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Substance use in a sample of medical patients.

A number of the Iranian patients use substances such as opium and tobacco for therapeutic purposes. Opium was known to the ancient Persians and has been traditionally used for relieving pain, treating diseases and also for enjoyment. Drug abuse remains a crime in Iran, but the authorities are now willing for substance dependence to be treated as a psychiatric disorder. Substance abusers undergoing treatment are no longer prosecuted, nor are the specialists who are treating them. Costs of treatment, medication and rehabilitation are paid by patients according to the approved tariffs, but the government will pay the costs for those unable to afford treatment (Drug Control Headquarters 1997). Alcohol is prohibited both by religion and law. Other illicit substances include opium, heroin, morphine, cocaine, stimulants, LSD, cannabis, and hallucinogens.

The State Welfare Organization, which is affiliated to the Ministry of Health, Treatment, and Medical Education, is in charge of treatment and rehabilitation of substance-dependent patients. At the present time, there are many treatment and rehabilitation centers in Iran, but in 1999 there were 12 treatment and rehabilitation centers in Iran, with one center specifically for women. Up until 1999, in four years approximately 25,000 to 30,000 individuals were admitted to these centers (90% of these referrals were ordered by courts; Razzaghi et al. 1999). The treatment was residential with the average duration of stay from two to six months. The centers were described as having the infrastructure of an overcrowded prison. Since that time outpatient treatment has been introduced and was initially based on detoxification with clonidine and tranquilizers, but more recently with buprenorphine or methadone. The usual duration of treatment is between three to six months, but on occasions it may be extended to two years. The treatment includes individual therapy, family therapy, and group therapy. Relapse rates are estimated to vary between 60% to 80%. Recently self-referral centers have developed across the country, as have Narcotic Anonymous groups, which now have approximately 5,000 members (Razzaghi et al. 1999).

In 1999, the number of intravenous drug users was between 200,000 and 300,000 of whom 1,841 were estimated to be to suffering from HIV infection; 74.8% of all those suffering from HIV infection are intravenous drug users (Drug Control Headquarters 2001; Moore 2001; Razzaghi et al. 1999).

Limited information is available about substance use disorders in Iran. A recent study showed that 3.8% of Iranian women were cigarette smokers (Ahmadi et al. 1999). An earlier study concluded that the opium addiction rate was 7%, and the rate of registered opium addicts was 1% in a rural population of the northern part of Iran (Alemi 1978).

Some Iranian patients who are medically ill use substances such as opium, tobacco, etc. to treat their disease, to relieve pain or reduce stress. Therefore it is of interest to assess substance use among them. This study evaluated the rate of substance use (except for legal medical drugs prescribed by a physician) among patients who were admitted in different wards at Shiraz Hospitals.

MATERIALS AND METHODS

Procedure

Six hundred and twenty two inpatients (equal numbers of men and women) on a stratified multistage probability sample of patients were chosen by area and cluster random sampling. To have a sample representing different groups, the subsamples were selected from different wards of different hospitals affiliated to Shiraz University of Medical Sciences in Shiraz city from January through September in 2001. Of the 622 randomly selected subjects, 22 were excluded due to incomplete information or lack of participation in the study. The characteristics of the excluded subjects were not significantly different from other subjects. The overall response rate was 96.46% with 600 participants (300 men and 300 women).

All the patients were interviewed by the researchers by means of a structured questionnaire, including DSM-IV criteria for substance dependent disorder (APA 1994). They were asked to identify their demographic characteristics such as age, sex, and marital status, and also to explain what substance(s) were used for the first time, reason/ motivations(s) for substance use, and also explain what substance(s) were currently used (except for legal medical drugs prescribed by a physician), and motivation for current use (defined as use at least within the past month).

Sample

The data were gathered from 600 inpatients, selected randomly (300 men and 300 women) whose mean age was 45.28 years (SD = 18.89). The mean ages for men and women were 45.81 years, (SD = 19.54) and 44.74 years, (SD = 18.24), respectively (P = 0.49). In this group, 76.7% of the men and 83.7% of the women were married ([chi square] = 4.62, P = 0.031).

