Introduction: Recurrence or returning to narcotics in treated addicts is a common phenomenon. The purpose of this study was to investigate some of the effective factors in drug returning in methadone-treated patients, referring to addiction treatment centers in Birjand.
Methods: This is a descriptive-analytic study in which, has been investigated 200 addicts, referred to addiction treatment centers in Birjand in their first year of treatment or at least have a positive addiction test in their case or have a history of drug rehabilitation. The data collection tool is a self-made questionnaire by the implementer whose validity and reliability have been confirmed. Data were analyzed using SPSS 16 software, independent t-test and ANOVA, Chi-square and Fisher’s exact test at 0.05> α level.
Results: 200 people entered this study. The mean age of the addicts in this study was 38.4 ± 12.68. Most participants were male (175, 87.5%). In terms of marital status, 159 (79.5%) were married. In this study, 139 people (69.5%) used opium / syrup. There was no significant relationship between the personal and environmental factors with sex, marriage, age beginning of drug use, and type of drugs. In the study, did not show any significant relationship between individual and environmental factors with the way of use, dose used, use of the first dose, preservative dosage, history of quitting, number of quitting, sufficiency of preservative dosage and residence. Statistical test results did not show significant relationship between personal factors with history of using other drugs, but there was a significant relationship between environmental factors and this variable.
Discussion: Recurrent drug addiction is one of the factors influencing addiction. Which can be categorized as individual factors (temptation, depression, illness, pleasure, lack of confidence, independence, lack of personality and hopelessness, lower education), family factors (One or more family members ‘addiction, family differences, parenting protection weaknesses, parents’ low education), social factors (school environment, unsuitable friends, unhealthy leisure, unemployment, lack of social acceptance, cultural poverty, population growth, excessive migrations), and Geographical and economic factors (ease of access to drugs, poverty and economic crisis, unemployment and fleeing from life problems).
Few phenomena can be found that threaten human societies like addiction. Despite the dangers and complications of addiction, the number of victims of this trap of death is increasing every day. Moreover, seeing its scary scenes, were not serious warning to avoid other people, especially young people in the community. (1) Cultural, social, attitudes and perspectives in each society, especially about the problem of addiction, can expose different groups of people in each society to drug abuse. (2)
The collapse of individual character, the destruction of the family institution, the increase of other types of injuries and social crimes, the efficiency reduction of job and occupation, the increasing unemployed people and overcrowding, the occupancy of hospital beds, the reduction of public health and dozens of other complications all have a complete dependence on the amount of addicts in community.
In Iran, due to its proximity to Afghanistan as the world’s largest producer of poppy and opium, opium and other derivatives of this substance are the most consumed, so that Iran is considered the world’s biggest opium consumer. (3) The latest statistics estimated that there are two million dependent addicts and six million recreational addicts in Iran, but according to available evidence, it is estimated that the number of addicts is much higher than this and if we consider the average household size in Iran for five, at least 10 million people are prone to addiction. (4) According to the Ministry of Health and the Welfare Organization, annually adds about 8% to drug users in the country. (5) Now, on average, 45% of prisoners in the country have been formed as drug detainees, while 70% of drug offenders in prisons are married. (6)
Over the past decade, there has been identified several risk factors for drug abuse among people. These factors include high familial conflicts, academic problems, simultaneous psychiatric disorders such as conduct disorder and depression, the consumption of drugs by peers and parents, impulsivity and early smoking. The higher the number of risk factors in a person, the more likely is to use drugs. (7)
To some people, continuous drug abandonment for who have been consuming many drugs for long time, seems to be an exception than a rule. (8) Methadone preservative treatment is a form of treatment that is used by opioid users. Although the search for other forms of opioid dependence treatment continues, methadone preservative treatment is still the most widely used (9). It seems that a small percentage of people with opioid dependence are treated with methadone and, on the other hand, a group of patients who have been treated, despite repeatedly experiencing this treatment, again left treatment incomplete or use drug during treatment. In the previous studies, recurrence factors of addiction are the same factors that are effective in addiction. Which can be categorized as individual factors (spiritual poverty, depression, illness, pleasure, lack of confidence, independence, lack of personality and hopelessness, lower education ), Family factors (one or more family members ‘addiction, family differences, parenting protection weaknesses, parental unemployment, especially father unemployment, parents’ low level of education), social factors (school environment, unsuitable friends, unhealthy recreation, unemployment, lack of social acceptance, cultural poverty, population growth, excessive migrations) and geographic and economic factors (residence in drug trafficking routes, ease of access to drugs, poverty and economic crisis, unemployment and escape from the problems of life).
