the Parental Bonding Instrument (PBI), Eysenck Personality Questionnaire(EPO), alexithymia, Chinese Health Questionnaire (CHQ )and an intimate relationship satisfaction scale. The study included 74 heroin abusers and 26 poly-substance abusers, but a few participants quit during the initial month, which reduced the total number of subjects to 70. Over a period of three months, the study conducted monthly follow-ups on the subjects’ intimate relationship satisfaction and used Generalized Estimating Equation Models (GEE-I)to understand the changes at different stages during the treatment. Result: The results indicated that poly-substance abusers demonstrate poorer mental health and more extroverted and paranoia tendencies; parental care was higher for heroin abusers while parental protection was more significant for poly-substance abusers; alexithymia was more evident in heroin abusers; and heroin abusers received methadone therapy showed significantly higher intimate relationship satisfaction (p<.05). Intimate relationship satisfaction had a moderate positive correlation (p<.05)with maternal care which high maternal care led to higher intimate relationship satisfaction. GEE statistical analysis showed a positive correlation between intimate relationship satisfaction and the length of treatment and whether the subject was a poly-substance abuser (p<.05). Conclusion: We found the imtimacy improved after the methdone replacement therapy, which is different with proveious finding of other studues. For future studies, increasing the number of subjects would be beneficial to corroborate the correlation between methadone replacement therapy and intimate relationship satisfaction and also allow for a more comprehensive implementation of related sex education.

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26

Chien, Chia-Chang, e 簡佳璋. "Sexual desire of Methadone replacement therapy in heroin dependence subjects". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/54097891250323396441.

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Abstract (sommario):

碩士
樹德科技大學
人類性學研究所
100
Purpose: The main purpose of this research is to understand whether or not methadone replacement therapy has differing effects between the demographics, personalities, and parental bonding instrument for populations of heroin users. Furthermore, we discuss the effect of methadone replacement therapy on sexual desire.Methods: In this purposive sampling study, we utilize the descriptive research method and case control study. Data was collected for Parental Bonding Instrument (PBI), Eysenck Personality Questionnaire (EPQ), alexithymia, Chinese Health Questionnaire (CHQ), and sexual desire inventory(SDI). Result: The sample population consisted of 139 male and 27 female subjects. 65 male and 10 female subjects were then followed monthly for three months for further analysis in changes in sexual desire. This research showed statistical significance between the drop out group and the case group for educational level (p=.08), mental health status (p=.044), personality trait of neurosis (p=.05), and the role of paternal care in the parental bonding instrument (p=.017). This represents that the cases that did not accept regular methadone treatment had a lower educational level, poorer mental health status, and a higher incidence of neurotic and psychotic personality traits. The research showed a moderately direct correlation between extroverts of the EPQ scale and sexual deisre ( p<.05), and a moderately inverse correlation between paternal protection and libido ( p<.05) in cases of heroin users. Further analysis showed the frequency of sexual needs, sexual desire, level of education, and paternal care to be predicting factors for the factors of re-enrollment in the study. Moreover, upon using generalized linear regression analysis (GEE) on cases who received methadone treatment, a direct and improving correlation was found in sexual desire of cases pre and post treatment with statistical significance (p=.018). Furthermore, the results showed that sexual desire is affected by gender and level of education (p=.01), years of usage (p=.002), and frequency of drug injection (p=.001). Conclusion: Therefore, we can predict that the issue of decreased sexual deisre experienced by heroin users may be improved after methadone treatment; moreover, after carrying out clinical evaluations and primary methadone treatments, we have reached the preliminary conclusion that, in the future, efficacious treatment may be anticipated for heroin users experiencing sexual desire problems.

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27

Tzu-YunWang e 王姿云. "The Aldehyde Dehydrogenase 2 Gene Is Associated with Heroin Dependence". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/14690664917048332832.

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Abstract (sommario):

碩士
國立成功大學
行為醫學研究所
100
Background: Determining the influences of genes involved in metabolizing dopamine and encoding dopamine receptors, such as the aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) genes, is critical for understanding addictive behavior. Therefore, we investigated the association between the ALDH2 and DRD2/ANKK1 Taq IA polymorphisms and heroin dependence. Methods: Heroin-dependent Han Chinese patients (250) and healthy controls (312) were recruited. ALDH2 and DRD2/ANKK1 Taq IA polymorphisms were genotyped. Results: The frequency of ALDH2*1/*2 and *2/*2 genotypes was significantly higher in heroin-dependent patients than in controls, but the frequency of DRD2 Taq IA genotypes was not significantly different. Logistic regression analysis showed no significant interaction between ALDH2 and DRD2 Taq IA genotypes in patients. Conclusions: The ALDH2 polymorphism, but not the DRD2, was associated with heroin dependence.

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28

"Association study of receptor genes between heroin addicts and controls". 2001. http://library.cuhk.edu.hk/record=b5890883.