Analysis

The SPSS program was used for data analysis. Chisquare and Fisher's Exact Test (FET) were used to compare the frequencies and t-test was used to compare the means.

FINDINGS

Table 1 gives the frequency of subjects who reported substance use once or more in their lives. About 40.8% (58.3% of men and 23.3% of women) reported the use of substance(s) once or more in their lives. The majority (38.7%) used cigarettes; 9.7% used opium. Nobody used LSD or cocaine. The mean ages for users and nonusers were 49.34 years, (SD = 18.07) and 42.47 years, (SD = 18.95), respectively (P < 0.001).

Table 2 summarizes the frequency of patients who reported current substance use. About 30.3% (43.7% of men and 17% of women) were current substance users. The majority (29%) were nicotine users, and 7.2% were opium users. The mean ages for current users and nonusers were 46.38 years, (SD = 18.08) and 44.79 years (SD = 19.23), respectively (P = 0.35).

The motivation or reasons for patients' first use of substance(s) are summarized in Table 3. Enjoyment (27.5%) was the first cited reason for substance use. Modeling (imitation of others) (13.3%) was the second most common reason given.

Table 4 shows the motivation or reasons for currently using substance(s). The majority (17.5%) reported habit as the reason for taking the substance. Enjoyment (8.2%) was the second most common reason listed, and only 5.8% reported need (i.e., avoiding withdrawal symptoms).

DISCUSSION

The relationship between having a physical illness and drug use is well known. Depression and anxiety are found to be high among patients with chronic diseases such as rheumatic diseases, diabetes, hypertention, malignancies, cardiovascular diseases, etc.

Tobacco use was found to be the most prevalent form of substance use among medical patients. Opium was the second most common drug used. In this study nobody reported usage of cocaine, LSD or other hallucinogens. It appears that western attitudes toward drugs have had little effect on the pattern of substance use in Iran.

Our study identified that males were at greater risk than females for substance use. This difference is in contrast with studies conducted in the West showing that lifetime substance use did not vary significantly by sex (Gulliver et al. 2000. It should be noted that Iranian people (especially women) culturally dislike substance use.

It should also be mentioned that this research was confined to Shiraz, and care must therefore be taken not to generalize these findings to the full Iranian patient population. However, the present work is the first scientific population based study of substance use. It will serve as a basis for prevention and treatment strategies.

It is hoped this information will influence the planning of prevention and treatment strategies.

CONCLUSION

Tobacco and opium were the most commonly used substances. Use of substances was significantly higher in males. There was no report of LSD, cocaine or hallucinogens use. These results can be considered for preventive and therapeutic programs.

REFERENCES

Ahmadi, J.; Khalili, H.; Jooybar, R.; Namazi, N. & Mohammadaghaei, P. 1999. Epidemiology of cigarette smoking among Iranian general population. Paper presented at World Psychiatric Association, Regional Congress, Preventive Psychiatry. Athens, Greece.

Alemi, A.A. 1978. The iceberg of opium addiction: An epidemiological survey of opium addiction in a rural community. Drug & Alcohol Dependence 3 (2) : 107-12 .

American Psychiatric Association (APA). 199. Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed. Washington, DC: American Psychiatric Association.

Coleman, E.A.; Honeycutte, G.; Ogden, B.; McMillan, D.E.; O'Sullivan, P.S.; Light, K. & Wingfield, W. 1997. Assessing substance abuse among health care students and the efficacy of educational interventions. Journal of Professional Nursing 13 (1): 28-37.

Drug Control Headquarters, International Relations Office. 2001. The National Drug Control Report-2000. Tehran, Islamic Republic of Iran: Drug Control Headquarters.

Drug Control Headquarters. 1997. The Anti Narcotics Law of the Islamic Republic of Iran (as Amended November 1997). Tehran: Drug Control Headquarters.

