natgillin/translations-raw huggingface dataset:
In considering the increase in treatment demands, itappears that changes in referral practice have an impact,and a substantial proportion of those referred appear not tobe intensive drug users.
Večinoma pa se ljudje s problemi, povezanimi s konopljo,zdravijo skupaj s tistimi, ki se zdravijo zaradiproblematičnega uživanja drugih prepovedanih drog,predvsem opioidov.
Nonetheless, in some countries atleast, a significant number of treatment demands come fromindividuals whose use of cannabis is intensive.
Ker je veliko takšnih specializiranihcentrov za zdravljenje z drogami povezanih problemovzasnovanih tako, da zadovoljujejo potrebe pogosto
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Letno poročilo 2004: O stanju na področju drog v Evropski uniji in na Norveškem so nujne raziskave.
Annual report 2004: the state of the drugs problem in the European Union and Norway most affected are young and may be using the drugintensively during important developmental stages or whenthey are particularly vulnerable.
•mlajši uživalci, pogosto študenti, ki jih na službe zazdravljenje odvisnosti napoti družina ali šola in kikonopljo uživajo bodisi samo bodisi skupaj zalkoholom ali stimulansi;
Among sociallydisadvantaged families or communities, cannabisdependence or abuse may compound individuals’ problemsby harming education or employment opportunities.
•uživalci več drog hkrati, ki so običajno starejši inslabše vključeni v družbo, na zdravljenje jih pogostejenapotijo pravni organi ali zdravstvene in socialneslužbe, prekrivajo pa se s populacijo kroničnihuživalcev drog.
problems. General population survey data suggest that,compared with occasional use, intensive cannabis use isrelatively uncommon.
Podatki raziskavesplošnega prebivalstva kažejo, da je v primerjavizobčasnim uživanjem intenzivno uživanje konopljerelativno nepogosto.
However, the widespread use ofcannabis means that considerable numbers of people maybe using the drug intensively — at least for some part oftheir life.
Vendar pa razširjeno uživanjekonoplje pomeni, da morda precejšnje število ljudi todrogo uživa intenzivno – vsaj nekaj časa v življenju.
The prevalence among youngmales is likely to be substantially higher.
Razširjenost med mladimi moškimi je običajnoznatno višja.
It is difficult to drawfrom the survey evidence a clear picture of the number ofusers experiencing problems with or becoming dependenton cannabis.
Iz podatkov raziskave je težko izluščiti jasnosliko o številu uživalcev, ki imajo probleme zaradikonoplje ali postajajo od nje odvisni.
Although the effects of cannabis dependenceor abuse are less severe than those of other drugs, this maynevertheless have a considerable public health impactbecause of the scale of use and the fact that many of those
Čeprav so učinkiodvisnosti od konoplje ali njene zlorabe manjši kot pridrugih drogah, lahko kljub temu precej vplivajo na javnozdravje zaradi obsega uživanja in dejstva, da sovečinoma najbolj prizadeti mladi, ki drogo morda uživajov pomembnih razvojnih fazah ali takrat, ko so posebejobčutljivi.
In summary, there remains a critical need for research toprovide an understanding of the relationship betweendifferent patterns of cannabis use and the development ofproblems.
Povzeti je mogoče, da so nujno potrebne raziskave, ki biomogočile razumevanje odnosa med različnimi vzorciuživanja konoplje in razvojem problemov.
The extent to which cannabis users experienceproblems and the nature of the problems that may be foundstill remain poorly understood.
Še vedno nepoznamo dovolj obsega težav, s katerimi se soočajouživalci konoplje, in narave problemov, na katere lahkonaletimo.
Methodological tools arerequired to assess problems at the population level.
Potrebna so metodološka orodja za presojoproblemov na ravni populacije.
Suchinformation is a prerequisite to the development, targetingand implementation of effective public health responses tocannabis use in Europe.
Takšni podatki so prvipogoj za razvoj, ciljno usmerjanje in izvajanje učinkovitihodzivov na uživanje konoplje na področju javnegazdravja v Evropi.
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Izbrano poglavje 3Komorbidnost
Determining the aetiology of comorbidity results in achicken and egg discussion: what came first?
