The impact of stress on addiction.

2 Declarations 3 Acknowledgements 4 List of

Character strengths as mediators in a mindfulness based intervention for recovery from addictive behaviour: a study in psychology of religion and positive psychology

Throughout the 1990s, Vietnam experienced a dramatic rise in the prevalence of HIV among people who use drugs. In response, Vietnam’s Ministry of Health implemented several legal and policy interventions in the name of harm reduction. However, perceptions about drug use, people who use drugs, addiction and the nature of official interventions are contested. For many Vietnamese officials, abstinence remains the dominant philosophy. Drug use is considered a ‘social evil’ in Vietnam and people who use drugs face draconian controls and incarceration in the name of treatment and crime prevention.  Against this background, this thesis explores how key stakeholders perceive harm reduction philosophy and how they apply it in policy and practice. Based on qualitative and quantitative methods, it presents findings from a survey with 250 respondents and 26 semi-structured interviews, all with professionals involved in responding to drug use in Vietnam. The thesis illustrates that these professionals prefer abstinence approaches, and often see addiction as the result of moral failings and brain diseases.  While some interventions in the name of harm reduction are accepted, they are firmly rooted within a narrow public health perspective. Professional misperceptions about the key principles and practices of ‘authentic’ harm reduction are widespread. Many professionals believe, for example, that harms can only be limited through reductions in the demand and supply of drugs, or that detaining people who use drugs in compulsory treatment centres is a form of harm reduction.  These rationales have resulted in continuing police crackdowns, and the use of ‘pseudo’ harm reduction strategies to control and punish people who use drugs. Meanwhile, there are limited official attempts to address problems experienced by people who use drugs, like social isolation, stigma, discrimination, human rights violations, or problems of community reintegration. In conclusion, while a harm reduction rhetoric is regularly employed in Vietnam, ‘pseudo’ harm reduction strategies are carried out.

A critical exploration of professional perceptions of harm reduction policy and practice in Vietnam

This study deals with how substance-dependent men perceive their paternal identity. Data were based on in-depth semi-structured interviews with 12 Israeli fathers who were enrolled in methadone maintenance treatment. Content analysis revealed that participants had undergone a process of parental identity formation composed of four distinct stages: absence, awakening, taking responsibility, and resolution to re-form oneself as a father. The discussion highlights the developmental nature of this process. Also discussed are the effects of three factors on the formation of paternal identity: the treatment for addiction, the subjects' newfound identity as "clean addicts," and social perceptions and discourses about fatherhood and addiction.Key Words: fatherhood, Methadone maintenance treatment, paternal identity, substance-dependent men.In these times of rapid social change, fatherhood is at once an identity, a practice, a social structure, and an individual life experience (Henwood & Procter, 2003; Lamb, 2010; Palkovitz & Palm, 2009). Paternal identity is complex and varied. Its formation is influenced by social perceptions of masculinity (Brandth & Kvande, 1998), by paternal roles (Doherty, 1997; Lamb & Tamis-LeMonda, 2004), and by intergenerational relations between father and son (Lamb, 1997). It binds together past events, present experiences, and thoughts about "my future self."Most of the literature on parenting and addictions has focused on the mothering practices of substance-abusing women (McMahon, Winkle, Luthar, & Rounsaville, 2005) and the effect of their substance use on the child (Loukas, Fitzgerald, Zucker & Von Eye, 2001) and less so on the issue of substancedependent men as fathers. The little that is known in this field suggests that substanceabusing fathers value their paternal status and are involved in their children's lives more than is commonly assumed (McMahon & Rounsaville, 2002), albeit accompanied by feelings of guilt and uncertainty about their relevance to their children's lives (Arenas & Greif, 2000). The paternal identity of substance-abusing men is still largely unexplored, so the purpose of the present study was to broaden what is currently known about this subject. The terminology in the literature on fathering and addictions is somewhat inconsistent in its use of the terms addiction, drug abuse, substance abuse, and drug dependence. In this article, we define the population at hand as substancedependent fathers, in keeping with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000).Fatherhood and Paternal IdentityFatherhood is a dynamic, complex, and multifaceted phenomenon subject to cultural, economic, and social change (Lamb & TamisLemonda, 2004). The concept of father is defined both by the father's biological function and by his emotional and social role (Dowd, 2000). In other words, it is a complex bio-psycho-social process that determines and shapes a man's identity and roles as a father in accordance with family-related and social ideologies (Branditi & Kvande, 1998; Lamb, 2010). The perception of fatherhood has changed over history, with each period placing the primary emphasis on a different aspect (Lamb, 1987): the father as moral teacher, responsible for his children's upbringing (particularly with regard to religious values); the father as breadwinner and gender role model; and the nurturing, or "New Father," who expresses his feelings and is sensitive to his children's needs, shows interest in them, and takes an active part in promoting their educational, cognitive, and emotional development (Coltrane, 1996; Lupton & Barclay, 1997). Despite these distinctions, fathers today appear to have no clear boundary between these four roles: They are all part of the fatherhood experience, with the relative importance attributed to each one varying from one father to the next and between different social groups (Lamb, 2010). …

''I've Fixed Things Up'': Paternal Identity of Substance-Dependent Fathers

Aims
Experiencing shame can be a risk factor for relapse for people recovering from alcohol dependence, but for some it may act as a necessary protective factor for preventing relapse. Knowing how best to manage shame is therefore an important issue, yet the precise nature of the relationship between shame and alcohol dependence remains largely unexplored. 
Research Questions
1)	In what ways do participants tell their stories of shame?
2)	How is shame experienced and/or understood by those in recovery from alcohol dependence?
Method
Eight participants were recruited from Alcoholic Anonymous (AA) groups and invited to tell their story of recovery. Stories were then analysed using a narrative analysis, focusing on how participants narrated their stories and made sense of their experiences of shame in particular.
Findings
Participants spoke about an inherent deep-rooted negative view about themselves, which was present long before alcohol dependence developed. Alcohol served as a means of connection to others and a way of artificially relieving feelings of worthlessness. Recovery was about finding somewhere safe to talk about feelings of shame and make sense of these experiences.
Conclusions
The results indicate that management of shame is an important component of recovery programmes for alcohol dependence.

Is shame a barrier to sobriety? A narrative analysis of those in recovery.

The two models which have most affected theory and practice of addiction medicine have been the disease model and the self-medication hypothesis. The disease model's fundamental concept is that the addicted individual is sick and suffers from a disease. The self-medication hypothesis proposes that drug and alcohol users are attempting to cope with an underlying psychological or social disorder by means of self-medication. These two viewpoints are presented in the light of a number of specific methadone maintenance treatment and drug abuse related issues such as the question whether drug abuse is an illness of the body, the mind or society; whether the disease model really de-stigmatized drug abuse; what the correct methadone dosing policy should be; the place of psychotherapy in methadone maintenance treatment and drug abuse and how polydrug abuse should be treated. These issues are discussed and an integrated approach is suggested stressing the need for social criticism and a renewed social policy towards drug abuse in general and its treatment in particular.

An integration of three approaches to addiction and methadone maintenance treatment: the self-medication hypothesis, the disease model and social criticism.

Shabtai Levitt

Papers

An integration of three approaches to addiction and methadone maintenance treatment: the self-medication hypothesis, the disease model and social criticism.