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Abstract (sommario):

Szeto Yi Ki.
Thesis submitted in: December 2000.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2001.
Includes bibliographical references (leaves 83-113).
Abstracts in English and Chinese.
Acknowledgement --- p.iv
Abstract --- p.v
List of Abbreviations --- p.ix
Chapter CHATPER ONE --- INTRODUCTION
Chapter 1.1 --- Heroin --- p.1
Chapter 1.1.1 --- Historical Background --- p.2
Chapter 1.1.2 --- Manufacturing of Heroin --- p.5
Chapter 1.1.3 --- Route of Administration and Absorption Rate --- p.6
Chapter 1.1.4 --- Metabolism of Heroin --- p.8
Chapter 1.1.5 --- Physical and Psychological Effects of Heroin --- p.9
Chapter 1.2 --- Opioid Receptors --- p.10
Chapter 1.2.1 --- Mu Opioid Receptors (MOR) --- p.11
Chapter 1.2.2 --- Kappa Opioid Receptors (KOR) --- p.14
Chapter 1.2.3 --- Delta Opioid Receptors (DOR) --- p.15
Chapter 1.3 --- Dopamine Receptors --- p.17
Chapter 1.4 --- Dopamine Transporter (DAT) --- p.19
Chapter 1.5 --- Gamma-Aminobutyric Acid (GABA) Receptors --- p.21
Chapter 1.6 --- Mesocorticolimbic Pathway --- p.22
Chapter 1.6.1 --- Neural Substrates of Drug Reinforcement --- p.25
Chapter 1.6.2 --- Molecular and Cellular Basis of Addiction --- p.26
Chapter 1.6.3 --- Intracellular Substrates of Relapse --- p.29
Chapter 1.7 --- Environmental Factors in Drug Addiction --- p.30
Chapter 1.8 --- Genetic Factors in Drug Addiction --- p.32
Chapter 1.9 --- Aim of Project --- p.35
Chapter CHAPTER TWO --- MATERIALS AND METHODS
Chapter 2.1 --- Recruitment of Subjects 、 --- p.39
Chapter 2.1.1 --- Heroin-dependent Subjects --- p.39
Chapter 2.1.1.1 --- Phenotype Assessment --- p.39
Chapter 2.1.1.2 --- Establishment of Socio-demographic Data --- p.40
Chapter 2.1.2 --- Control Subjects --- p.42
Chapter 2.2 --- DNA Extraction --- p.42
Chapter 2.3 --- Genotyping --- p.43
Chapter 2.3.1 --- A118G Polymorphism in Exon 1 of the Human MOR (hMOR) Gene --- p.43
Chapter 2.3.2 --- C1031G Polymorphism in Intron 2 of the hMOR Gene --- p.45
Chapter 2.3.3 --- T921C Polymorphism in Exon 3 of the Human DOR (hDOR) Gene --- p.46
Chapter 2.3.4 --- 3'VNTR Polymorphism of the DAT Gene --- p.47
Chapter 2.3.5 --- TaqI A Polymorphism of the DRD2 Gene --- p.48
Chapter 2.3.6 --- NciI Polymorphism of the GABRG2 Gene --- p.48
Chapter 2.4 --- DNA Sequencing --- p.49
Chapter 2.5 --- Statistical Analysis --- p.50
Chapter CHAPTER THREE --- RESULTS
Chapter 3.1 --- Socio-demographic Data --- p.52
Chapter 3.1.1 --- Age of the Control and Heroin-dependent Subjects --- p.52
Chapter 3.1.2 --- Education Standard of the Heroin-dependent Subjects --- p.52
Chapter 3.1.3 --- Years of Heroin Use --- p.53
Chapter 3.2 --- Addition Severity Index (ASI) --- p.53
Chapter 3.2.1 --- ASI-Medical --- p.53
Chapter 3.2.2 --- ASI-Employment --- p.54
Chapter 3.2.3 --- ASI-Drug --- p.54
Chapter 3.2.4 --- ASI-Legal --- p.54
Chapter 3.2.5 --- ASI-Family/Social Relationships --- p.55
Chapter 3.2.6 --- ASI-Psychiatry --- p.55
Chapter 3.2.7 --- Correlation Among the Factors of ASI --- p.55
Chapter 3.3 --- A118G Polymorphism in Exon 1 of the Human Mu Opioid Receptor (hMOR) Gene --- p.56
Chapter 3.4 --- C1031G Polymorphism in Intron 2 of the hMOR Gene --- p.58
Chapter 3.5 --- T921C Polymorphism in Exon 3 of the Human Delta Opioid Receptor (hDOR) Gene --- p.59
Chapter 3.6 --- Interaction Between Genotypes --- p.60
Chapter 3.6.1 --- Combined Genotypes of A118G and C1031G Polymorphisms of the hMOR Gene --- p.60
Chapter 3.6.2 --- Combined Genotypes of A118G Polymorphism of the hMOR Gene and T921C Polymorphism of the hDOR Gene --- p.61
Chapter 3.6.3 --- Combined Genotypes of C1031G Polymorphism of the hMOR Gene and T921C Polymorphism of the hDOR Gene --- p.61
Chapter 3.7 --- Correlation Between Allelic Frequencies and Factors of the ASI --- p.62
Chapter 3.8 --- 3'VNTR Polymorphism of DAT Gene --- p.62
Chapter 3.9 --- TαqI A Polymorphism of DRD2 Gene --- p.63
Chapter 3.10 --- NciI Polymorphism of GABRG2 Gene --- p.64
Chapter CHAPTER FOUR --- DISCUSSION & CONCLUSION --- p.66
REFERENCES --- p.83
APPENDIX I The Addiction Severity Index
APPENDIX II Table of Severity Ratings
APPENDIX III Allelic Frequency of A118G Polymorphism in Different Populations
APPENDIX IV Details Information About the Single Nucleotide Polymorphisms In Present Study

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29

Minhas, Meenu. "The Effect of Heroin Dependence on the Resumption of Heroin Self-administration after a Period of Abstinence and Extinction". Thesis, 2013. http://hdl.handle.net/10214/7816.

