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Ardakani SMY, et al, 2013, Journal Addiction
Research & Therapy, S8


Iran has a drug abuse history of several thousand years. Since 400 years ago,
enacted laws banning opium have shown politicians long existed concerns on the
relevant consequences.
Growing trend of drug abuse in todays world as well as its imposed economic,
cultural, and social exorbitant costs on communities, have raised many concerns
among states and international organizations to the extent that Anti-Drug Center
announced that; addiction is considered as one of the world four current
issues and crisis
According to Kaplan Comprehensive Textbook of Psychiatry, in a superficial glance
addiction (drug-dependence) is caused as a result of consuming a specific
substance following an abused consumption pattern

Since 1964, WHO replaced the term Addiction with Opioid-Dependency

Dependency implies: behavioral or psychological dependency, as well as somatic
Addiction and psychological disorders have bilateral correlation. Generalized anxiety,
social phobia, and depression disorders increase the likelihood of risky behaviors
Kaplan: 30 60 % of opioid-addicts participants in various studies were diagnosed
with antisocial personality disorder while such figure in other sample groups is 2 to 3
Mr. Lester from US: on 138 students found that recreational drug abuse is associated
with impulsive behavior, high depression test scores, mania, and anxiety
Based on such notable result it must not be expected that psychiatric disorders only
reflect on long term opioid-dependent individuals.

This study aims to assess behavioral and psychiatric characteristics of those addicts
who have referred to rehabilitation centers, hence to identify and conduct
necessary remedial measures.

Cross-sectional study
Subject: 110 opioid-addicts along with their 110 family members. Patients were selected
following a random cluster sampling method within 22 rehabilitation clinics which were
spread over Yazd city various districts. These individuals were randomly selected based on
similar demographic characteristics (age, gender, education)
Inclusion: at least orientation primary school education level and their treatments have to
be commenced within less than two weeks time
Research tool : SCL-90 Standard questionnaire consists of 90 questions addressing
psychiatric disorders such as; somatization, interpersonal sensitivity, anxiety, aggression,
depression, obsessive-compulsive, psychosis, phobia, paranoia
Individuals are categorized into 4 groups as following; normal, borderline, pathological
sensitivity, and ill.
Analysis: SPSS-16 software; chi-square and t-test at a significance level of 0.05.


Patient group assessment:
-Age range 51 to 59 in all the domains scored the highest excluding anxiety and
interpersonal sensitivity in which, age range 41 to 50 had the highest
-Psychiatric disorders prevalence in opioid-addict patients had no significant
correlation with their age (p>0.05)
Reference group assessment:
-OCD(p=0.019), interpersonal sensitivity (P= 0.028), depression (p=0.003),
anxiety (p=0.023), phobia (p=0.012) higher in age range 31 to 40
-Somatization disorder (p=0.007) higher in age range 51 to 59
-Psychosis, paranoia, and aggression disorders no significant (p>0.05)

Psychiatric disorders assessment within patients group:
-Women had higher average scores in all the nonuple psychiatric disorders
excluding anxiety domain (panxiety=0.048) and aggression (pagression=0.031)
Reference group:
-Mens paranoia and psychosis domains average scores were higher than womens,
not significantly
-Somatization (psomatization=0.014) and anxiety (panxiety=0.03) women scored higher,
statistically significant

Marital status
Patients group: higher average score for singles, no significant discrepancy.
Reference group: higher average scores for married subjects in all the domains,
furthermore; in somatization (psomatization<0.0001), anxiety (panxiety=0.014),
aggression (pagression=0.029), and phobia (pphobia=0.04) statistically

Patients group: no significant discrepancy in any of the domains (p>0.05)

Main substance: opium 52 subjects (47.2%), the least: opium sap 9 subjects
30 subjects (27.2%): heroin, 19 subjects (17.2%): >1 substance
Patients group:
-Consume only opium have higher average scores on somatization, obsessive
compulsive, depression, anxiety, and paranoia
-In other domains, multiple drug had higher scores compared to all
-No significant correlation between psychiatric disorders and the type of
substance (p>0.05)

Drug abuse duration: max 21 years and min 6 months (average of 7.55
5.57 years)

0-1 year: higher scores in all the assessed nonuple psychiatric disorders
10-11 years: had higher average scores on depression domain
Psychiatric disorders prevalence in patients had no significant correlation
with drug abuse duration (p>0.05)

Totally, opioid-dependent patients average scores in all the assessed domains

were higher than their family members, however; on somatization, obsessivecompulsive, interpersonal sensitivity, depression, and anxiety the discrepancies
were statically significant (Table 3).

Prevalence of obsessive-compulsive, somatization, and interpersonal sensitivity,
depression, and anxiety disorders in opioid-addict patients is significantly higher than
their family members
The most common disorder in both patient and reference groups was somatization
The least common disorder was paranoia in patient group and phobia in reference
Opioid-addict women indicated significantly higher anxiety and aggression compared
to men
None of characteristics such as; education, marital status, age, drug type, and
duration had substantial effects on opioid-addict psychiatric disorders prevalence
Further studies found depression as the most common opioid-addict patients disorder,
however; the present study ranked depression as the second common disorder

Women vs men
In this study: prevalence of anxiety and aggression in women of patients group is
significantly higher than men
Jacobs: prevalence of all nonuple psychiatric disorders in women is significantly
higher than men
On the other: anxiety and aggression in normal population is common in women
we cannot say exactly that psychiatric disorders in women is higher due to
addiction. further studies with larger samples are required

Drug abuse duration

Lester et al. and Zoheir-Aldin et al. : drug abuse duration doesnt have significant
influence on psychiatric disorders prevalence
However, seen that the lower the duration, the higher the disorders prevalence
Present study: shorter the duration, the higher the average scores, depression
excluded no significant discrepancy
Long term drug abuse develops kind of adaptability in an individual and reduces
psychiatric disorders

Other supporting researches: psychiatric disorders prevalence in opioid-addict

patients has no significant correlation with education, age and drug type
Ghafarinezhad et al.: have conducted an analogy between 96 opium-dependent and
96 heroin-dependent patients obsessive-compulsive, anxiety, phobia, and
psychosis are significantly higher among heroin-dependent patients
Present study: single patients had higher average scores on all domains compared
to married (no significant discrepancy), while some other studies have suggested
significant discrepancy in this field

Opioid-addict patients had higher psychiatric disorders prevalence than their family
members in all the assessed nonuple domains
Regarding the determining role of psychiatric diseases on opioid-addict patients
treatment results, it is necessary to take into consideration and treat such
psychiatric disorders so to achieve a successful remedy
On the other hand, since psychiatric disorders prevalence, such as depression
among family members is an effective factor toward drug tendency and since
patients family members live with the fellow patient, hence access to drugs
exposes them to higher drug tendency risk compared to the others, therefore; it is
recommended that treatment programs for patients family members to be included
in the framework of care centers.

A higher psychiatric disorders prevalence among the patients compared to their
family members can be explained in a way that their tendency toward drugs is due
to their psychiatric problems and since drug abuse also develops psychiatric
problems, therefore; further studies is recommended to explain the main reason for
such high disorder rate among the patients.