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Write us. Support chat. Open Access. Cigdem Karakukcu 2. Hide authors affiliations Show authors affiliations: 2 affiliations. Publication type : Journal Article. Publication date : Journal : Behavioral Sciences. Quartile SCImago. Quartile WOS. Impact factor : 2. ISSN : X. DOI: Copy DOI. Ecology, Evolution, Behavior and Systematics. Behavioral Neuroscience. General Psychology. The chameleon can disguise itself in nature by taking on different colors and forms. As synthetic cannabinoids SC have clinically similar effects to those of several psychoactive agents, they are one of the most difficult intoxications to diagnose. The reasons for this are due to clinical variations throughout the world and the differences in symptoms having not been determined due to their similarity to the intoxication of several other drugs. The aim of this study was to obtain prospective data of patients presenting at the Emergency Department ED with suspected SC intoxication, and as a result of prospective examination of samples, to determine a new generation of SC use, SC types, clinical findings, and treatments. Conclusions: Three significant findings emerged as a result of this study. Firstly, due to the different clinical forms of presentation at ED associated with SC use and the range of intoxications that cannot be diagnosed, advanced laboratory tests are required, in addition to routine tests for the determination of SC. Secondly, those diagnosed as having taken SC were also determined to have used it concurrently with substances that have a high potential for addiction, such as amphetamines and quetiapine. Thirdly, in regard to examples of cases presented in the literature, anti-psychotics, fluid hydration, and anxiolytics can be used as treatment options for those diagnosed with SC use. References Export references. By date By citations. Export citations. Biomedical Chromatography. Journal of Analytical Toxicology. Society of Forensic Toxicologists. We do not take into account publications without a DOI. Statistics recalculated only for publications connected to researchers, organizations and labs registered on the platform. Statistics recalculated weekly. Are you a researcher? Create a profile to get free access to personal recommendations for colleagues and new articles. Publication data. Publication PDF. Cite this. GOST Copy. Altintop I. GOST all authors up to 50 Copy. RIS Copy. BibTex Copy. MLA Copy. Altintop, Ismail, and Cigdem Karakukcu. Found error? Behavioral Sciences. Medicina, 1, Biomedical Chromatography, 1, Journal of Analytical Toxicology, 1, Wiley, 1, Society of Forensic Toxicologists, 1,

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Official websites use. Share sensitive information only on official, secure websites. This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Shame and guilt in polysubstance abusers are still understudied despite their significance in substance use disorders SUD. The goal of the current study is to develop a better understanding of how shame and guilt interact among polysubstance abusers who are receiving residential treatment. The sample of two hundred four males with SUD admitted to five rehabilitation centers from two cities in Pakistan participated in this study. For comparison, age-matched healthy individuals were recruited control. All participants reported their scores on the state shame and guilt scale SSGS and demographic form. A cross-sectional study design was adopted. Further, multivariate analysis indicated that people with SUD who were of older age, unemployed, living in a nuclear family system, with a higher level of education, and low income, experienced higher levels of shame and guilt. Multinomial logistic regression analysis revealed that people with SUD in the age group 41—60 years OR 5. Findings of the current study indicate an association between shame and guilt activation and SUD. These results suggest that polysubstance users may benefit from therapeutic interventions to avoid a generalization of shame and guilt toward their substance use. Reducing shame and guilt should be considered a priority in treating adults with multiple SUD. Keywords: guilt-activation, shame-activation, inpatient treatment, polysubstance abusers, healthy individuals. There is evidence that individuals with a history of addictive behaviors experience excessive self-conscious emotions, and shame and guilt can be especially challenging 1 — 3. Shame is often confused with guilt. Shame is more related to the self e. It is a painful feeling that occurs due to negative evaluations of the self and fear of negative evaluations by others about the self 5. Whereas guilt is more focused on behavior e. Toxic shame and chronic guilt are major reasons for all addictive behaviors 6. A study found a positive association between shame and guilt activation in alcohol dependence. The author claimed that people with substance use disorder SUD reported a higher level of guilt than those who didn't use drugs 7. Additionally, shame can be a barrier to recovery from the treatment of addictive behaviors 8. Shame predicts a tendency to relapse, the severity of relapse, and a decline in mental and physical health. Research conducted on alcoholics presented that shame and guilt activation were positively associated 9. However, guilt is positively correlated with protective behavior strategies, and shame is negatively associated with alcohol consumption. One other study suggested that university drinkers who took more alcohol and experienced more alcohol-related problems scored higher on the shame. On the contrary, lower scores were reported on the guilt Regarding sociodemographic factors, a study on aging and self-conscious emotions in a non-clinical sample proved that shame and guilt are usually reported by older adults A study in Vietnam reported that unemployed men with SUD, faced more stigmatization and had a sense of shame and guilt activation Based on the researchers' initial review of related literature, it was found that limited studies have been conducted on this topic in Pakistan among inpatient