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Abstract (sommario):

It has been proposed that relapse vulnerability in previously dependent individuals results from augmentation of drug-induced reinforcement due to repeated associations between the interoceptive properties of the drug and reduction of acute withdrawal distress. To test this hypothesis, male Sprague-Dawley rats self-administered 0.05 mg/kg/inf heroin on continuous and progressive ratio (PR) schedules. During this period, they also received injections of vehicle or escalating doses of heroin. Following tests of naloxone-precipitated withdrawal (0.01 or 0.1 mg/kg, SC), as well as abstinence (4 days), and extinction training (9 sessions), they were pre-treated with vehicle or yohimbine (0.5 mg/kg, IV) and tested for resumption of heroin self-administration (0.05 mg/kg/inf) on continuous and PR schedules (Experiments 1 & 2), or tested for reinstatement in extinction conditions. Differences between vehicle- and heroin-injected rats were noted on self-administration on the continuous reinforcement schedule, but not on the PR schedule, in spite of greater signs of withdrawal precipitated by naloxone in the heroin-injected rats. More importantly, there were no group differences in resumption of heroin self-administration, and this was not altered by yohimbine. These results suggest that relapse vulnerability cannot be uniquely ascribed to the altered reinforcing action of drugs; contextual and other conditioning factors must play a role in modulating resumption of drug intake after periods abstinence.

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30

YEN e 陳嬿如. "A pilot study of drug education that dissolve drama on heroin dependence outpatients". Thesis, 2008. http://ndltd.ncl.edu.tw/handle/42ws35.

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31

Kun-ChiaChang e 張耿嘉. "Mortality and cause of death in patients with heroin dependence receiving opioid substitution treatment (OST)". Thesis, 2013. http://ndltd.ncl.edu.tw/handle/79391112751349633828.

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Abstract (sommario):

碩士
國立成功大學
公共衛生研究所
101
Background: Recent years have seen increased concern being given to the life-saving effect of Opioid Substitution Treatment (OST) on heroin abusing population and OST have been implemented in Taiwan since 2006, evidence-base research is helpful for the future direction of OST strategies. Objective: To investigate the mortality among heroin users and related risk factors. The current study also aims to examine reductions in mortality related to OST. Material and Methods: A cohort of heroin users (N=1283) who had been evaluated were recruited from 2006-2008. These subjects were followed through December 31, 2011(longest following period: 71 months). We divided the cohort to receiving OST or not (OST group, N=983 and non-OST group, N=300) through the National MMT system. Record linkage performed to identify the death of these patients was managed by computerized files of Death Certification System. Crude mortality rate was calculated according to age, sex, receiving OST or not, period in-or out-of-treatment and medication type. Survival analysis was conducted to compare between heroin users receiving OST or not. The mortality risk among the heroin users after seeking OST was also examined using Cox regression model. Results: Compared with non-OST group, the characteristics OST group were: older age (37.8±7.7:36.6±11.7, p 〈0.05), lower educational level (two-thirds below junior high school), longer length of heroin use (6.9±4.3:5.7±5.2, p〈0.001), higher proportion of criminal records( illegal drugs offense：91.5%:74.1%,p〈0.001;Property offense：46.5%:26.1%, p〈0.001.), ever needle/syringe sharing (78.3%:40.8%,p〈0.001), IDUs (Injection drug users) (91.0%:84.5%,p=0.0016), HCV-seropositive (91.4%:86.4%,p=0.038) and HIV-seropositive (18.1%:6.3%,p〈0.001).The result of survival analysis showed that the all-cause mortality rate per 1000 person-year among OST group (15.5/1000 py) was lower than non-OST group (23.9/1000 py).After adjustment for significant covariates using the Cox regression model, all-cause mortality rate among OST group still had better survival outcome(Adjusted Harzard Ratio: 0.47; 95% CI: 0.28 – 0.79).However, the mortality rate directly related to suicide among OST group was significantly higher than non-OST group, (3.88/1000 py: 0.7/1000 py, p 〈 0.05). The survival analysis among OST group showed that the all-cause mortality relative risk between out-of-OST and in-OST period was 7. Conclusions: The all-cause mortality rate among OST group is significantly lower than non-OST group. Among OST group, the survival outcome among in-OST period is better than out-of-OST period. The life-saving effect of enrollment and continued participation in OST still exists under the circumstances that harm reduction strategies in Taiwan is more attractive for HIV carrier and ex-prisoner. However, mortality from suicide among OST group is higher than non-OST. In addition to increasing the availability and access of OST program, suicide prevention program should be given high priority in order to prevent mortality among this high risk population.

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32

Chia-WeiChen e 陳家威. "Therapeutic Effects of Transcranial Direct Current Stimulation on Neurocognitive Function in Patients with Heroin Dependence". Thesis, 2019. http://ndltd.ncl.edu.tw/handle/habuww.

