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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.

Age of Substance Use Onset in Kermanshah Province: Results from a Large Cross-Sectional Study

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