poly-substance abusers. Some researchers have claimed shame and guilt are detrimental to treatment-seeking behaviors 4 , 7 , 8 , 13 , and others proved these are important to make reflections on wrongdoings 14 , The relationship between shame and guilt activations is still unclear in inpatient polysubstance abusers. Thus, more studies are needed to investigate the relationship between the two constructs. Thus, the current research was designed a to explore the relationship between shame and guilt activations among inpatient polysubstance abusers and b to investigate the difference between shame and guilt activations concerning sociodemographic factors. It was hypothesized that there would be a strong positive correlation between shame and guilt activations in polysubstance abusers. Further, it was expected that there might be significant differences in shame and guilt activations in sociodemographic variables. The current study adopted cross-sectional research design. To receive services at the hospital participants had to meet the criteria presented at least six or more symptoms, ensuring the severity of SUD according to the diagnostic and statistical manual of mental disorders DSM-V. It has already been defined by Flanagan 4 that people with SUD often report feelings of shame and guilt. So, all participants in the addiction group were polysubstance users and were receiving residential treatment. All patients had recovery of at least 21 days and were recruited during their third week of detoxification. They had no other psychiatric disorders. The presence of such other psychiatric diseases is evaluated through an in-depth psychiatric investigation conducted by a qualified psychiatrist and clinical psychologist. The demographic characteristics of the control group were matched, as much as possible, with the group of SUD. Divisions of the sample are given in Table 1. Comparison of qualitative variables' proportion between the group with SUD and control group was performed using chi-square test, and quantitative variables' mean between groups was compared using t-test. The ethics board committee of the Department of Psychology, Wuhan University, China, approved the study. Participants were approached in five rehabilitation centers and debriefed about the study procedures. Once they understood the study protocols, they signed the informed consent and filled in the questionnaire and demographic sheet. The control group was recruited via the snowball sampling technique. The research purpose was explained and the participants in an online survey signed informed consent. It was mentioned that only males above 18 years of age who didn't take alcohol and drugs could participate in this research. The participants confirmed that they had not experienced addiction or accessed services for addiction. This study was not time-bound; however, completing the questionnaires takes 10—15 min. Participants weren't compensated for taking part in this study. All Data were collected from August to December All participants included in the group with SUD were males over the age of 18 years, diagnosed with polydrug addiction, receiving residential treatment, in recovery of at least 21 days, and free from other psychiatric disorders. The study excluded patients with a single drug use, outpatient treatment, a neurological problem, or a chronic illness and patients who were unwilling to participate. All participants in the control group were males over 18, without a history of substance abuse or psychiatric disorders and any need for treatment. Participants whose ages did not match, those who had a mental disease, those undergoing treatment for psychiatric problems, and were unwilling to participate were excluded from the study. This researcher is a Ph. He is also fluent in the English language and a native Urdu speaker. We developed a 6-item demographic form to include in the survey packet. Questions addressed age, education, occupation, family system, monthly income, and marital status. The age of participants was asked as a quantitative variable. Education, occupation, family system, monthly income, and marital status were categorical variables. The 10 items of two subscales from the state shame and guilt scale developed by Marschall et al. The original scale comprises 15 items and 3 subscales shame, guilt, and pride. Each subscale consists of 5 items. Minimum-maximum scores for each subscale are 5 to As this was a state scale, participants rated their responses on the scales based on how they were feeling at the moment. The scores on the scale were interpreted as the lower and higher score. Descriptive statistics were used to clarify the detail of the demographic sample. Pearson correlation coefficient was applied to quantify the relationship between shame and guilt. Further, Spearman rank correlation was performed to investigate the correlation of sociodemographic characteristics with shame and guilt scores among group with SUD and control. The differences in qualitative demographic variables age, education, occupation, family system, family monthly income, and marital status between the addiction and control group were examined, a Chi-square test was performed, t -test was used to compare the shame and guilt mean score between two groups. To measure the variability of shame and guilt across the group and sociodemographic factors a Multivariate two-way MANOVA was performed. All models were estimated separately for the group with SUD and control. The detailed descriptive statistics for the level of education, employment status, family system, and sample group characteristics can be seen in Table 1. The Pearson correlation coefficient between shame and guilt score was performed separately for both group with SUD and control individuals. Relationship between shame and guilt in the group with SUD and control group. Table 2 below shows that occupation was strongly correlated with shame-activation and guilt-activation in the group with SUD. At the same time, these variables were also linearly correlated in the control group. Results show that the family system had a significant positive correlation with