Gulliver, S.B.; Kalman, D.; Rohsenow, D.J.; Colby, S.M.; Monti, P.M. & Eaton, C.A. 2000. Smoking and drinking among alcoholics in treatment: Cross-sectional and longitudinal relationships. Journal of Studies on Alcohol 61 (1): 157-63.

Moore, M. 2001. Iran: Once hidden, drug addiction is changing Iran. Washington Post 18 July: 26.

Razzaghi, E.; Rahimi, A.; Hosseini, M. & Chatterjee A. 1999. Rapid Situation Assessment (RSA) of Drug Abuse in Iran. Tehran, Islamic Republic of Iran: Prevention Department, State Welfare Organization, Ministry of Health, I.R. of Iran and United Nations International Drug Control Program.

Jamshid Ahmadi, M.D., Professor of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.

Leila Benrazavi, M.D., General Practioner, Shiraz University of Medical Sciences, Shiraz, Iran.

Mohammadali Babaeebeigi, M.D., Associate Professor of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Ahmad Ghanizadeh, M.D., Associate Professor of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran.

Mohammadjavad Ghanizadeh M.D., Sadooghi Yazd University of Medical Sciences, Yazd, Iran.

Saxby Pridmore, M.D., Professor of Psychiatry, Center for Remote Health, Flinders University, Alice Springs, Australia.

Please address correspondence and reprint requests to Jamshid Ahmadi, M.D., P. O. Box 71345-1416, Department of Psychiatry, Shiraz University of Medical Sciences, Shiraz, Iran. Email: ahmadij@sums.ac.ir
TABLE 1
Number of Subjects who Reported Use of Substance at Least
Once or More in their Lives

Substance Used Never Used

 Number Percent Number Percent Test
Cigarette
 Male 167 55.7 133 44.3 [chi square]
 Female 65 21.7 235 78.3 73.11
 Total 232 38.7 368 61.3
Opium
 Male 54 18 246 82 [chi square]
 Female 4 1.3 296 98.7 47.71
 Total 58 9.7 542 90.3
Heroin
 Male 6 2 294 98 FET
 Female 0 0 300 100
 Total 6 1 594 99
LSD
 Male 0 0 300 100
 Female 0 0 300 100
 Total 0 0 600 100
Cocaine
 Male 0 0 300 100
 Female 0 0 300 100
 Total 0 0 600 100
Hashish
 Male 7 2.3 293 97.7 EFT
 Female 0 0 300 100
 Total 7 1.2 593 98.8
Marijuana
 Male 2 0.7 298 99.3 EFT
 Female 0 0 300 100
 Total 2 0.3 598 99.7
Morphine
 Male 1 0.3 299 99.7 EFT
 Female 0 0 300 100
 Total 1 0.2 599 99.8
Total
 Male 175 58.3 125 41.7 [chi square]
 Female 70 23.3 230 76.7 76.05
 Total 245 40.8 355 59.2

Substance

 DF Significance
Cigarette
 Male 1 0.00000
 Female
 Total
Opium
 Male 1 0.00000
 Female
 Total
Heroin
 Male 0.03047
 Female
 Total
LSD
 Male
 Female
 Total
Cocaine
 Male
 Female
 Total
Hashish
 Male 0.01508
 Female
 Total
Marijuana
 Male 0.49917
 Female
 Total
Morphine
 Male 1.00000
 Female
 Total
Total
 Male 1 0.00000
 Female
 Total

These testings were the difference between male and female.
Respondents were allowed to list more than one answer
(substance).

