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This study examined the prevalence and correlates of HIV risk behaviors among 1, current drug users in China. Chi-squared tests of differences were used to test if drug users differed from non-users; logistic regression was used to identify behavior-specific risk factors. Among drug users, ethnic minorities and migrants were most vulnerable to unprotected casual sex and needle sharing. Drug users who experienced social isolation were associated with lower odds of risk behaviors; those who had experiences of anti-social behaviors and commercial sex, poor HIV knowledge, and perceived greater vulnerability were more prone to unprotected casual sex and needle sharing. Additional risk factors of needle sharing included education and initiated drug use at younger ages. It is imperative that HIV interventions in China target drug users and address behavior-specific risk factors. The sweeping HIV epidemic among drug users has taken place in the context of growing drug consumption and spread of HIV risky drug using and sexual behaviors in contemporary China. The number of registered drug users has been increasing rapidly since the s, reaching one million in ; the actual number of drug addicts being probably many times higher CCTV, While very few in the country injected drugs before , a number of studies have reported sharp increases in the proportion of drug users who inject; among injecting drug users, a growing number share used needles without appropriately cleaning them first Garten et al. In addition, unprotected sex with multiple partners is common among drug users Lau et al. The intermingling of risky drug using and sexual behaviors greatly increases drug users' vulnerability to HIV and also makes them an important source and a critical bridging population in the spread of the AIDS virus to the general population through sexual transmission Lau et al. While the HIV risk among drug users as a group has been well documented, not all drug users engage in HIV risk behaviors to the same extent and are at the same risk of acquiring or transmitting HIV. In a study of heroin users in Guangxi province, Lai and colleagues found that more recent, male, and non-ethnic minority users were at increased risk of injecting drugs Lai et al. Age and age at initiation of drug use were also important predictors of injection drug use Lai et al. Among female drug users, exchange of sex for drugs or money was significantly associated with HIV risk behaviors Wang and Lin, Although more limited, research in China has suggested the important influence of family and peers in risky drug using behaviors. For example, Lai et al. The encouragement from friends to try drugs was the strongest predictor of the initiation of drug use Wu et al. A study in southwestern China among the general population, too, suggested that having family members or friends who used drugs or had risky sexual behaviors was a significant predictor of HIV risk behavior Yang, in press. More studies in western societies have documented the importance of social influence of family and peers Hoffmann et al. More systematic research and better understanding of the social and behavioral correlates of drug users' HIV risk behaviors are critical for designing effective behavioral prevention interventions among drug users in China Yu et al. However, such studies are still limited in China Lau et al. Further, prior studies of risky behaviors among drug users in China were largely based on convenient non-probability samples of largely institutionalized drug users; few had looked at the impact of drug users' social and psychological wellbeing on their HIV risk behavior. The purpose of this paper is to examine the prevalence and risk factors of HIV risk behaviors among a random probability sample of 1, current drug users both in and outside drug rehabilitation institutions in southwestern China. Specifically, we address: which drug users are particularly vulnerable to unprotected casual sex and needle sharing and to what extent these HIV risk behaviors were predicted independently by demographic characteristics, measures of economic and psychosocial wellbeing, behavior-specific characteristics and social influence, and HIV-related knowledge and perceived vulnerability. Data used in the analysis were from a large and population-based survey conducted in , covering an entire province in southwestern China. In total, a population-based and probability sample of 5, individuals 18 to 55 years of age was successfully recruited, who consented to participate and completed a face-to-face interview. However, only the sub-sample of 1, current drug users, which included probability samples of both current drug users enrolled in drug rehabilitation institutions and those lived in communities at the time of the survey will be included in the analysis of risk factors of unprotected casual sex and needle sharing among drug users. Briefly, first, eight counties were selected, considering HIV and drug use prevalence and geographic representation of the province. This resulted in a total of 40 townships and neighborhoods as the primary sampling units PSUs. Finally, in each PSU, all individuals between the ages of 18 and 55 were ordered in sequence in one of four mutually exclusive categories: HIV positive, drug users, migrants, and non-migrants. Target random samples of 20 HIV positive, 30 drug users, 40 migrants, and 60 non-migrants were selected from the corresponding categories in each PSU via disproportionate probability sampling Bilsborrow et al. Because not every PSU had the target number of subjects in all