The lack of planning for the employment of addicts, lack of knowledge about ways to cope with life problems, contaminated social environment, addicted friends, not filling leisure time, lack of participation in group therapy, anxiety, depression and low level of hope, are the most important causes of recurrence of addiction. (10) Other studies indicate that complementary activities such as psychotherapy, group therapy, occupational therapy, exercise therapy, faith therapy, and finally family therapy, in addition to medication, reduce the chance of recurrence from 25% to 2%. (11) From a psychiatric and medical point of view, an addict is a patient and his illness is like any other illness and needs primary and secondary prevention measures. (12)
Using the views of people with drug abuse during treatment with methadone can be effective way to understand the causes of returning to addiction. Considering the regional differences in thoughts, beliefs and opinions of people, and the proximity of the city of Birjand to the eastern borders of the country and the relatively high rates of addicts, we determined the effective factors in recurrence of drugs in patients treated with methadone referred to addiction treatment centers in Birjand. So that we can assist the relevant authorities in helping to plan for preventing drug use in methadone-treated patients. The purpose of this study was to evaluate the recurrence of drug use and its related factors in methadone-treated patients referred to addiction treatment centers in Birjand.
Recurrence factors of addiction are the same factors that are effective in addiction. Which can be categorized as individual factors (spiritual poverty, depression, illness, pleasure, lack of confidence, independence, lack of personality and hopelessness, lower education ); Family factors (one or more family members ‘addiction, family differences, parenting protection weaknesses, parental unemployment, especially father unemployment, parents’ low level of education); social factors (school environment, unsuitable friends, unhealthy recreation, unemployment, lack of social acceptance, cultural poverty, population growth, excessive migrations) and geographic and economic factors (residence in drug trafficking routes, ease of access to drugs, poverty and economic crisis, unemployment and escape from the problems of life).
In the end, it is worth noting that in this study, despite attempting to complete the questionnaire and reviewing the most important re-addiction factors, we were not able to investigate all factors, and it is suggested that in future plans, the number of recurrence and the duration of cleanness (non-use of the drug) compared with these factors. In addition, due to the non-random approach of this study and considering the limitations of this method, it is suggested that random research should be carried out in future studies
This article is an excerpt from the doctoral thesis of General Medicine student, Mr. Hamid Jafarzadeh. We are thanked of the supervisors, advisors and all the patients who collaborated on the implementation of this study.
- Farjad MH. Addiction (Complete and practical manual for families). First Ed. Tehran: Badr publication; 1998. P. 14, 18, 82.
- Shaikhavandi D.Sociology of Misdemeanour. Tehran: Ofogh Publishers; 2004.
- Senior Lecturer in Economic Sciences, Employee of Shahid Bahonar University of Kerman, Kerman, Iran
- Raedi M, Rezaee F. A guildline on prevention of addiction in family.3th edition. Sanandaj: Department of Cultural Affairs and Prevention Welfare Organization of Kurdistan; 2000
- Maleki FH. Close road of Addiction in Iran. Ebtekar newspaper. 2006 December 7.
- Sadeghieh Ahari S, Azami A, Amani F, Sedigh A. Factors affecting the relapse among the patients referring voluntarily to addictionabandoning centers, 2000. Journal of Ardabil University of Medical Sciences (JAUMS). 2004 June-September; 3(12):36-40.
- Hakala C. Kaplan AP Psychology. NewYork:Kaplan Inc; 2013
- Program UNIDC. Addiction: Inclined factors, health hazards, prevention and treatment. Tehran: Poorsina, 2000:204-7.
- Brands B, Marsh D, Heart L, Jamiesan W. Health Canada Literature review. Methadone Maintrance Therapy. Ottawa:Miniser of public works and Government Services. Canada, 2002; PPI-94.
- Narimani M, Sadegiye Ahari S. Recurred addiction and ways to deal with it. First Ed. Ardabil: Department of Culture and Islamic Guidance; 2004. (Persian).
- Yegane B. Reducing the risk of recurred addiction from 25 to 2 percent with complementary therapy. Tehran: Iranian Students New Agency; 2007.
- Yonesi J, Mohammadi MR. Using the approach of publishing information on programs to prevent drug addiction among teenagers. Daneshvar Raftar J 2006; 13 (16):1-10. (Persian).
- Karrari P, Mehrpour O, Afshari R, Keyler D. Pattern of illicit drug use in patients referred to addiction treatment centres in Birjand, Eastern Iran. JPMA. The Journal of the Pakistan Medical Association. 2013, 63(6), 711-716.