TABLE 2
Number of Subjects who Reported Current Use of Substance

 Current Users Non users Test

Substance Number Percent Number Percent

Cigarette
 Male 125 41.7 175 58.3 [chi square]
 Female 49 16.3 251 83.7 46.75
 Total 174 29 426 71
Opium
 Male 41 13.7 259 86.3 [chi square]
 Female 2 0.7 298 99.3 38.1
 Total 43 7.2 557 92.8
Heroin
 Male 4 1.3 296 98.7 EFT
 Female 0 0 300 100
 Total 4 0.7 596 99.3
LSD
 Male 0 0 300 100
 Female 0 0 300 100
 Total 0 0 600 100
Cocaine
 Male 0 0 300 100
 Female 0 0 300 100
 Total 0 0 600 100
Hashish
 Male 5 1.7 295 98.3 EFT
 Female 0 0 300 100
 Total 5 0.8 595 99.2
Marijuana
 Male 2 0.7 298 99.3 EFT
 Female 0 0 300 100
 Total 2 0.3 598 99.7
Morphine
 Male 1 0.3 299 99.7 EFT
 Female 0 0 300 100
 Total 1 0.2 599 99.8
Total
 Male 131 43.7 169 56.3 [chi square]
 Female 51 17 249 83 50.47
 Total 182 30.3 418 69.7

 DF Significance

Substance

Cigarette
 Male 1 0.00000
 Female
 Total
Opium
 Male 1 0.00000
 Female
 Total
Heroin
 Male 0.12375
 Female
 Total
LSD
 Male
 Female
 Total
Cocaine
 Male
 Female
 Total
Hashish
 Male 0.06146
 Female
 Total
Marijuana
 Male 0.49917
 Female
 Total
Morphine
 Male 1.00000
 Female
 Total
Total
 Male 1 0.00000
 Female
 Total

These testings were the difference between male
and female. Respondents were allowed to list
more than one answer (substance).

TABLE 3
Reasons for Subjects who Reported Use of
Substance at Least Once

Reason Number Percent [chi square]

Modeling
 Male 57 19 16.67
 Female 23 7.7
 Total 80 13.3
Enjoyment
 Male 130 43.3 75.44
 Female 35 11.7
 Total 165 27.5
Release of Tension
 Male 24 8 2.8
 Female 14 4.7
 Total 38 6.3
Depression
 Male 15 5 1.043
 Female 10 3.3
 Total 25 4.2
Other
 Male 16 5.3 5.97
 Female 5 1.7
 Total 21 3.5

Reason D.F. Significance

Modeling
 Male 1 0.00004
 Female
 Total
Enjoyment
 Male 1 0.00000
 Female
 Total
Release of Tension
 Male 1 0.09371
 Female
 Total
Depression
 Male 1 0.30701
 Female
 Total
Other
 Male 1 0.01454
 Female
 Total

These testings were the difference between
male and female.

TABLE 4
Reasons For Subjects who Reported Current
Use Of Substance

Reason Number Percent [chi square]

Habit
 Male 78 26 30.02
 Female 27 9
 Total 105 17.5
Need (Avoid Withdrawal
 Symptoms)
 Male 30 10 18.96
 Female 5 1.7
 Total 35 5.8

Enjoyment
 Male 31 10.3 3.75
 Female 18 6
 Total 49 8.2
Release of Tension
 Male 21 7 5.05
 Female 9 3
 Total 30 5
Depression
 Male 13 4.3 1.23
 Female 8 2.7
 Total 21 3.5
Other
 Male 6 2 3.49
 Female 1 0.3
 Total 7 1.2

Reason D.F. Significance

Habit
 Male 1 0
 Female
 Total
Need (Avoid Withdrawal
 Symptoms)
 Male 1 0.00001
 Female
 Total

Enjoyment
 Male 1 0.5263
 Female
 Total
Release of Tension
 Male 1 0.02459
 Female
 Total
Depression
 Male 1 0.26670
 Female
 Total
Other
 Male 1 0.06195
 Female
 Total

These testings were the difference between
male and female.
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Article Details
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Title Annotation:Short Communication
Author:Ahmadi, Jamshid; Benrazavi, Leila; Babaeebeigi, Mohammadali; Ghanizadeh, Ahmad; Ghanizadeh, Mohammad
Publication:Journal of Psychoactive Drugs
Article Type:Report
Geographic Code:7IRAN
Date:Sep 1, 2008
Words:2541
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