categories, the actual sample size in a category varied across PSUs. During the fieldwork, trained interviewers visited the sampled individuals, explained to them the purpose of the study, their right to refuse, and compensation for their time, and invited them to participate. If the respondent was absent, a second visit was scheduled. If a respondent could not be reached the second time or refused to participate, a replacement was selected randomly from the original sampling list containing the absent or refused respondent unless there was no one left on the list. The main outcome variables were self-reported lifetime and day measures of HIV risk drug using and sexual behaviors, namely, unprotected casual sex and needle sharing while injecting. Independent variables included individual demographic characteristics, economic and psychosocial wellbeing, behavior-specific characteristics and influence, and HIV-related knowledge and perceived vulnerability. Individual demographic and most behavior-specific characteristics are self-explanatory. Economic and psychosocial wellbeing was measured by four composite scales, indicating the extent of economic marginalization, social isolation, and lax social control. The higher the score, the more economically marginalized the individual. Cronbach's alpha for the summative composite score was 0. For the former, survey respondents reported on a four-point scale how lonely they felt on each of 20 statements, while the latter was based on ratings of 20 statements on a four-point scale on the frequency of depressive symptoms experienced in the week prior to the interview. The higher the scales, the more lonely or depressed the respondent felt. Cronbach's alphas for the two scales are 0. Lax social control was measured by a modified version of the Attitudes toward Authority Scale Emler, Answers were then summed to create a lax social control scale. The higher the scale, the more likely the respondent had behaved in anti-social or deviant ways. Cronbach's alpha for the scale is 0. Behavior-specific social influence was measured by respondents' self-report of having family members or peers with HIV risk behaviors. For sexual behavior influence, respondents reported separately on whether they knew if parents, siblings, relatives, and friends had multiple sexual partners, homosexual behavior, and exchanged sex for money or drugs. For drug influence, respondents answered separately whether they had parents, siblings, relatives, and friends known to have ever used drugs. Finally, HIV-related knowledge was measured by respondents' number of correct answers to a set of 11 questions on the transmission of HIV and a dichotomous variable indicating whether respondents had discussed condom use with peers. A hot-deck imputation Korn and Graubard, was used to replace missing values for any variable with more than 20 of the 1, cases missing. First, the entire sample was classified into cells, 40 PSUs by four groups HIV positive, drug users, migrants, and non-migrants. Respondents within each cell were then randomly sorted into a sequence. Missing values of respondents within a cell were replaced by the corresponding values of a randomly selected respondent donor from the same cell. If the initial donor happened to also have missing values, the next respondent from the cell was chosen. The process continued until a donor with non-missing values was found within the cell and used to replace the missing values. The validity of the hot-deck imputation is premised on the assumption that, if they had responded, study participants who had missing values would have had the same distribution of responses as the one by participants who had non-missing values on the question. In other words, if respondents who had missing values and those who had non-missing values were very different in what the variable was designed to measure, the imputation method would produce biases. However, for most questions for which imputation was applied, the number of cases with missing value was small, ranging between 20 and Potential biases, if any, introduced by the imputation, would likely be small. Statistical analyses were divided into two parts. In the first part, Chi-squared test of difference in proportions was used to test if drug users differ from non-users in prevalence of HIV risk sexual behaviors as well as STDs and HIV. The second part of the analysis then focused on the sub-sample of 1, current drug users. Chi-squared test of difference in proportions and t -test of difference in means were first used to test bivariate relationship between each independent variable and the likelihood of having unprotected casual sex and needle sharing while injecting in the 30 days prior to the survey. Logistic regression analysis was then conducted to identify if and to what extent the four groups of factors predict independently the odds of having unprotected casual sex and needle sharing while injecting in the 30 days prior to the survey. Compared to non-users, current drug users were on average younger mean age of Both lifetime measures and measures within the 30 days prior to the survey indicate that current drug users had a sex life that was significantly HIV riskier than their non-drug using counterparts. Drug users were also significantly more likely to have been involved in commercial sex than non-users. Further, one in four drug users had taken drugs or alcohols while having sex. The difference in prevalence rates of HIV was large and highly significant between drug users and non-users. After controlling for possible differences in the rate of HIV testing, the likelihood of