shame and guilt-activation in the group with SUD. In contrast, the control group showed a linear correlation for these variables. Remarkably, family monthly income was negatively correlated with shame-activation and guilt-activation in the group with SUD, as shown in Table 2. Correlation of sociodemographic characteristics with shame and guilt-activation among group with SUD and control group. Results show significant mean differences in shame and guilt across age groups between the group with SUD and control. Participants from the group with SUD scored higher on shame and guilt levels in all age groups compared to the control group. By education level comparison, results revealed significant mean differences between groups. Participants in SUD group reported high mean scores compared to the control. Furthermore, findings revealed a significant multivariate main effect for occupation between the group with SUD and the control group. This partial eta square value indicates a large effect size. Comparison over occupation categories revealed that unemployed participants got high scores than other occupation ranks on shame and guilt in the group with SUD. Moreover, findings showed significant mean differences in both groups concerning the family system. Moreover, participants from the nuclear family system reported high scores on shame and guilt among people with SUD. When considering family monthly income, the finding revealed that participants from the group with SUD scored higher on shame and guilt than those from the control group. Furthermore, we observed that people with SUD having low income reported greater shame and guilt score than other income levels. There were significant mean differences in marital status between the group with SUD and the control. People with SUD having single marital status got higher scores on shame and guilt than the control group. Mean comparison of group with SUD and control group by sociodemographic factors on shame and guilt using multivariate analysis. A Multinomial logistic regression analysis was performed to investigate the association of sociodemographic factors with different levels of shame and guilt. Results indicated that people with SUD in the higher age group 41—60 yrs. As for other demographic variables, the participants belonging to unemployed, nuclear family system, and low monthly income groups had a significantly high risk of shame and guilt in the last three models as compared to the reference group among both groups with SUD and control individuals see Tables 4 , 5. Association of socioeconomic factors with different levels of shame in group with SUD and control group. Association of socioeconomic factors with different levels of guilt in group with SUD and control group. This research has addressed an identified gap in the literature whereby little has been written about shame, guilt, and their relationship to inpatient polysubstance abusers. This study aimed to determine the correlation between shame and guilt-activation among polysubstance abusers hospitalized in a rehabilitation center. The study also explored whether the people with SUD reported higher shame and guilt scores than the control group. We were also interested in how sociodemographic characteristics might be associated with shame and guilt scores among people with SUD and control groups. The study was restricted to male participants, given the fact that SUD is significantly more prevalent in men where the study was conducted, and whether the findings of this study are generalizable to female populations needs further exploration i. The findings from this study have revealed a strong connection between shame and guilt scores among polysubstance abusers. The findings supported the first hypothesis and suggested that polysubstance abusers who experience a higher level of shame also experience a higher level of guilt. This relationship is possible because people with SUD take drugs to cope with negative self-conscious emotions, including shame and guilt. The more they take drugs to relieve their shame and guilt-based feelings, the more they experience shame and guilt. Using drugs is the only quick way to get short-term relief from these painful emotions Such acting out then causes negative consequences and creates even uncomfortable feelings of shame and guilt. The findings are consistent with other studies which show shame-activation to be positively associated with guilt-activation on alcohol dependence among university individuals 7 , 9 , 10 , 21 , According to cognitive theories of addiction, relying on drugs as a mood adjuster can lead to the development of substance use disorder Shame and guilt activations may be responsible for inner judging voices that may need to be silenced with maladaptive behaviors. Additionally, as we expected, healthy individuals will likely have lower shame and guilt scores compared to people with SUD. We further compared the shame and guilt scale between healthy individuals and people with SUD. We found that people with SUD reported a higher tendency to experience shame and guilt-activation than healthy individuals. So, the findings also confirmed the second hypothesis. It is thought that the reason for this is the efforts of people with SUD to get rid of the situation are in vain, and the negative feelings caused them to finally surrender to addiction. This study corroborated the previous studies 22 , 24 , 25 , which showed that guilt and shame might contribute to alcohol and drug addiction. The authors proved that the people with SUD felt more guilt and shame than the individuals from the control group. The results of another study in which 60 alcoholics and 40 healthy people were compared showed that the alcoholics had significantly higher levels of shame and guilt The studies conducted on the Turkish sample examined the feelings of shame and guilt in individuals who use and do not use alcohol, and they proved that the guilt and shame levels of people with alcohol problems are higher than those who do not have alcohol problems 27 , Similarly, comparing the degrees of guilt and shame between the control group and