Seyed Mojtaba Yassini Ardakani, Shahin Banaei-Boroujeni* and Ghasem Dastjerdi
Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Received May 19, 2013; Accepted June 14, 2013; Published June 20, 2013
Citation: Ardakani SMY, Banaei-Boroujeni S, Dastjerdi G (2013) Psychiatric Disorders Prevalence Comparison in Opiate-Dependent and Non-Opiate Dependent Individuals. J Addict Res Ther S8:005. doi:10.4172/2155-6105.S8-005
Copyright: © 2013 Ardakani SMY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Introduction: Psychiatric disorders are causes of addicts’ rehabilitation failure, on the other side psychiatric diseases are not objective thus hardly diagnosed by general practitioners who play substantial roles in addiction treatment. To improve the treatment quality offered to opioid-dependent patients, this study aims to assess psychiatric characteristics of those addicts who have referred to rehabilitation centers. Method: These cross-sectional study 110 opioid-addicts along with their 110 family members were assessed. Patients were selected following a random cluster sampling method within 22 rehabilitation clinics. Individuals were randomly selected based on similar demographic characteristics (age, gender, education). Research tool was SCL- 90 Standard questionnaire, the questionnaire consists of 90 questions that addressing 9 psychiatric disorders. Data collection and entry into SPSS-16 software; the analysis was conducted following descriptive and analytical statistics such as chi-square and t-test at a significance level of 0.05. Results: Opioid-dependent patients’ average scores in all the assessed domains were higher than their family members, however; on somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety the discrepancies were statically significant. Conclusion: 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 are recommended to explain the main reason for such high disorder rate among the patients.
Psychiatric disorders; Opioid addiction; Opioid addict; Non-opiate-dependent
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 today's 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" [2,3].
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 ; however, the simplicity cannot address such complicated question on why just a few certain people suffer from drug abuse and drug-dependency? On the other hand, one of behavioral science researchers' main questions is there any specific characteristics which differentiate addicts from ordinary people? Are these characteristics due to drug-induced changes caused by long term drug abuse; or an individual had such trait and characteristics prior to the addiction? How the above components are affected by cultural and social factors?
Since 1964, World Health Organization (WHO) replaced the term "Addiction" with "Opioid-Dependency". Dependency implies two concepts: behavioral or psychological dependency, as well as somatic dependency . It suggests that opioid-dependency is more complicated than what superficially observed. Addiction and psychological disorders have bilateral correlation. Generalized anxiety, social phobia, and depression disorders increase the likelihood of risky behaviors. On the other side, in Kaplan Comprehensive Textbook of Psychiatry, Sadock and Sadock, stated that; between 30 to 60 percent of opioid-addicts participants in various studies were diagnosed with antisocial personality disorder while such figure in other sample groups is 2 to 3 percent . Mr. Lester from United States, in his studies 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.
Iran has the world’s highest opiate consumption rate . To address the issue, experiences of those countries which succeeded in fighting drugs indicate that their success were due to scientific typology of addicts and to apply them in primary and secondary prevention measures . Studies include psychiatric disorders as causes of addicts' rehabilitation failure [7-11], on the other side psychiatric diseases are not objective thus hardly diagnosed by general practitioners who play substantial roles in addiction treatment. To improve the treatment quality offered to opioid-dependent patients, 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.
Throughout this cross-sectional study 110 opioid-addicts along with their 110 family members were assessed. Patients were selected following a random cluster sampling method within 22 rehabilitation clinics which were spread over Yazd city various districts. Due to the high level of cultural and economic similarities within family members, reference groups were selected from each opioid-dependent patient's family members. These individuals were randomly selected based on similar demographic characteristics (age, gender, education). Participants were required to have at least orientation primary school education level and their treatments have to be commenced within less than two weeks time. Subjects who didn't meet the minimum requirements were excluded from the study.
Research tool was SCL-90 Standard questionnaire which its validity and reliability has been confirmed through previous studies [12,13]. The 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.
Further to ethic committee's approval, questionnaires were distributed among participants who followed self-report answering method in two groups.
After data collection and entry into SPSS-16 software; the analysis was conducted following descriptive and analytical statistics such as chi-square and t-test at a significance level of 0.05.
110 opioid-addict patients, age range 21 to 59 years old, participated in this study with an average age of 33.45 ± 8.67 years old. Reference group consisted of 110 individuals, age range 22 to 58 with an average age of 29.52 ± 9.33 years old. Subjects' demographic characteristics as age, gender, education, and marital status were assessed, however; there was no significant correlation between the two groups (Table 1).