Če želimo opredeliti etiologijo rezultatov komorbidnosti,končamo pri razpravi o kokoši in jajcu: kaj je bilo prej?Sedanje raziskave o vzročnih povezavah medpsihiatričnimi motnjami in motnjami, povezanimi z zlorabosnovi, niso dokončne.
Existingresearch about the causal relations between psychiatric andsubstance disorders is inconclusive.
Simptomi duševne motnje inproblemov odvisnosti medsebojno delujejo in vplivajodrug na drugega.
Research evidence indicates that psychiatric and personalitydisorders usually occur before substance use disorders, i.e.they increase individuals’ susceptibility to such problems(e.g. Kessler et al., 2001; Bakken et al., 2003); however,psychiatric disorders may also be aggravated by drug use(e.g. for depression: McIntosh and Ritson, 2001) or occurin parallel.
Raziskovalni dokazi pokažejo, da se psihiatrične inosebnostne motnje navadno pojavijo pred nastopommotenj, povezanih z zlorabo snovi, kar pomeni, dapovečajo dovzetnost posameznika za take probleme (npr.Kessler et al., 2001; Bakken et al., 2003); vendar sepsihiatrične motnje lahko poslabšajo tudi zaradi uživanjadrog (npr. pri depresiji: McIntosh in Ritson, 2001), ali sepojavijo vzporedno s tem.
The co-occurrence of psychiatric illness and substancedisorders, commonly termed comorbidity or dualdiagnosis, is not a new phenomenon.
Sopojavnost duševne bolezni in motenj, povezanih zzlorabo snovi, ki jo običajno imenujemo komorbidnost alidvojna diagnoza, ni nov pojav.
However, in recentyears the issue has gained momentum in the political andprofessional discussion as it has become apparent that alarge and probably growing number of people areaffected.
Vendar se je to vprašanjepostavilo v ospredje političnih in strokovnih razprav,sajjepostalo jasno, da je prizadeto veliko število oseb,kinajbrž še narašča.
In this chapter the focus will be on the coexistenceof psychiatric and personality disorders and the use of illicitdrugs.
V tem poglavju bo v ospredjuobravnave sočasni obstoj psihiatričnih in osebnostnihmotenj ter uživanje prepovedanih drog.
In fact, it is often appropriate to speak aboutmultimorbidity, as affected individuals often also suffer fromsomatic illnesses, e.g. human immunodeficiency virus (HIV)or hepatitis C virus infection, as well as social disorders,such as family problems, unemployment, incarceration orhomelessness.
Pravzaprav jemnogokrat ustrezno govoriti o multimorbidnosti, saj so priprizadetih posameznikih običajno prisotne tudi somatskebolezni, npr. virus človeške imunske pomanjkljivosti (HIV)ali infekcija z virusom hepatitisa C, kakor tudi socialnemotnje, kot so družinski problemi, brezposelnost,prestajanje zaporne kazni ali brezdomstvo.
Care and treatment services are usuallyinadequately equipped to deal with the diagnostic andtreatment needs of this client group, disregarding and/orbeing incapable of coping with the totality of the client’sproblems.
Službe zaoskrbo in zdravljenje običajno niso ustrezno opremljene,da bi se ukvarjale s potrebami diagnostike in zdravljenjate skupine oseb, ter ne upoštevajo in/ali se niso zmožneukvarjati s celotnim skupkom problemov osebe, ki sezdravi.
The result is frequently a ‘revolving door’situation, with individuals in great need of treatment beingreferred from one service to another while all the time theirsituation deteriorates.
Pogosto je posledica stanje “vrtljivih vrat”sposamezniki, ki zares potrebujejo zdravljenje, vendar sonapoteni od ene službe v drugo, medtem ko se njihovostanje slabša.
Drug use can also be perceived as a component orsymptom of a psychiatric or personality disorder and as anattempt to self-medicate (e.g. Williams et al., 1990; Murrayet al., 2003).
Uživanje drog se lahko razume tudi kot sestavni deloziroma simptom psihiatrične ali osebnostne motnje in kotposkus samozdravljenja (npr. Williams et al., 1990;Murray et al., 2003).