being HIV positive for a current drug user remained to be more than 50 times that of a non-drug user. Table II presents the results comparing individual demographic characteristics, economic and psychosocial wellbeing, behavior-specific characteristics and social influences, and HIV-related knowledge and perceived vulnerability between current drug users who had unprotected casual sex in the 30 days prior to the survey and those who did not. Compared to those who did not have unprotected casual sex, drug users who had unprotected casual sex in the month prior to the survey were younger and more likely to be single and migrants. In terms of economic and psychosocial wellbeing, they scored significantly higher on the depression, loneliness, and lax social control scales. For behavior-specific characteristics and influence, all five factors were statistically significant. Drug users who reported unprotected casual sex were more likely than those who did not to have initiated sex at an earlier age and before marriage, to have bought sex or exchanged sex for money, to take drugs or alcohols while having sex, and to have more relatives or peers with HIV risk sexual behaviors i. Finally, for HIV-related knowledge, current drug users who had unprotected casual sex did not differ significantly from those who did not. But they perceived greater HIV vulnerability and were more likely to have discussed condom use with friends or peers. However, data in Table III suggest that few variables could statistically separate drug users who shared needles while injecting drugs from those who did not inject or who injected but did not share needles. Of the 15 factors examined, only age, the lax social control scale, age at first drug use, and ever selling or buying sex obtained statistical significance at the bivariate level. On average, drug users who shared needles were younger and initiated drug use at younger ages; they were also more likely to have had more anti-social behaviors i. In the multivariate logistic regression, marital status, ethnicity, and migrant status were significant and independent predictors of the odds of having unprotected casual sex See Table IV. Being married and ethnic majority i. Being migrant, however, was associated with more than four-fold increase in the odds of unprotected casual sex. Therefore, demographically, current drug users who were single, ethnic minority, and migrants were the most vulnerable to HIV risk sexual behavior. As expected, psychosocial wellbeing contributed independently to drug users' sexual behavior. Depression and lax social control both increased the odds of unprotected casual sex among current drug users. But social isolation as measured by the loneliness scale decreased the odds of unprotected casual sex. Two behavior-specific characteristics were predictors of drug users' sexual behavior. Taking drugs or alcohol during sex increased the odds of unprotected casual sex by more than 10 fold, confirming the impact of drug and alcohol consumption on decisions and judgments related to one's sexual behavior. Involvement in commercial sex was another independent risk factor, more than doubling the odds of unprotected casual sex. Somewhat unexpectedly, having family members and friends who practiced risky sexual behavior did not influence drug users' own risky sexual behavior once other factors were controlled for. Finally, drug users' risky sexual behavior was associated independently with perceived vulnerability and peer discussion of condom use. As expected, peer discussion of condoms use predicted lower odds of unprotected casual sex. But the positive impact of perceived HIV vulnerability seemed just the opposite of what would be expected. Instead of decreasing, greater perceived vulnerability actually increased significantly the odds of unprotected casual sex. For the likelihood of needle sharing while injecting drugs, three of the six demographic characteristics were independently associated with the odds of needle sharing among current drug users. The relationship between education and the odds of needle sharing seemed to be curvilinear in that current drug users with a junior high school education had significantly lower odds than both their more and less educated counterparts. For measures of psychosocial wellbeing, social isolation predicted lower, whereas lax social control predicted higher odds of needle sharing among current drug users. In addition, drug users' odds of needle sharing were also predicted independently and significantly by two behavior-specific characteristics, HIV-related knowledge, and perceived vulnerability. Once other factors were controlled, involvement in commercial sex more than doubled the odds of needle sharing. The older the respondent initiated drug use, the lower the odds of having shared needles while injecting. Drug users who know more about HIV and its transmission were less likely to share needles while injecting. But, in opposite to what would be expected, drug users who perceived greater vulnerability were more likely to share needles. Compared to non-users, current drug users were significantly more likely to have had unprotected casual sex with non-stable partners. The combination of high prevalence of HIV and unprotected casual sex among drug users suggests that drug users are not only at significant risk themselves but also an important source of HIV infection and a critical bridging population between high risk and the general populations through sexual transmission. Effective intervention efforts are urgently needed, which should target not only drug users' HIV risk drug using practices but also