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Abstract (sommario):

碩士
國立成功大學
行為醫學研究所
107
This study aims at probing the effect of transcranial direct current stimulation on neurocognitive function in patients with heroin dependence. Through different stimulation sites of prefrontal cortex targeted, effects from two stimulation sites would be compared and further tested if they benefit frontal function to the same extent. This experiment is a randomized, counterbalanced, sham-controlled factorial design, which includes two prefrontal areas to be targeted, dorsolateral prefrontal cortex and orbitofrontal cortex, as one between variable; while two experimental treatments, sham and active treatments, as one within variable. All research participants have been diagnosed as heroin dependence and shared a characteristic of heavy tobacco use to　a　moderate or severe extent. Results showed that no significant effects were obtained on their neurocognitive performance; moreover, no final conclusion has yet to be reached about the interaction effect of stimulation sites and experimental treatments. This study would like to suggest scaling a larger sample, treatment intensity or dosage, and/or combining neuropsychological rehabilitation to shape a more specific cognitive learning that may be facilitated by tDCS.

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33

Huang, Wei-Lieh, e 黃偉烈. "Methadone-mediated Autonomic Functioning of Male Patients with Heroin Dependence: the Influence of Borderline Personality Pattern". Thesis, 2013. http://ndltd.ncl.edu.tw/handle/00553897074512807647.

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Abstract (sommario):

碩士
國立陽明大學
腦科學研究所
101
Background: Among subjects with heroin dependence, ones with borderline personality trait show poor response to methadone maintenance treatment. They also reveal high sympathetic and low parasympathetic modulation when facing psychological stimuli. Hypothesis: We hypothesize that the population with borderline personality shows different autonomic response to methadone compared to individuals with other personalities. Methods: Forty-four male patients with heroin dependence were recruited from a methadone maintenance treatment program. Eight personality patterns were classified according to the Tridimensional Personality Questionnaire (TPQ) norm used in Taiwan. The borderline pattern (BP, composed of high novelty seeking, high harm avoidance and low reward dependence) and the other personality patterns (OP) were separated into two groups. We compared the heart rate variability (HRV) profiles between the BP and OP groups. Correlation and regression analysis were performed to clarify relationship between HRV differences and the borderline index (BI, a new concept defined by us, which is calculated as novelty seeking + harm avoidance – reward dependence). The HRV targets investigated included low frequency (LF) power, high frequency (HF) power, total power (TP), normalized LF (LF%), and LF/HF. Results: No baseline HRV parameters showed any inter-group difference. The BP group had a significantly lower ΔHF and a higher ΔLF/HF than the OP group. BI was negatively correlated with ΔHF and positively correlated with ΔLF/HF and ΔLF%. Conclusion: Borderline personality individuals show increased sympathetic activity and decreased parasympathetic activity compared to other personalities after taking methadone. The results support the hypothesis that there is a meaningful relationship between borderline personality and autonomic modulation.

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34

Santos, Monika Maria Lucia Freitas dos. "Healing the dragon : heroin use disorder intervention". Thesis, 2008. http://hdl.handle.net/10500/2317.

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Abstract (sommario):

The history of heroin use disorder intervention has been characterised by fads and fashions. Some of the treatments that have been used have been, at best ineffective, and at worst harmful, and occasionally even dangerous. It is a sad reflection upon the field that practices and procedures for the treatment of heroin use disorders can so easily be introduced and applied without (or even contrary to) evidence. In South Africa, the field of heroin use disorder intervention has been `in transition' since the outbreak of the heroin epidemic. Yet despite growing evidence of an association between heroin dependents use of supplementary intervention services (such as psychosocial and pharmacological/medical care) and intervention outcomes, and the fact that international emerging standards for substance use disorder intervention have called upon treatment intervention providers to enhance traditional substance use disorder services with services that address clients' psychological and social needs, heroin use disorder intervention programmes in South Africa generally fail to meet these research-based intervention standards. Much of what is currently delivered as intervention is based upon current best guesses of how to combine some science-based (for example, cognitive-behavioural therapy and pharmacotherapies) and self-help (12-step programmes) approaches into optimal intervention protocols. As progression is made in the twenty-first century, scientific information is now beginning to be used to guide the evolution and delivery of heroin use disorder care internationally. Regrettably, a scarcity of heroin use disorder intervention research is noted in South Africa. The present study delved into the insights of ten heroin use disorder specialists, and synthesised the findings with the results of a previous study undertaken by the author relating to forty long-term voluntarily abstinent heroin dependents. In terms of theory and practice, findings of the study suggest that the field is less in transition now than it was in 1995. It is an imperative that law-enforcement action be followed by an integrated programme of psychological, social and pharmacological outreach. These programmes will have to be expanded to address new demands and will need to include specialised skills training. Many interventions and procedures have begun to be integrated routinely into clinical practice.
Psychology
(D. Phil. (Psychology))

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35

Lu, Ju-Ting, e 呂如婷. "Association study of genetic polymorphisms in ABCB1, CYP2B6, CYP2D6 genes and efficacy dosage for methadone therapy in Han heroin dependence patients". Thesis, 2016. http://ndltd.ncl.edu.tw/handle/64877175118359429690.