The fact that substance use alleviatesdistressing symptoms encourages the development ofaddiction.
Razvoj odvisnosti spodbuja dejstvo,da uživanje prepovedane snovi olajša težavnostnesimptome.
Once the drug use is discontinued, e.g. throughwithdrawal or substitution treatment, the symptoms mayreappear.
Po prenehanju uživanja drog, npr. z odtegnitvijoali nadomestnim zdravljenjem, se simptomi lahko znovapojavijo.
Acute drug-induced psychoses occur particularlyin users of cocaine, amphetamines and hallucinogens andusually subside relatively quickly.
Akutna psihoza zaradi uživanja drog se pojavizlasti pri uživalcih kokaina, amfetaminov in halucinogenovter se po navadi sorazmerno hitro poleže.
It may, however, be verydifficult to differentiate between symptoms due to substanceintoxication and unrelated psychotic episodes.
Vendar je zelotežko razlikovati med simptomi zaradi zastrupitve s snovmiin nepovezanimi psihotičnimi epizodami.
Krausz (1996) suggests four categories of dual diagnosis:
Krausz (1996) predlaga štiri kategorije dvojne diagnoze:
• a primary diagnosis of a mental illness, with asubsequent (dual) diagnosis of substance misuse thatadversely affects mental health;
•primarna diagnoza duševne bolezni z nadaljnjo(dvojno) diagnozo zlorabe snovi, ki škodljivo vpliva naduševno zdravje;
• concurrent diagnoses of substance misuse andpsychiatric disorders;
•primarna diagnoza odvisnosti od drog s psihiatričnimizapleti, ki vodijo do duševne bolezni;
• a dual diagnosis of substance misuse and mooddisorder, both resulting from an underlying traumaticexperience, for example post-traumatic stress disorder.
Komorbidnost ali dvojno diagnozo je Svetovnazdravstvena organizacija opredelila kot “sopojavnostmotnje zaradi uživanja psihoaktivne snovi in drugepsihiatrične motnje pri istem posamezniku” (WHO, 1995).Glede na opredelitev Urada za droge in kriminal pri Združenih narodih je oseba z dvojno diagnozo “oseba, kiji je bila poleg drugih diagnoz, običajno psihiatričnih, npr.razpoloženjskih motenj, shizofrenije, postavljena šediagnoza zlorabe alkohola in drog” (UNODCCP, 2000).Z drugimi besedami, komorbidnost se v tem smislu nanašana začasno sopojavnost dveh ali več psihiatričnih ali
Co-morbidity, or dual diagnosis, is defined by the World Health Organization (WHO) as the ‘co-occurrence in thesame individual of a psychoactive substance use disorderand another psychiatric disorder’ (WHO, 1995).
•hkratna diagnoza zlorabe snovi in psihiatričnih motenj;
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Izbrano poglavje 3: Komorbidnost
Similarly, the Swedish national report differentiates betweenpsychiatric patients suffering from comorbidity and drugdependent clients with personality disorders that areaggravated by drug use and which are not alwaysadequately diagnosed.
Podobno švedsko nacionalno poročilo razlikuje medpsihiatričnimi bolniki s komorbidnostjo in osebami,odvisnimi od drog, z osebnostnimi motnjami, ki jihuživanje drog še poslabša in niso ustrezno diagnosticirani.
It is possible thatsome individuals with depression may self-medicate withopiates and benzodiazepines: clients in treatmentprogrammes have lower depression scores than clients inlow-threshold services (Rooney et al., 1999) or at initiationof treatment (McIntosh and Ritson, 2001).
Možnoje, da se nekateri posamezniki z depresijo samozdravijo zopiati in benzodiazepini: med osebami, ki so v programuzdravljenja, je manj primerov depresije kakor pri osebah, kiso pod okriljem nizkopražnih programov za pomočuživalcem drog (Rooney et al., 1999) ali na začetkuzdravljenja (McIntosh in Ritson, 2001).
Morel (1999) distinguishes non-specific psychiatricdisorders found among drug addicts from complicationsspecifically connected with drug use.
Morel (1999) razlikuje nespecifične psihiatrične motnjemed odvisniki od drog in zaplete, ki so izrecno povezani zuživanjem drog.