- Hosseini F, Yassini M, Ahmadieh M, Vafaei_Nasab F, Kholasezadeh G, Dastjerdi G. Retention Rate in Methadone Maintenance Therapy. Journal of Shaeed Sdoughi University of Medical Sciences Yazd. 2010;18(3):152-158
- Mir Ahmadi AR, Javadi A, Hemmati AR. New epidemiologic findings in AIDS in 2003, annual WHO/UNAIDS Report.P. 27. [Persian]
- Kaplan HI, Freedman AM, Sadock BJ. Comprehensive textbook of psychiatry. 9th ed. University of Michigan: Williams &Wilkins;.2009. P. 1380-432.
- D Ippoliti D, Davoli M, Perucci CA, Pasqualini F, Bargagli AM. Retention in treatment of heroin users in Italy: the role of treatment type and of methadone maintenance dosage. Drug and Alcohol Dependence. 1998; 52(2): 167-71.
- Nastizayi N, Hezareh Moghadam M, Mollazehi A. The Study of Factors for Recurred Addiction from the View of Self-Introduced Addicts to the Addiction Abandonment Centers of Zahedan. Journal of Nursing and Midwifry, Urumia University of Medical Sciences. 2011;8(3):164-174
- . Abdollahi Z, Taghizadeh F, Hamzehgardeshi Z, Bahramzad O. Relationship between Addiction Relapse and Self-Efficacy Rates in Injection Drug Users Referred to Maintenance Therapy Center of Sari, 1391. Global Journal of Health Science; 2014;6(3):138-144
- Mirzaei T, Ravary A, Hanifi N, Miri S, Oskouie F, Mirzaei Khalil Abadi S. Addicts’ Perspectives about Factors Associated with Substance Abuse Relapse. IJN. 2010; 23 (67) :49-58
- Otary M, Otart A. Addiction: prevention & treatment. Mashhad: ketab darmani 2004:81-3.
- Elgeili ES, Bashir TZ. Precipitants of Relapse among Heroin Addicts. Addict Disord Their Treat. 2005. 4(1):29-38
- Mutasa HCF. Risk factors associated with noncompliance with methadone substitution therapy (MST) and relapse among chronic opiate users in outer London community. JAN. 2001 35:1.
- Jackal I. Addiction relapse. 2005 [cited 2013 December 7]; Available from: http://jackal inta.net. au/prev
- Amini K, Amini D, Afshar M, Azar M. A study on social and environmental factors, which made addicts to relapse into drug abuse in Hamedan. J Zanjan Univ Med Sci Health Serv. 2004; 11(45):41-7. [Persian]
- Ghorban Hosseini AA. New Research in Addiction and Addictive substances. Tehran: Sepehr, 1989:308-11. [Persian]
- Sharg A, Shakibi A, Neisari R, Aliloo L. Survey Of Factors Related To The Relapse Of Addiction From View Of Addict Patients Attending To Drug Abuse Treatment Clinics In West Azerbaijan. URMIA MEDICAL JOURNAL. 2011; 22 (2) :129-136
- Taghva A, Kazemi H, Abbas R, Ebrahim M, Mostafazade B. The Relapse Rate, One and Six Months after Detoxification in Opioid Dependent Patients. Ann Mil Health Sci Res. 2009; 7 (1) :35-38
- Amini K, Amini D, Afshar F, Azar M. Social and environmental factors related to relapse in patients addicted to opiate drug addiction to public centers in Hamadan. Journakl of Zanjan University of Medical Sciences. 2002;45(11):40-47
- . Levinson JH, Ruiz P, Millman RB, Langrod JG. Substance Abuse (A Comprehensive Text Book). 3th ed.m Boston: Williams & Wilkins; 1997: 674-81.
- Carroll KM, Rounsaville BJ, Gawin FH. A camparative trial of psychothrapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychothrapy. Am J Drug Alcohol Abuse 1991; 17: 229-47.
- Seraji A, Momeni H, Salehi A. The investigation of factors affecting dependence on narcotics and reappearance of drug usage in narcotics anonymous population in Khomein (2009). Arak Medical University Journal. 2010; 13(3): 68-75
- Krakowski JC, Orebaugh SL. Opioids and Benzodiazepines. In Basic Clinical Anesthesia (pp.139-150). Springer New York. 2015
- Park TW, Saitz R, Ganoczy D, Ilgen MA, Bohnert AS. Benzodiazepine prescribing patterns and drug overdose mortality among individuals receiving opioid analgesics. Addiction science & clinical practice. 2015, 10(Suppl 1), A48.
- Vaughan BR, Kleber HD. Opioid Detoxification. The American Psychiatric Publishing Textbook of Substance Abuse Treatment. 2015
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