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碩士
慈濟大學
生物化學碩士班
104
Opioids dependence is one of the most serious problems affecting social norms and public health system. Methadone Maintenance Therapy (MMT) is now widely used to treat heroin dependence with high efficacy. Methadone is a synthetic opioid anesthetic, past studies showed that gene polymorphism and individual’s differences may affect the pharmacodynamics of Methadone, which is majorly metabolized by Cytochrome P450 and P-glycoprotein. Studies also showed that genetic variations of CYP450 CYP2B6, G516T and A785G enzyme are related to Methadone blood concentration, and CYP2D6*10, with high variations in Asians, plays a major role in Methadone metabolism. Besides, ABCB1 C1236T, G2677T and C3435T gene variants of P-glycoprotein are confirmed to be related to effectiveness of MMT. This study is to explore the relationship between CYP450 genetic polymorphism (ABCB1, CYP2B6, ＆CYP2D6*10) and effective dosage of Methadone. The study subjects were heroin dependence outpatient treated with MMT in Lotung Poh-Ai and General Keelung Hospitals in northern Taiwan. The study protocol was approval by the Ethics Committees of Cathy Hospital. From January 2015 to September 2015, a total of 100 (82 men and 18 women, the average age is 42.53±6.65 years respectively,) heroin dependence patients were enrolled. Characteristics including daily Methadone dosage, BMI index, and other clinical data were collected; gene extraction from oral mucosa and was analyzed via Real-time PCR. Our study finds that the average Methadone dosage in different sex, BMI index, ABCB1 2677GG and CYP2B6 516GG variations is statistically significant. Male(p＜0.009), BMI＞25(p＜0.007), and CYP2B6 516GG homozygote are related to higher average Methadone dosage(p＜0.02), while ABCB1 2677GG homozygote is related to lower dosage(p＜0.05). Multiple linear regression is done to examine the relationship between variants above and average Methadone dosage, and it can predict more than 30% of effective Methadone dosage in our study objects. The future in-depth study to explore interactions between variants above and effective MMT dosage is warrant. This study outcome should be helpful to precisely dosing MMT for Taiwan Heroin dependence patients in the future. Key words: Methadone Maintenance Therapy (MMT), Genetic polymorphism , Pharmacodynamics.

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36

Van, der Walt Hugo Denton. "Naltrexone maintenance therapy with pellet implantation as an aid for relapse prevention of heroin dependent individuals : a South African perspective". Diss., 2016. http://hdl.handle.net/10500/22064.

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Heroin use and dependency is a growing concern within South Africa, individuals face difficulty in remaining abstinent from the use of heroin due to constant relapse. The opioid antagonist known as the naltrexone pellet implant offers an alternative form of aid to relapse prevention in the recovery and abstinence from heroin dependency. This qualitative study explored the subjective experiences and perceptions of heroin dependent individuals, that made use of the naltrexone pellet implant. This study was rooted in the interpretive, qualitative paradigm where a phenomenological research design was used. Participants were selected using a purposive, snowball sampling technique and four individuals who had made use of the naltrexone pellet implant for the aid in heroin dependency for a minimum of three-months were interviewed. Interpretative Phenomenological Analysis (IPA) was used to extract recurrent themes across participants. The findings suggested that the use of the naltrexone pellet implant was beneficial in the aid for relapse prevention from heroin use. Furthermore, the exploration of difficulties that were faced in remaining abstinent, the attempt to make use of the naltrexone pellet implant and the physical and psychological aspects regarding the use of this alternative method of remaining abstinent were explored in this study.
Psychology
M.A. (Psychology (Research Consultation))

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37

Opperman, Hester Catharina. "Behandelingsbehoeftes van Heroïenafhanklikes met spesiale verwysing na SANRA Kliniek, Witbank". Thesis, 2006. http://hdl.handle.net/10500/721.

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The motivation for this study is the increase of treatment needs of heroin dependents at SANCA, (South African National Council of Alcohol and Drug Abuse) Witbank. SANCA Witbank wants to ensure that the most effective treatment can be supplied. Research goals are to:  Do a literature study of out-patient treatment programmes.  Assess the needs of heroin out-patient dependents with regard to out-patient treatment programmes.  Make recommendations with regard to out-patient treatment programmes for heroin dependents. It was an exploratory research subject and the data collection methods were qualitative and quantitative. Interview schedules were used as research tools. Schedule B was completed by the researcher with heroin dependents that visited SANCA Witbank for the period 31 January 2005 to 4 February 2005. Schedule A was completed by the researcher with personnel of SANCA out-patient clinics and the questions were discussed and completed telephonically. The conclusion is that the treatment programme of SANCA Witbank is in line with the rest of the drug dependent field and only minimal recommendations were made.
Social Work
MA(SS)(MENTAL HEALTH)

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38

Ming-Hong e 謝明鴻. "The Predictors of Retention in Methadone Maintenance Treatment among Heroin-Dependent Individuals". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/31656415679576960318.