Disorders often foundamong drug users include:
Motnje, ki so pogoste med uživalci drog,vključujejo:
• sleep disorders, resulting from depression, anxietydisorder or psychosis;
•motnje spanja zaradi depresije, anksiozno motnjo alipsihozo;
A survey in Norway (sample size= 2359) found that ahigh proportion of drug users have experienced severefamily problems during childhood and youth.
Raziskava na Norveškem (n=2359) je pokazala, da jevelik delež uživalcev drog v otroštvu in mladosti doživelresne družinske probleme.
Some 70%had experienced learning and behavioural problems inschool, 38%had been the victim of bullying and 21%hadreceived psychiatric treatment during childhood andadolescence (Lauritzen et al., 1997).
Sedemdeset odstotkov jih jeimelo v šoli učne težave in vedenjske probleme, 38% jih jebilo žrtev nadlegovanja in 21% se jih je duševno zdravilov otroštvu in adolescenci (Lauritzen et al., 1997).
Female drug userswith psychiatric comorbidity have often been the victims oftraumatic sexual abuse (e.g. Beutel, 1999).
Uživalkedrog s psihiatrično komorbidnostjo so bile pogosto žrtvetravmatične spolne zlorabe (npr. Beutel, 1999).
aggressive and violent behaviour, indicating antisocial,psychopathic, schizophrenic or paranoid personalitydisorders.
•agresivno in nasilno vedenje, ki kaže na antisocialne,psihopatske, shizofrene ali paranoidne motnjeosebnosti.
Problems specifically linked to drug use include:
Problemi, ki so izrecno povezani z uživanjem drog,vključujejo:
• pharmaco-psychoses induced by hallucinogenic drugsor amphetamines;
•toksične psihoze zaradi uživanja halucinogenih drogali amfetaminov;
Routine assessment for psychiatric and personality disordersdoes not always form part of the standard diagnosticprocedures performed at the commencement of treatment indrug services.
Rutinska ocena psihiatričnih in osebnostnih motenj nivedno del standardnega diagnostičnega postopka nazačetku zdravljenja v službah, ki se ukvarjajo zodvisnostjo od drog.
Except in some particularly aware and/orspecialised services, mental symptoms and disorders arerarely explored in drug treatment services.
Razen v nekaterih službah, ki se tegaše posebej zavedajo, in/ali v specialističnih službah, seduševni simptomi in motnje redko obravnavajo v službahza zdravljenje odvisnosti od drog.
Recent neuropsychological and neurobiological studies andthe advent of techniques that enable brain processes to bevisualised have made it possible to hypothesise about theinteractions between mental and physical trauma, braindevelopment, drug effects, stress and mental development.The reward system is essential in the development ofaddiction, and addiction is linked to structural changesandadaptation of the brain at micro and macro levels(Nestler,2001).
Nedavne nevropsihološke in nevrobiološke študije ter prihodtehnik, ki omogočajo vizualizacijo možganskih procesov, soomogočili postavljanje hipotez o medsebojnem vplivanjumed psihološkimi in fizičnimi travmami, razvojem možganov,učinki drog, stresom in duševnim razvojem. Pri odvisnosti jebistven sistem ugodja, odvisnost pa je povezana sspremembami zgradbe in prilagajanja možganov na mikroin makro ravni (Nestler, 2001).
In any case, comorbidity is notoriously difficult todiagnose. Drug addiction and the disruptive behaviour itcauses often dominates the clinical picture and disguisespsychiatric symptoms.
Znano dejstvo je, da je komorbidnost zelo težko ugotoviti.Odvisnost od drog in razdiralno vedenje pogostoprevladujeta v klinični sliki in prikrivata psihiatričnesimptome.
In addition, substance abuse cancause psychiatric symptoms that are barely distinguishablefrom those of psychiatric disorders (Berthel, 2003), whilesubstance withdrawal or acute intoxication can also mimicalmost any such disorder (Liappas, 2001).
Poleg tega lahko zloraba snovi povzročipsihiatrične simptome, ki se jih komaj loči od tistih pripsihiatričnih motnjah (Berthel, 2003), medtem koodtegnitev snovi ali akutna zastrupitev lahko posnemataskoraj vsako tako motnjo (Liappas, 2001).