their risky sexual behavior. However, not all drug users have engaged in HIV risk behaviors to the same extent and are at the same risk of acquiring or transmitting HIV. As the analyses suggest, being ethnic minority and migrant were the common risk factors of unprotected casual sex and needle sharing. Therefore, ethnic minority and migrant drug users are particularly vulnerable to HIV and should be particularly targeted for prevention intervention. Drug users' psychosocial wellbeing was found to contribute significantly and independently to their HIV risk behaviors. An important finding was that drug users who had experience of anti-social behaviors i. The implication and challenge for HIV prevention intervention is, therefore, the need to develop a comprehensive approach that goes beyond targeting exclusively specific HIV risk behaviors and promotes HIV risk reduction in the context of problem behavior reduction in general. In particular, early prevention of problem behaviors through measures that enhance the normative control of behavior may be an important step to take to prevent HIV risk behaviors. An interesting and unexpected finding was that other things being equal social isolation was associated with lower odds of both unprotected casual sex and needle sharing. One possible explanation is that social withdrawal—often a result of drug addiction—may insulate drug users from social contacts, which in turn may advertently reduce their likelihood of unprotected casual sex and needle sharing. Results on behavior-specific factors underscored the potentially detrimental impact of drug and alcohol consumptions on individuals' decisions concerning sexual behavior, which in turn may increase the likelihood of having unprotected casual sex. Given the widespread consumption of alcohols in China, HIV intervention programs need to pay particular attention to the influence of alcohol on risky sexual behavior. Our results also confirmed a clear link between the age at initiation of drug use and the likelihood of needle sharing later. This calls for early prevention and education to be built into school curriculum, job training, or community outreach programs Cuijpers, ; McBride, ; Nation et al. Such early prevention efforts can help to prevent young adults from starting the drug habit. Even if that outright prevention fails our finding suggests that a delay in initiation in drug use may help reduce drug addicts' HIV risk drug using behavior later. A surprising finding on behavior-specific factors was the lack of significant impact of social influences of family and peers. Neither unprotected casual sex nor needle sharing among drug users was predicted by similar behaviors in their social network of family and peers. The finding is in sharp contrast to the literature, which suggests important influence of family and peers in risky drug using behaviors Lai et al. It is also inconsistent with a previous study in the general population from the same survey Yang, in press , in which the same sexual and drug use influence indices were found to be significant and powerful predictors of risky behaviors in the general population. It is possible that family members and peers may exert important influence on the initiation of drug use. But once started the drug habit, drug users' risky behaviors are influenced more by factors other than family and peers. More research is needed to look into the impact of social influence of family and peers on drug users' HIV risk behaviors. Consistent with the literature, we found that knowledge about HIV and its transmission helped to reduce drug users' HIV risk behaviors. Although perceived vulnerability was found significant in predicting both unprotected casual sex and needle sharing, the direction of the impact was counterintuitive. Instead of reducing risk behavior, greater perceived vulnerability predicted higher odds of both unprotected casual sex and needle sharing among the study participants. Unfortunately, the cross-sectional and retrospective design of the survey did not provide data that would allow a clear identification of cause and effect. Another limitation of the study is that, like many behavioral studies of HIV risk behavior, data were based on self-report, which is subject to recall errors. Further, because of high sensitivities of drug using and casual sex in China, people may underreport these behaviors. A third limitation of the study was the use of drug user registries in sample selection. Although the study sample included both drug users enrolled in involuntary detoxification centers and those living in communities, they were known to community and government authorities. Some hidden drug users might have been included in the sample and revealed drug using activities during the interview. But the final sample consisted mainly of known drug users, not representative of hidden drug users. For these study limitations, a prospective study design that also includes hidden drug users in natural settings and incorporates biomarkers to verify HIV risk behaviors is highly recommended in future research. This is one of only a few population-based studies in China that have used probability samples of both drug users enrolled in detoxification centers and those living in communities and appropriate statistical methods to adjust for sampling weights and survey design effects. It is also one of few studies in China that have examined the impact of drug users' psychosocial wellbeing on their HIV risk behavior. The results are, therefore, more representative, offering a more comprehensive understanding of risk factors of unprotected sex and needle sharing among drug users in China. Bilsborrow, R. International migration statistics: Guidelines for the improvement of data collection systems. Geneva: International Labor Office. News broadcast, February Google Scholar. Compton, W. Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users? Drug and Alcohol Dependence , 37 , 37— Cuijpers, P. Effective ingredients of school-based drug prevention programs: A systematic review. Addictive Behaviors , 27 , — Article PubMed Google Scholar. Emler, N. Moral character. Derlega, B. Winstead, and W. Jones Eds. Chicago, IL: Nelson-Hall. Garten, R. Rapid transmission of hepatitis C virus among young injecting heroin users in southern China. International Journal of Epidemiology , 33 , — Grusky, O. AIDS and Behavior , 6 , — Article Google Scholar. Hammett, T. Correlates of HIV status among injection drug users in a border region of southern China and northern Vietnam. Journal of Acquired Immune Deficiency Syndromes , 38 , — Hoffmann, J. Changes in network characteristics and HIV risk behavior among injection drug users. Drug and Alcohol Dependence , 46 , 41— Kalton, G. Sampling considerations in research on HIV risk and illness. Ostrow and R. Kessler Eds. New York: Plenum Press. Kelley, J. HIV risk behaviors in male substance abusers with and without antisocial personality disorder. Journal of Substance Abuse Treatment , 19 , 59— Korn, E. Analysis of health surveys. New York: John Wiley and Sons. Lai, S. Adoption of injection practices in heroin users in Guangxi province, China. Journal of Psychoactive Drugs , 32 , — Journal of Acquired Immune Deficiency Syndromes , 26 , — Latkin, C. Routes of drug administration, differential affiliation, and lifestyle stability among cocaine and opiate users: Implications to HIV prevention. Journal of Substance Abuse , 13 , 89— The relationship between risk networks' patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: A prospective study. Drug and Alcohol Dependence , 42 , — Lau, J. Needle sharing and sex-related risk behaviours among drug users in Shenzhen, a city in Guangdong, southern China. AIDS Care , 17 , — Li, X. Injection drug use and unprotected sex among institutionalized drug users in China. Journal of Drug Issues , 30 , — McBride, N. A systematic review of school drug education. Health Education Research , 18 , — Nation, M. What works in prevention: Principles of effective prevention programs. American Psychologist , 58 , — Qu, S. The potential for rapid sexual transmission of HIV in China: Sexually transmitted diseases and condom failure highly prevalent among female sex workers. Radloff, L. Applied Psychological Measurement , 1 , — Russell, D. Development and evolution of the UCLA loneliness scale. Stata Statistical Software: Release 7. Wang, Q. Sex exchange and HIV-related risk behaviors among female heroin users in China. The Journal of Drug Issues , 33 , — CAS Google Scholar. Geneva: WHO. Wu, Z. Risk factors for intravenous drug use and sharing equipment among young male drug users in Longchuan County, south-west China. AIDS , 10 , — Community-based trial to prevent drug use among youths in Yunnan, China. American Journal of Public Health , 92 , — PubMed Google Scholar. Risk factors for initiation of drug use among young males in southwest China. Addiction , 91 , — Xia, G. Prostitution in contemporary China: Is it a personal choice by immoral women? Qiu Ed. Xia, M. Risk factors for HIV infection among drug users in Yunnan province, China: Association with intravenous drug use and protective effect of boiling reusable needles and syringes. AIDS , 8 , — Xu, R. Yufang Yixue Wenxian Xinxi , 7 , — Yang, J. Behavioral characteristics of drug use population and HIV prevalence in Zhejiang. Yang, X. Temporary migration and HIV risk behaviors in China. Environment and Planning A. Yap, L. A rapid assessment and its implications for a needle social marketing intervention among injecting drug users in China. International Journal of Drug Policy , 13 , 57— Yu, E. American Journal of Public Health , 86 , — Yu, X. Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi province, China. Journal of Acquired Immune Deficiency Syndromes , 22 , — Zhang, C. High prevalence of HIV-1 hepatitis C virus coinfection among injection drug users in the southeastern region of Yunnan, China. Journal of Acquired Immune Deficiency Syndromes , 29 , — Zhang, K. Changing sexual attitudes and behaviour in China: Implications for the spread of HIV and other sexually transmitted diseases. AIDS Care , 11 , — Zheng, X. Injecting drug use and HIV infection in southwest China. Zhou, H. Zhu, T. Download references. The authors would like to thank the editor and two anonymous reviewers for their helpful suggestions on an earlier version of the paper. You can also search for this author in PubMed Google Scholar. Correspondence to Xiushi Yang. Reprints and permissions. AIDS Behav 10 , 71—81 Download citation. Published : 02 December Issue Date : January Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Use our pre-submission checklist Avoid common mistakes on your manuscript. Measures The main outcome variables were self-reported lifetime and day measures of HIV risk drug using and sexual behaviors, namely, unprotected casual sex and needle sharing while injecting. Missing Values A hot-deck imputation Korn and Graubard, was used to replace missing values for any variable with more than 20 of the 1, cases missing. Statistical Analysis Statistical analyses were divided into two parts. Table I. Table II. Table III. Table IV. Google Scholar Compton, W. Google Scholar Garten, R. Article Google Scholar Hammett, T. Google Scholar Kelley, J. Google Scholar Lai, S. Google Scholar McBride, N. Article Google Scholar Radloff, L. Article Google Scholar Russell, D. Google Scholar Wang, Q. Google Scholar Wu, Z. Google Scholar Xia, M. Google Scholar Yang, J. Article Google Scholar Yu, E. View author publications. Rights and permissions Reprints and permissions. About this article Cite this article Yang, X. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