alcoholics in remission, it was found that the intensity of these feelings was higher in alcoholics Regarding sociodemographic factors, we observed significant mean differences in shame and guilt across age groups between people with SUD and healthy individuals. The findings presented here provide two clues, participants from the group with SUD reported higher shame and guilt scores in all age groups, and the control group reported a lower level of shame and guilt. Results suggest participants in high-age groups experience a higher level of shame and guilt. Consistent with the previous study 11 which proved that in late adulthood, individuals experience more emotions of shame and guilt. Furthermore, the literature supports that in late adulthood person's feelings of shame and guilt are followed by emotions such as regrets in life In later life, it is difficult for an individual to fix these strong emotions like guilt Therefore, it can be stated that guilt greatly affects the life satisfaction of older individuals as compared to younger ones. Results further revealed significant mean differences in education level within groups. Findings demonstrated that educated people feel more shame and guilt while suffering from addiction. Higher shame and guilt might occur at a high level of education. Socio-emotional Selectivity Theory 32 Suggested that when an individual achieves maturity level along with greater knowledge as a result of educational level, they start perceiving that time is running out and become more present-focused as compared to future and more goal-oriented. It also changes the person's emotional processing of information, ultimately reducing negative emotional experiences, and they can interpret their emotions more appropriately and positively. It is also assumed based on the above theory that while attainting treatment and awareness sessions regarding drug addiction side effects, how it affects the person's life, and how they better cope with life stressors, it may change their emotional processing and further they can be able to interpret their life experiences more positively and cope more effectively. Further, results suggested unemployed participants experience greater shame and guilt than other occupation ranks. The recent research on a large clinical population revealed that unemployment status, older age, and lack of social support are related to suicidal ideation in gambling disorder, shopping disorder, gaming disorder, and sex addiction, and these disorders are characterized by higher levels of shame and guilt feelings 33 — In addition, polysubstance abusers may have less family support, loss in their business, or be kicked off from jobs, and after all, they spend all their savings in buying drugs. Maybe that's why people with SUD having unemployment status experience higher feelings of shame and guilt. Financial problems, social isolation, and feelings of failure that frequently come with unemployment may contribute to the increase of shame and guilt feelings. Our study has several limitations. Firstly, due to the cross-sectional research design, it would be difficult to comment on the direction of relationships among these variables in the current study. However, future research must be based on longitudinal design to investigate whether the degree of shame and guilt change over time. Secondly, we used one scale to measure all types of guilt; future studies might use different scales for each type of guilt e. Moreover, in the present study, other psychiatric disorders remain as an exclusion criterion; future studies should investigate the joint influence of polysubstance dependence and comorbidities e. Finally, our whole sample consisted primarily of men. Future research should examine whether shame and guilt affect men and women differently. From the study results, one possible implication for clinicians is the importance of evaluating people with SUD for their shame and guilt levels. Clinicians may help patients differentiate between shame and guilt, particularly by noting the motivating potential of guilt and the more extreme negative significance of shame. The present study's findings provide more credence to Dearing et al. According to the results of the current study, shame-prone people may benefit from learning how to deal with negative emotions in clinical settings without resorting to drugs, which could lead to drug dependence. Further, current research added to the body of knowledge on sociodemographic characteristics by providing evidence that polysubstance users who are older, more educated, unemployed, from nuclear families, and have lower incomes feel more shame and guilt. We found a strong relationship exists between shame and guilt activations among inpatient polysubstance abusers. The findings of this study confirm that polysubstance abusers experience a higher degree of state shame and guilt than healthy individuals. Further, polysubstance abusers with older age, higher education, unemployment status, nuclear family system, and low income, experience higher levels of shame and guilt. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by the Ethics Board Committee of the Department of Psychology, Wuhan University, China. NA: funding acquisition. YY: project administration, resources, and supervision. MN: data curation. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. We wish to thank the staff at the rehabilitation center for their invaluable efforts in supporting the ongoing data collection procedures that made this work possible. We are also very grateful to the patients who agreed to use their clinical data for research purposes. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Najam ul Hasan Abbasi. Find articles by Mujahid Iqbal. Find articles by Yu Yan. Find articles by Sumaira Mubarik. Find articles by Muhammad Nadeem. Find articles by Mehmet Behzat Turan. Find articles by Romana Younas. Received Aug 17; Accepted Oct 6; Collection date Sociodemographic characteristics between the group with SUD and control group. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. 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