Furthermore,depression and anxiety can be viewed as inherentsymptoms of the intoxication–withdrawal cycle; symptomsthat used to be alleviated by drugs become manifest in thecourse of abstinence or substitution treatment.
Nadalje sedepresija in anksioznost lahko obravnavata kot inherentnasimptoma cikla zastrupitve-odtegnitve; simptomi, ki jih jeuživanje drog ublažilo, postanejo vidni med abstinenco alinadomestnim zdravljenjem.
Other theories link specific drugs to specific mentaldisorders, e.g. it has been postulated that heroin couldreduce stress, alleviate pain and abolish menacing voices inschizophrenic and borderline schizophrenic patients;however, patients with severe mental illnesses do not useheroin.
Druge teorije povezujejo posamezne droge z določenimiduševnimi motnjami, npr. domnevalo se je, da heroin lahkozmanjša stres, olajša bolečino in prepreči grozeče glasovepri bolnikih s shizofrenijo ali mejno shizofrenijo tipa“borderline”; vendar bolniki s hudo duševno boleznijo neuživajo heroina.
Cocaine, it is suggested, could lighten depressivestates, allow behavioural disinhibition and permitnarcissistic personalities to act out grandiosity. Cannabiscould relieve tension and ecstasy ease social inhibitions(Verheul, 2001; Berthel, 2003).
Za kokain pravijo, da lahko olajšadepresivna stanja, dopušča vedenjske motnje in dovoljujenarcističnim osebnostim, da izživijo svoj občutek veličastnosti.Konoplja lahko zmanjša napetost, ekstazi pa lahko olajšasocialne inhibicije (Verheul, 2001; Berthel, 2003).
The 2002 Irish national report specifically examineddepression among drug users, based on the results ofseveral studies, and concluded that there is a strongassociation between problem drug use, in particular use ofopiates and benzodiazepines, and high rates of depression.German research into the relationship between substancedisorders, depression and suicide concluded that the risk ofsuicide is greatly increased in those with a depressive
V irskem nacionalnem poročilu za leto 2002 so na podlagirezultatov različnih študij posebej preučili depresijo meduživalci drog in ugotovili močno povezavo medproblematičnim uživanjem drog, zlasti uživanjem opiatov inbenzodiazepinov, ter visokimi stopnjami depresije. Nemškaraziskava o povezavi med motnjami zaradi uporabe snovi,
Methodological advances have also improved the diagnosisof both psychiatric and substance use disorders.
Metodološki napredek je izboljšal tudi ugotavljanjediagnoze pri psihiatričnih motnjah in motnjah, povezanih zzlorabo snovi.
A widerange of standardised and validated instruments are nowavailable to measure psychiatric symptoms and personalitydisorder, as are various instruments that assess the level ofdrug use patterns and addiction.
Sedaj je na voljo široka izbirastandardiziranih in potrjenih instrumentov za merjenjepsihiatričnih simptomov in osebnostnih motenj, kot sorazlični instrumenti, ki pri uživanju drog ocenijo stopnjovzorcev in odvisnosti.
The addiction severity index(ASI) is a multifunctional instrument that can be used indiagnosis, treatment planning and follow-up, and research.The ASI has the advantage of being multidimensional,measuring past and current problems in seven areas: healthstatus, employment and self-support, alcohol use, drug use,legal status, family and social relationships and psychiatricsymptoms (Krausz, 1999a; Öjehagen and Schaar, 2003).
Indeks stopnje odvisnosti (ASI) jevečnamenski instrument, ki ga lahko uporabljamo pripostavljanju diagnoz, načrtovanju zdravljenja innadaljnjem spremljanju ter pri raziskavah.
Itis standardised and has been translated from English into
Prednost ASI jev tem, da je večdimezionalen, saj meri pretekle in sedanje
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To je v skladuspovečanjem uživanja drog, čeprav se ne navajaneposredna vzročna povezava.