Study the causes of relapse among Iranian drugs users in Kermanshah

Buy Cocaine Kermanshah

Shiraz E-Med J. Phenomenon of substance use is presently one of the major health problems worldwide 1. This phenomenon can directly or indirectly overshadow the quality of life of people in short and long term 2. Drug dependence inflicts severely deep physical and psychological damages, and also causes social harm, such as increased rates of divorce, crime, and unemployment 3. World Health Organization WHO identifies illegal drugs as a critical issue threatening and challenging human life seriously 1 , 4. The pattern of substance use varies widely across developed and developing countries and also varies across different regions of the country. Developing countries face considerable drug-related social problems because of a high proportion of youth population 5. Iran is a country with the highest proportion of drug abusers in the world, where substance use is the third biggest problem following inflation and unemployment 6 , 7. Although no precise data on the number of substance users is available in Iran, one to two million has been estimated, according to official reports and field studies. Diagnostic and statistical manual of mental disorders-fifth edition DSM-V criteria for substance dependence includes several specifiers. Dependence was diagnosed when three or more dependence criteria were met. The remission category can also be used for patients receiving agonist therapy such as methadone maintenance or for those living in a controlled, drug-free environment 9. Results of previous researches showed that drug abuse has no single cause and there are different individual, social, and economic factors that contribute to the tendency towards this behavior Considering the effects of age on addiction epidemiology and etiology, and given the lack of examination of patterns and effects of age on drug dependence in Iran, this study was performed with the aim of determining the epidemiology of age of substance use initiation, duration of substance use, and age of seeking treatment as well as studying the effects of these factors on the success of drug quitting in methadone maintenance treatment MMT centers of western Iran. Hopefully, results from the present study will help initiation of useful steps towards framing and providing appropriate plans to prevent this predicament in the society. This cross-sectional study was performed on drug-dependent clients, whose records were available during year and who underwent treatment after they had referred to Kermanshah province MMT centers. Kermanshah is a western province of Iran, and is bordered by Iraq to the west. It has a population of more than people. After obtaining the required permits from the provincial MMT center, a list of all centers was made. There are 95 active MMT centers in the province. Forty-two centers were randomly selected. Data were collected by addiction ward psychologists using interviews with all clients referring to selected centers. In the present study, age of onset of substance use was the age at which an individual began to use drugs such as alcohol, tobacco, and marijuana for the first time. Drug dependence was assessed based on DSM-V. The most important feature of drug dependence set forth in DSM is a set of cognitive, behavioral, and psychological indications signifying that despite considerable problems caused by using illegal drugs, a person may continue using them. There exists a pattern of repeated use of drugs, which usually results in appearance of tolerance, and quit and forced substance use-related behaviors. In addition, the age at which a person begins seeking treatment to quit substance use, whether by medications or by non-medication methods, is considered as age of quitting. If the test is positive, this will be regarded as a failed treatment. The main inclusion criterion was treatment with methadone with at least one year and the exclusion criterion was not providing a urine test to check failed treatment. Based on illegal drug classification, there are seven different categories, as follows:. Depressants: Those drugs, which slow down brain reactions such as heroin, opium, and morphine;. Stimulants: Those drugs, which make the nervous system work faster. Cocaine, amphetamine, methylene dioxyamphetamine, methamphetamine Ice , Ritalin, and crack smoking form of cocaine are examples of this category. Although crack falls in the group of stimulants, the crack available on the Iranian market is considered an opioid stimulant drug because of having synthetic opioid compositions;. Somnolent and Tranquillizers: These drugs are typically used to mitigate anxiety and to treat insomnia, such as benzodiazepines, including diazepam, chlordiazepoxide, lorazepam, flurazepam, etc. The second group of these sedative hypnotic drugs include barbiturates, such as phenobarbital, sec barbital, and amobarbital;. Opioids: This group is divided to two subgroups; a natural drugs like opium, opium extraction, and paregoric; and b synthetic drugs like morphine and similar opioids Methadone, Laam, Propoxyphene, Daroon ; and. Description of data was done by using frequency, mean, and standard