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博士
中山醫學大學
醫學研究所
100
The importance and contribution of both the duration of receiving methadone maintenance treatment and the retention in treatment were well established for therapeutic success and better prognosis of heroin dependence. Retention in treatment and its related factors have been the important issues of research in improving the outcome of treatment program of heroin addiction. The rates of retention in treatment in Taiwan were lower than those of Europe, USA and other countries in the world. The goals of our survey were to detect the retention in treatment and its related factors of the patients with heroin addiction after receiving methadone maintenance treatment for one year in two hospitals in middle Taiwan, and the study results could improve the treatement outcome and establish the suitable treatment programs of heroin addiction in the future. The design of our study was a prospective, non-randomized cohort study and survival analysis was used to evaluate the risk factors of drop-out rate and stopping methadone maintenance therapy. Our sample composed of 995 patients with heroin dependence who received methadone maintenance therapy in the clinics of Chung Shan medical university medical center and Tsaotun psychiatric center, and they all agreed to take part in the survey. The measurement of the related risk factors in our study included the Severity of Dependence Scale, SDS (SDS-ch), World Health Organization Quality of Life (WHOQOL) questionnaire, Barratt Impulsiveness Scale, Family APGAR score, and the Center for Epidemiological Studies Depression Scale（CES-D）. The results of our survey showed that the retention in treatment was 65.7% in the third month, 61.7% in the sixth month, 58.6% in the twelfth month, and the drop-out rate was highest during the first 3 months of the treatment. The results of our study also demonstrated that those patients living with the sexual partner or their friends, being female, having no deferred prosecution, using lower dosage of methadone（lower than 60 mg）, poorer family support, higher psychological satisfaction of quality of life may increase the risk of stopping methadone maintenance treatment during the period of one-year treatment. It is important for the therapists to closely monitor those patients who have the above risk factors and it may decrease the drop-out rate. Besides, longer period of cohort study is warranted to study all risk factors, which may have impact on the retention in treatment of methadone maintenance therapy, then it may increase the retention in treatment and improve the treatment outcome. Therefore the treatment goal of decreasing the use of heroin may be achieved.

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39

Lai, Jen-Chieh, e 賴仁傑. "Error-Related Negativity and Error Positivity of Heroin-Dependent Patients with Different Learning Type". Thesis, 2017. http://ndltd.ncl.edu.tw/handle/jdc88n.

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Abstract (sommario):

碩士
國立東華大學
諮商與臨床心理學系
105
Recent studies suggest that addiction is related to learning and neurobiological impairment of error processing. The purpose of current study is to investigate the heroin-dependent patients’ neurobiological impairment of error processing and to find out the difference in error- related brain activity of heroin-dependent patients with different learning types. In the current study, Eriksen flanker task is used to measure both of the error- related brain activities, i.e. error- related negativity (ERN) and error positivity (Pe), of the heroin-dependent patients and the control group, and Probabilistic Selection Task (PST) is used to differentiate all subjects’ learning types. According to the investigation, the heroin-dependent patients showed reduced ERN amplitude as compared to the control group and the negative learners showed reduced ERN amplitude as compared to the positive learners; however, the same results were not found in Pe amplitude, and the interactions between heroin dependence and learning type failed to reach significance level in both ERN and Pe amplitudes. Interestingly, while the difference in wellbeing index between the heroin-dependent patients and the control group, and between the positive learners and the negative learners, is not significant, current study finds a significant interaction between heroin dependence and learning type in wellbeing index. Based on the aforesaid findings, two main conclusions can be derived from this study. First, these results highlight the possibility that heroin-dependent patients show neurobiological impairment in error processing. Second, heroin-dependency may have effect on the relationship between reward learning and mood. Further researches are needed to clarify the effect of learning type on the relationship between heroin-dependency and error processing.

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40

Chen, Kuei-Ying, e 陳葵螢. "The Predictors for Duration of Retention in Methadone Maintenance Treatment among Heroin-Dependent Individuals". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/99912388422511489526.

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Abstract (sommario):

碩士
高雄醫學大學
醫學系神經學科碩士班
100
Methadone maintenance treatment (MMT) is an effective harm reduction treatment method for heroin-dependent individuals. Duration of retention in MMT is a predictor of treatment outcomes. The aims of this study were to examine the duration of retention in MMT and to identify the predictors for duration of retention in MMT among heroin-dependent individuals in southern Taiwan. The current study used the secondary data for analysis. Primary data was gathered from three MMT units in southern Taiwan. The sample consisted of 368 heroin-dependent individuals who were investigated at baseline and followed during the treatment period. The duration of retention in MMT (in days) was the main outcome of the study. The predictor variables were categorized into client characteristics, family support and methadone dose after 3 months of admission. The study used Kaplan-Meier product-limit method to analyze retention rate in the MMT program, and used Cox proportional hazard regression and logistic regression to examine the predictors for drop-out from the MMT program. The results found that cumulative probability of retention at 360-days and 540-days were 41.6% and 31.3%, respectively. However, if the involuntary dropouts were excluded, cumulative probability of retention at 360-days and 540-days were 47.1% and 39.5%, respectively. Among pre-treatment variables, the predictors for drop-out from MMT program included: higher heroin cost, higher severity of harm caused by heroin use, and poorer family support. If the methadone dose was included in the regression model, methadone dose <50mg and higher severity of harm caused by heroin use were the significant predictor variables for drop-out. Implications for treatment were discussed.