Annual report 2004: the state of the drugs problem in the European Union and Norway most other European languages (EuroASI) (172
probleme na sedmih področjih: zdravstvenem statusu,zaposlitvi in samostojnem preživljanju, uživanju alkohola,uživanju drog, pravnem statusu, družinskih in družbenihodnosih ter psihiatričnih simptomih (Krausz, 1999a;Öjehagen in Schaar, 2003).
The Spanish national report notes that the observedincrease in comorbidity might partly be due to an increasein dependence on psychostimulants.
Špansko nacionalno poročilo poudarja, da je zaznanopovečanje komorbidnosti deloma posledica povečanjaodvisnosti od psihostimulansov.
Prevalence of comorbidity in treatment settings
Razširjenost komorbidnosti v enotah za zdravljenje
Table 7 gives details of some studies of comorbidity indifferent drug treatment and psychiatric settings in Member States as presented in the national reports.
Tabela 7 prikazuje podatke nekaterih študij komorbidnostiv različnih enotah za zdravljenje odvisnosti od drog inpsihiatričnih enotah v državah članicah, kakor so bilipredstavljeni v nacionalnih poročilih.
Data onsubstance disorders in psychiatric settings are not as readilyavailable as data on psychiatric disorders in drug treatmentsettings.
Podatki o motnjah,povezanih z zlorabo snovi v psihiatričnih enotah niso takodosegljivi kot podatki o psihiatričnih motnjah v enotah zazdravljenje odvisnosti od drog.
Although the studies presented in this review arenot comparable, they do give an indication of the situationin EU countries.
Čeprav študije,predstavljene v tem pregledu, niso primerljive, vendarlepokažejo stanje v državah EU.
There is considerable divergence in thepopulations studied, the diagnostic criteria selected, theinstruments used and the time of diagnosis.
Obstaja občutna razlikavpreučevanih populacijah, izbranih diagnostičnihkriterijih, uporabljenih instrumentih in času postavljenediagnoze.
For reasonsdiscussed above, under-diagnosis is likely in many cases.
Zaradi zgornjih razlogov je v mnogih primerihmožna poddiagnoza.
Numerous studies have been carried out to measure theprevalence of psychiatric and personality disorders as wellas drug use patterns in the general population as well asamong psychiatric patients and drug users in and outsidetreatment services.
V pregledu različnih študij sta Uchtenhagen in Zeiglgänsberger (2000) ugotovila, da je najbolj običajnapsihiatrična diagnoza med uživalci drog osebnostnamotnja, ki prizadene od 50% do 90% uživalcev.
In a review of different studies, Uchtenhagen and Zeiglgänsberger (2000) concluded that the most commonpsychiatric diagnosis among drug users is personalitydisorder, affecting 50–90%, followed by affective disorder(20–60%) and psychotic disorders (20%).
Temusledijo čustvena motnja (20% – 60%) in psihotične motnje(20%).
Between 10 and50%of patients exhibit more than one psychiatric orpersonality comorbidity disorder.
Med 10% in 50% bolnikov izkazuje več kot enopsihiatrično ali osebnostno komorbidnostno motnjo.
In a review of international studies on psychopathology indrug-dependent subjects, Fridell (1991, 1996) outlined aclinical picture of comorbidity in drug addiction that hasbeen confirmed by his own studies in Lund, Sweden.
V pregledu mednarodnih študij o psihopatologiji inodvisnikov od drog je Fridell (1991, 1996) opisal kliničnosliko komorbidnosti pri odvisnosti od drog, ki so jo potrdilenjegove študije v Lundu na Švedskem.
Threemain groups of disorders could be identified: personalitydisorders (65–85%), depression and anxiety states(30–50%), and psychoses (15%).
Motnje je mogočeuvrstiti v tri skupine: osebnostne motnje (65% – 85%),depresija in anksiozna stanja (30% – 50%) ter psihoze(15%).
Verheul (2001), in hisoverview of six studies of treated addicts, found thatantisocial (23%), borderline (18%) and paranoid (10%)personality disorders were particularly prevalent.
Verheul (2001) je v svojem pregledu šestih študijo zdravljenih odvisnikih ugotovil, da posebej prevladujejoantisocialne (23%), mejne (18%) in paranoidne (10%)motnje osebnosti.