In terms of age, prevalence assessment on the nonuple psychiatric disorders within patients' group indicated that; 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. However, there was no significant discrepancy in neither of these disorders. Psychiatric disorders prevalence in opioid-addict patients had no significant correlation with their age (p>0.05). The reference group assessment indicated that obsessive-compulsive disorder (p=0.019), interpersonal sensitivity (P= 0.028), depression (p=0.003), anxiety (p=0.023), phobia (p=0.012) in age range 31 to 40; and somatization disorder (p=0.007) in age range 51 to 59 were significantly higher than the other groups. However, in psychosis, paranoia, and aggression disorders no significant discrepancy were reported in various range groups (p>0.05)
|0.101||41.8||46||48.2||53||Primary school||Educational level|
Table 1: Frequency of demographic data.
Table 2: Drug abuse duration frequency in patients.
In terms of gender, psychiatric disorders assessment within patients' group indicated that women had higher average scores in all the nonuple psychiatric disorders excluding anxiety domain (panxiety=0.048) and aggression (pagression=0.031). Such discrepancies were statistically significant.
Within the reference group, men's paranoia and psychosis domains average scores were higher than women's although not significantly. Within other domains women scored higher than men, furthermore; in somatization (psomatization=0.014) and anxiety (panxiety=0.03) disorders the discrepancy were statistically significant.
In terms of marital status, psychiatric disorders prevalence assessment within the patients' group reported higher average score for singles in all assessed domains, compared to married subjects, however; with no significant discrepancy. The same assessment on the reference group indicated higher average scores for married subjects compared to the singles in all the domains, furthermore; in somatization (psomatization <0.0001), anxiety (panxiety=0.014), aggression (pagression=0.029), and phobia (pphobia=0.04) there were statistically significant discrepancies.
In terms of education, psychiatric disorders prevalence assessment within the patients' group reported no significant discrepancy in any of the domains (p>0.05), however; the assessed disorders had been scored considerably higher within subjects of the reference group with orientation cycle education level, paranoia (pparanoia=0.575) excluded.
The main substance consumed by the patients was opium with a frequency of 52 subjects (47.2%) and the least consumed substance was opium sap with the frequency of 9 subjects (8.2%). 30 subjects (27.2%) mentioned heroin consumption and 19 subjects (17.2%) stated that they consume more than one substance.
In terms of substance, psychiatric disorders prevalence assessment within the patients' group indicated that those who consume only opium have higher average scores on somatization, obsessive compulsive, depression, anxiety, and paranoia, however; in other domains multiple drug consumers had higher scores compared to all the others while no substantial discrepancies were reported in any of the disorders. In fact, there was no significant correlation between psychiatric disorders and the type of substance (p>0.05). Drug abuse duration was ranged between maximum 21 years and minimum 6 months with an average of 7.55 ± 5.57 years (Table 2).
In terms of drug abuse duration, psychiatric disorders prevalence assessment indicated that individuals with 0-1 year of duration had higher scores in all the assessed nonuple psychiatric disorders, however; individuals with 10-11 years of drug abuse duration had higher average scores on depression domain while no substantial discrepancies were reported in any of the disorders. The assessed psychiatric disorders prevalence in patients had no significant correlation with drug abuse duration (p>0.05).
|Pvalue||df||t||Std. Error Difference||Mean Difference||Std. Deviation||Mean||Groups Psychiatric disorder|
Table 3: A comparison between the two groups’ assessed domain average scores.
Totally, opioid-dependent patients' average scores in all the assessed domains were higher than their family members, however; on somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety the discrepancies were statically significant (Table 3).
The study showed that the 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 group. Opioid-addict women indicated significantly higher anxiety and aggression compared to men. However none of characteristics such as; education, marital status, age, drug type, and duration had substantial effects on opioidaddict psychiatric disorders prevalence.
In this study prevalence of anxiety and aggression in women of patients group is significantly higher than men, but Jacobs indicated in his study that 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 , so, we cannot say exactly that psychiatric disorders in women is higher due to addiction. However it seems further studies with larger samples are required.
Lester et al.  and Zoheir-Aldin et al.  indicated in their studies that drug abuse duration doesn't have significant influence on psychiatric disorders prevalence. However, seen that the lower the duration, the higher the disorders prevalence [5,19]. In the present study the shorter the duration, the higher the average scores, depression excluded, however; with no significant discrepancy. It has been suggested that perhaps long term drug abuse develops kind of adaptability in an individual and reduces psychiatric disorders .
Other supporting researches indicated that psychiatric disorders prevalence in opioid-addict patients has no significant correlation with education, age and drug type [20,21]. However, Ghafarinezhad et al., have conducted an analogy between 96 opium-dependent and 96 heroin-dependent patients, through which was suggested that obsessive-compulsive, anxiety, phobia, and psychosis are significantly higher among heroin-dependent patients . However, it seems further studies within a time interval with larger samples are required.
As this study presented, single patients had higher average scores on all domains compared to married, however; with no significant discrepancy, while some other studies have suggested significant discrepancy in this field [3,23].
Totally, this study indicated that 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.
In this research Dr. Ghalebi and Dr. Zare greatly helped us, we are sincerely grateful for their efforts.