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41

Wei, Hae-Lanq, e 韋海浪. "Short Term Effects of Abstinence After Using Methadone Maintenance Treatment in Heroin-Dependent Volunteers". Thesis, 2006. http://ndltd.ncl.edu.tw/handle/39140454316440229811.

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Abstract (sommario):

碩士
國立陽明大學
醫務管理研究所
94
Abstract Since 2004, intravenous drug users (IDUs) have become the major cause for the AIDS epidemic in Taiwan. Subsequently, the Taiwan government started a harm reduction program in 2006, which included the methadone maintenance treatment (MMT). In this study, a survey was conducted on voluntary IDUs who participated in the MTT in Taoyuan. The purpose of the survey was to collect information in regards to the voluntary IDU’s opinion on the harm reduction and their beliefs towards drug abstinence between those who took methadone 3-6 months (treated group) and those who did not take methadone (untreated group). Results: from June to August, 2006, 105 subjects (39 in the treated group and 66 in the untreated group) were recruited. We found that: 1. Attitude of harm reduction: There was no significant difference in the attitude of harm reduction between the two study groups, in which the treated group had a mean of 3.23 (SD=0.40) and the untreated group had a mean of 3.12 (SD=.41). However, the mean score of “can work normally after participating MMT (one question in the attitude of harm reduction)” was significantly higher in the treated group (3.31) than that in the untreated group (3.05) (p=.0201). 2. Short term effect on drug abstinence: The mean score for the treated group (3.13 with SD=0.50) did not have a significant difference from that of the untreated group (3.09 with SD=0.48). 3. Payment for methadone at their own expense: At the present time, the government provides MMT to the voluntary IDUs free of charge. When asking two study groups whether they are willing to pay for methadone at their own expense in the future, the treated group (48.7%) turned out to be less likely to pay for methadone at their own expense as opposed to the untreated group (92.4%). 4. Other demands: Drug consultation (42.9%) was the highest in demand, followed by psychological help (41.9%), AIDS test (32.4%), seeking jobs (21.9%), and AIDS consultation (15.2%). The demand for AIDS consultation was significantly higher in the treated group (25.6%) than that in the untreated group (9.1%) (p=.0226). 5. Influence by friends: The reason for the first time use of drug was due to friends’ seducement (30.5%), while the reason for abstinent failure was also due to friends’ seducement (21.9%). The participation in the MMT was caused by friends’ recommendation (53.3%), and “friends can refrain from drugs, I can do so” ranked number two in the belief of drug abstinence. All findings suggested that friends can affect the IDUs’ behavior of drug use and abstinence of drug. Suggestions: 1. Continue to provide MMT to voluntary IDUs: Although there was no significant difference in the belief of substance abstinence and attitude of harm reduction and consistency with the findings in overseas studies, the mean score of "can work normally after participating in the MMT" in the treated group was significantly higher than that in the untreated group. It is evident that MMT is cost benefit because of the reduction of crime problems, reduced medical expenses on psychological or mental problem in IDUs, as well as the IDUs’ ability to work normally. We suggest that the government should continue to provide MMT to voluntary IDUs. 2. Provide MMT free of charge: Since the treated group was able to take methadone free of charge, it was less likely for the treated group to accept the idea of paying methadone at their own expense in comparison to the untreated group. We suggest that when a policy is first implemented, the policy makers should be cautious and avoid a change of the policy in a short period of time. 3. Provide psychological consultation: As many subjects were interested in having a drug consultation and psychological help, psychological consultation should be offered. Hopefully, the effect of drug abstinence can be promoted. 4. Establish a mutual help group: As friends are very influential towards the behavior of IDUs’ first use of the substance and the conquering of abstention addiction, we suggest that these voluntary IDUs can get together and form a group. This group can assist each other in continuous participation in MMT, or refrain from substance abuse.

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Ting, Shuo-Yen, e 丁碩彥. "Factors associated with retention in treatment and change of daily amount of heroin abused in heroin-dependent patients receiving Methadone Maintenance Treatment for three months". Thesis, 2010. http://ndltd.ncl.edu.tw/handle/20302483080768579443.

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Abstract (sommario):

碩士
臺灣大學
醫療機構管理研究所
98
OBJECTIVE: To determine factors associated with retention in treatment and change of daily amount of heroin abused in heroin-dependent patients receiving Methadone Maintenance Treatment for three months. METHODS: This is a prospective cohort study. Participants were from 5 hospitals with larger case numbers of Methadone Maintenance Treatment (MMT) in Taiwan. Participants were patients never received MMT before or had already dropped out from previous treatments for at least 6 months. Questionnaire including demographic data and Opiate Treatment Index (OTI) were distributed to 333 patients at the beginning of the treatment course from June to September 2009. Three months later, the OTI were re-interviewed for127 patients remained in the MMT for 3 months from September to December 2009. RESULTS: After 3 months, heroin use with smoking was associated with higher rates of discontinuing treatment compared with heroin use with injection. Dropout rates among hospitals were significantly different. More reduction in heroin use after 3-month treatment was associated with higher amount of heroin use when entering the treatment. Better self-perception of physical wellbeing at the beginning was associated with less reduction in heroin use 3 months later. CONCLUSION: Methadone has greater effect on reducing heroin use in patients abusing more amounts of heroin. The policy makers might encourage heroin-dependent patients to continue treatment and it will benefit those patients, their families and even the whole society. Since patients abusing heroin with different routes have significant difference in dropout rates, the diversity of patient composition among different hospitals should be considered in evaluating their performance with indicator of retention rates. There are differences of some effectiveness indicators among those hospitals participating in the study. Reviewing current service procedures and improving accessibility for those patients might help reducing dropout rates and finally the amounts of heroin use.