deviation. T-test and Chi-square tests were used to compare means and ratios, respectively. Moreover, logistic regression test was used to examine reasons why treatments failed. The study population consisted of subjects, of whom Mean age of substance use initiation was Drug dependence in males and females occurred on average 3. In summary, mean age of drug dependence was The proportion of treatment failure was The mean age of subjects seeking treatment was Age of substance use initiation, drug dependence, injection, and seeking treatment in western Iran. As shown in Table 1 , there is no significant difference with respect to the types of substance used, age of substance use initiation, and age of seeking treatment. The univariate model showed that the chance of treatment failure in males was 1. However, after adjusting the age of substance use initiation and duration of substance use, no significant difference was observed between males and females in terms of the chance of treatment failure, 1. Univariate analysis showed a significant relationship between older age of substance use initiation and higher chance of treatment failure. The findings indicated that older individuals seeking treatment had a higher chance of treatment failure that is the chance of treatment failure in subjects above 55 years was 2. In summary, with increasing one year of seeking treatment the chance of treatment failure increased by 1. Addiction is an important public health challenge threatening modern society, which, as a social problem, has always motivated individuals, organizations, and associations. The growing number of individuals addicted to illegal drugs has turned this problem to a national crisis in Iran. Something remarkable and shocking in this regard is the age of substance use initiation and of drug dependence. For this reason, prevalence of substance use can be reduced by implementing preventive programs for this age group, especially for individuals younger than 20 years old. Unfortunately, age of substance use initiation has been decreasing recently so that, according to results of a research evaluating drug abuse in Iran, mean age of substance use initiation decreased by three years during to 7 , Rostami et al. This declining trend of age of substance use initiation is not limited to Iran and according to the UN Office on Drugs and Crime report, mean age of substance users was In other words, age of substance use initiation was globally decreased by four years during the recent ten years 14 , Therefore, solving any one of the mentioned problems can be an effective step in dealing with the declining age of substance use initiation 16 , Although the number of females using illegal drugs has increased recently in Iran and other countries, substance abuse and dependence is still considered as a gender-dependent illness in Iran Previous evidence reported gender differences in smoking and alcohol consumption worldwide Age of substance use initiation among females is five years older than that of males, which is in agreement with the results of studies carried out in this field 20 , For various reasons, such as physiological, psychological, and physical characteristics, females become dependent on illegal drugs more quickly, which is in agreement with results of similar studies 22 , The older age of substance use initiation was associated with the higher chance of treatment failure. Similar studies had different results so that the chance of treatment failure was more than 10 years with older persons in a cohort study and with young persons in a month follow-up However, the results from most studies indicate that chance of treatment failure increased as individuals grew older. On average, substance users embark on seeking treatment nine years after starting to use drugs which indicates that duration of substance use had greater effect on treatment failure compared to the age of seeking treatment, which is in agreement with similar studies. In the US, the most commonly used illegal drugs are marijuana, cocaine, and heroin, respectively Limitations of the present research include not recording information, documents un-readability, and missing data in the subject's records. To solve this problem, the researchers attempted to collect data and information from staff and psychologists of MMT centers in addition to using statistical methods. As with other studies on addiction, the most important limitation of the present research was the changing patterns of drug abuse from the onset of substance use till the time when addicts try to seek treatment. Initially, drug abuse begins with using drugs, such as opium and hashish, eventually, ending up with using several types of drugs simultaneously. Most of these patients suffer from multi-substance abuse. Therefore, the age of substance use initiation can be related with each type of these substances. Also, drugs are used initially by simple modes, such as smoking and oral mode, ending up with modes of injection, as duration of substance use increases. For this reason, types and modes of substance use cannot be identified correctly. In order to reduce the study bias, the researchers considered the type of drug mostly used by an individual as the substance used. Another important limitation was self-reported data, the results of which should be warily interpreted. This research had several strengths, including use of a large sample, selection of several MMT centers, and collection of information with help of people specialized in the field of drug abuse prevention. In Iran, issue of substance use is of more importance because this country has a high