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43

SHIAO, FEN-YU, e 蕭芬郁. "Exploring the Experience of Heroin-Dependent Individuals With High Retention Rates While Receiving Methadone Maintenance Treatment". Thesis, 2019. http://ndltd.ncl.edu.tw/handle/7c6qgd.

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Abstract (sommario):

碩士
國立臺南大學
諮商與輔導學系碩士在職專班
107
The purpose of this study is to understand the personal feelings, life and experience of heroin-dependent individuals in the replacement of maintenance therapy in the treatment of heroin-dependent individuals, as a future improvement of heroin addicts in Methadone alternative maintenance therapy. In this study, 4 patients who had taken Methadone for one year in the replacement therapy of Methadone, and the attendance rate reached 70% were recruited. In addition, the semi-structured in-depth interviews for the qualitative study were used and the data was analyzed by the content analysis. The research results are as follows: First, the experience of heroin addicts in the high retention rate of Methadonereplacement treatment, including： (1) Physiological dependence of high retention rate (2) Psychological dependence of high retention rate (3) Family support experience with high retention rate Second, the psychological course of the experience of the high retention rate in the treatment of Methadone, including： (1) The self of Methadone，containst：「The role of the」、「Methadone and the lack of dependency」、「I don't know how long it will be in the life of Methadone」. (2)Seeing different self in alternative therapy，containst：「Different mother roles due to participation in Methadone Therapy」、「economic independence」、「the future that I dare not think about」 (3) Find yourself，containst：「Discovering a different life」、「Expecting your own self-defeatin」、「 Self under the Lotte Mask」 Finally, based on the findings and conclusions of the research, the researcher made recommendations for future research and related professionals. Keywords: heroin-dependent individuals, high retention rate, Methadone

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44

Silvestre, Ana Rodrigues Oliveira. "Fármacos usados no tratamento da dependência de opioides". Master's thesis, 2020. http://hdl.handle.net/10284/9316.

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A dependência opioide é considerada uma condição médica com determinantes sociológicas e individuais bastante complexas. O desenvolvimento de tratamentos eficazes para esta dependência revela-se de extrema importância devido às consequências devastadoras da doença. A farmacoterapia deverá ser abrangente e pode incluir opioides agonistas, agonistas parciais ou antagonistas, e, ainda, agonistas alfa-2-adrenérgicos e tem como objectivo a desintoxicação do doente e a substituição por uma terapia de longo prazo. As normas orientadoras actuais enfatizam a necessidade de uma abordagem integrada do tratamento. Actualmente, o tratamento de substituição é a forma mais comum de tratamento especializado da dependência de opioides na União Europeia. A metadona continua a ser o fármaco mais prescrito, no entanto a buprenorfina apresenta resultados promissores. O ciclo da dependência opioide é bastante complexo e a farmacoterapia disponível apresenta algumas lacunas. Por estes motivos, encontram-se em desenvolvimento novos fármacos e novas estratégias para prevenir e tratar este distúrbio em todas as fases do processo. O ibudilast e a vacina anti-heróina são os fármacos que se encontram em estudo. Em suma, estão disponíveis diversas opções farmacoterapêuticas eficazes no tratamento da dependência opioide, mas ainda assim, devido à natureza crónica e recorrente da mesma, muitos indivíduos abandonarão o tratamento e retornarão a um estilo de vida dependente e permanecerão em risco de overdose e diminuição da qualidade de vida. Por este motivo, surge a necessidade de enfatizar o estudo desta patologia de forma global reforçando a inclusão de abordagens psicossociais nos regimes de tratamento.
Opioid addiction is considered a medical condition with very complex sociological and individual determinants. The development of effective treatments for this addiction is extremely important due to the devastating consequences of the disease. Pharmacotherapy should be comprehensive and may include opioid agonists, partial agonists or antagonists, as well as alpha-2-adrenergic agonists and is aimed at detoxifying the patient and replacing it with long-term therapy. Current guidelines emphasize the need for an integrated approach to treatment. Substitution treatment is currently the most common form of specialized treatment for opioid addiction in the European Union. Methadone remains the most prescribed drug, however buprenorphine shows promising results. The cycle of opioid dependence is quite complex and the available pharmacotherapy has some gaps. For these reasons, new drugs and new strategies are being developed to prevent and treat this disorder at all stages of the process. Ibudilast and the anti-heroin vaccine are the drugs under study. Inconclusion, several effective pharmacotherapeutic options are available in the treatment of opioid dependence, but still, due to its chronic and recurrent nature, many individuals will abandon treatment and return to a dependent lifestyle and remain at risk of overdose and decreased quality of life. For this reason, there is a need to emphasize the study of this pathology globally, reinforcing the inclusion of psychosocial approaches in treatment regimes.

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Tesi sul tema "Heroin dependence"

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