percentage of young population and shared borders with the largest narcotic drugs producing countries. On one hand, age of substance use initiation is very low and has a declining trend and, on the other hand, with decreased age of substance use initiation, drug dependence probably increases. Wodak A, Cooney A. Geneva: World Health Organization; Self-reported prevalence of dependence of MDMA compared to cocaine, mephedrone and ketamine among a sample of recreational poly-drug users. Int J Drug Policy. Persuasive communication and drug abuse prevention. London and New York: Routledge; Int J Infect Dis. Black C. It will never happen to me: Growing up with addiction as youngsters, adolescents, adults. Center City, Minnesota, U. S: Hazelden Publishing; Loeffler AG. The indigenisation of allopathic medicine in Iran. Anthropol Mid East. Mokri A. Brief overview of the status of drug abuse in Iran. Arch Iran Med. United Nations Office on Drugs and Crime. World Drug Report Vienna, Austria: United Nations Publication; DSM-5 criteria for substance use disorders: Recommendations and rationale. Am J Psychiatry. HIV and risk environment for injecting drug users: The past, present, and future. Endogenous endophthalmitis associated with intravenous drug abuse. Invest Ophthalmol Visual Sci. Ziaaddini H, Ziaaddini MR. The household survey of drug abuse in Kerman, Iran. J Appl Sci. Gender and geographical inequalities in fatal drug overdose in Iran: A province-level study in and Spat Spatiotemporal Epidemiol. Brady JE, Li G. Trends in alcohol and other drugs detected in fatally injured drivers in the United States, Am J Epidemiol. International standards on drug use prevention: the future of drug use prevention world-wide. Boles SM, Miotto K. Substance abuse and violence: A review of the literature. Aggress Violent Behav. Impulsive action and impulsive choice across substance and behavioral addictions: Cause or consequence? Addict Behav. Moghanibashi-Mansourieh A, Deilamizade A. The state of data collection on addiction in Iran. The correlation between gender inequalities and their health related factors in world countries: A global cross-sectional study. Epidemiol Res Int. From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Substance use initiation: The role of simultaneous polysubstance use. Drug Alcohol Rev. Sex, drugs, and violence: An analysis of women in drug court. Drug Alcohol Depend. Alcohol and drug misuse, abuse, and dependence in women veterans. Epidemiol Rev. Special section on relapse prevention: Substance abuse relapse in a ten-year prospective follow-up of clients with mental and substance use disorders. Psychiatr Serv. Cuijpers P. Effective ingredients of school-based drug prevention programs. A systematic review. J Ilam Univ Med Sci. Prescription opioid abuse in the UK. Br J Clin Pharmacol. Results from the national survey on drug use and health: Summary of national findings. SMA We use cookies to provide you with the best possible experience. They also allow us to analyze user behavior in order to constantly improve the website for you. Navigate to Shiraz E-Medical Journal. Shiraz E-Medical Journal: Vol. Abstract Objectives: The aim of this study is to determine the epidemiology of substance use in terms of age of initiation, duration of use and age of patients when they seek the treatment. Methods: This cross-sectional study was performed on drug-dependent individuals subjects , who had referred to methadone maintenance treatment MMT centers of Kermanshah province, western Iran, during year The information was gathered by psychologists working in substance use wards, who interviewed clients seeking treatment. Results: Mean age of substance use initiation was On average, males and females became dependent on illegal drugs only after 3. The chance of treatment failure for persons over 55 years was 2. Generally, chance of treatment failure increased by 1. Background Phenomenon of substance use is presently one of the major health problems worldwide 1. Methods 2. Study Design This cross-sectional study was performed on drug-dependent clients, whose records were available during year and who underwent treatment after they had referred to Kermanshah province MMT centers. Data Collection and Definition of Variables After obtaining the required permits from the provincial MMT center, a list of all centers was made. Based on illegal drug classification, there are seven different categories, as follows: 1. Depressants: Those drugs, which slow down brain reactions such as heroin, opium, and morphine; 2. Although crack falls in the group of stimulants, the crack available on the Iranian market is considered an opioid stimulant drug because of having synthetic opioid compositions; 3. Inhalants: Those drugs, which are used by inhaling, such as marijuana and glue; 5. The second group of these sedative hypnotic drugs include barbiturates, such as phenobarbital, sec barbital, and amobarbital; 6. Opioids: This group is divided to two subgroups; a natural drugs like opium, opium extraction, and paregoric; and b synthetic drugs like morphine and similar opioids Methadone, Laam, Propoxyphene, Daroon ; and 7. Alcohol 2. Data Analysis Description of data was done by using frequency, mean, and standard deviation. Results The study population consisted of subjects, of whom Age of substance use initiation, drug dependence, injection, and seeking treatment in western Iran Figure 1. Table 1. Table 2. Variable No. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. Cookie Setting We use cookies to provide you with the best possible experience.

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