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Official websites use. Share sensitive information only on official, secure websites. Corresponding author: Hemmat Maghsoudi, MD maghsoudih yahoo. Box , Tabriz , East Azerbaijan, Iran. Phone: , FAX: A five-year prospective study March March of burn victims hospitalized in a major burns centre in Iran was conducted in order to survey the aetiology and outcome of burns in patients who were drug addicts. Three hundred and thirty patients addicted to drugs were identified and stratified by age, sex, burn size, presence or absence of inhalation injury, kinds of abuse agents, and cause of burn. The mean patient age was There were 60 deaths overall The mortality rate was significantly higher in multi-drug abusers than in single-drug abusers. Except for burn incidence, there were no significant differences between males and females. The mean burn size, Inhalation injuries were strongly associated with large burns, and were present in all flame-burn fatalities. Flame burns were the most common type of burns in drug-addicted patients: incorrect use of a lighter and match and falling onto a brazier were the most common causes of flames. There were 11 deaths related to electrical injuries. Large burn size was the strongest predictor of mortality followed by the presence of inhalation injury. The most common agent of abuse was opium, followed by heroin and hashish; there was no difference between males and females in relation to the type of agent of which abuse was made. The principal effects of opioids opiate-like drugs are a significant damping of pain perception along with modest levels of sedation and euphoria. Tolerance of any one opioid is likely to be generated to others i. Each of these opioid substances is capable of producing physical addiction, and the withdrawal syndrome after abstinence from any one of the substances can be treated by administering any of the others. Stimulants are drugs that stimulate the central nervous system. These substances tend to increase alertness and physical activity. They include amphetamines, cocaine, crack, and some inhalants like amyl or butyl nitrites. Caffeine present in tea, coffee, and many soft drinks is also a mild stimulant drug. Different stimulants act on the body in different ways. For example, nitrate inhalants cause the blood vessels to dilate, cocaine and crack interfere with normal levels of the neurotransmitter serotonin, and amphetamines cause the release of adrenalin. Hallucinogens have no legal medicinal uses and are therefore all classed as drugs of abuse. The most commonly seen are LSD, ecstasy, and psilocybin magic mushrooms. Other hallucinogenic substances such as mescaline and DMT are not widely available on the illicit drug market in the United Kingdom. Cannabis is a central nervous system depressant obtained from the plant Cannabis sativa, which grows in many parts of the world. It is available for use as a drug in three main forms: as the dried leaves and buds known as grass or marijuana , as a solid resin hashish or hash which is collected from the buds and flower heads, and as a thick liquid prepared from the flowers or resin hash oil. The main psychoactive i. Hashish is made by taking the resin from the leaves and flowers of the cannabis plant and pressing it into cakes or slabs. It is usually stronger than herbal cannabis and may contain five to ten times as much THC. The attention paid by the general public, the government, and the media to heroin, cocaine, and ecstasy in recent years may have led some adults and young people to assume that cannabis is of less concern. Cannabis availability is at an all-time high. Among teenagers, those who smoke cigarettes are more likely to drink alcohol. Those who smoke and drink are more likely to use cannabis. And those who use all three are more likely to use other illicit drugs. Using cannabis exposes the young to the company and influence of those who use and deal in illicit drugs and may encourage other dangerous and illegal activities. Some estimates suggest that more road accidents are caused by the use of cannabis than by that of alcohol. Heroin is a powerful painkiller that depresses the central nervous system. This produces a feeling of relaxation, security, and well-being. Opium addiction in Iran has long historical roots and is a major social and health problem. Numerous publications have documented the association between alcohol and drug abuse, particularly between alcohol and motor vehicle crashes, injuries to pedestrians and cyclists, falls, burns, drowning, suicides, assaults, domestic violence, and even murder. Most studies have examined the association between alcohol consumption and injury using hospital emergency-department admissions data. In particular, in the case of burn injury, we hypothesized that multi-drug abuse represented a more powerful risk factor for burn injury than single drug abuse. We also hypothesized that, considering the most severely affected substance abusers amongst patients receiving care in a burns unit, opium was the main cause. In this study, we planned to conduct an aetiological survey of burns suffered by abusers of various kinds of opioids, stimulant drugs, hallucinogens, and cannabinoids in patients admitted to the burns ward at Tabriz Sina Hospital, Iran. From 20 March to 20 March , patients with burn injury including patients addicted to opium were admitted to the burns centre at Sina Hospital in Tabriz. Various kinds of abused drugs were classified as opium agents including opium, morphine, codeine, heroin, opium residue, crack, petedine, and methadone , stimulant agents amphetamine, crystal, cocaine, and ecstasy , and hallucinogenic agents LSD, PCD. Between these dates a prospective study of all drug-abusing patients with burn injuries presenting solely at the Tabriz Burns Centre was designed to analyse the association between age, percentage total body surface area TBSA burned, inhalation injury, causes of burn, type of opioid, the risk of death, and the epidemiology of burns. Survival was defined as discharge from the burns unit. A special dossier was prepared to study epidemiological, demographical, and therapeutic data. The patients were categorized by age, sex, percentage TBSA burned, presence or absence of inhalation injury, cause of burn, outcome, educational status, occupational status, length of hospital stay, type of opium addiction, and type of family. The diagnosis of the opiate abuser was made by one of two attending burns surgeons on the basis of the clinical history, which included the patterns of opiate usage, information regarding the possible existence of an antisocial personality disorder, history of chronic pain, search for physical stigmata of misuse e. A blood and urine screen was used to identify opiates in patients in whom misuse was suspected. The diagnosis of inhalation injury was made by one of the two attending burns surgeons, based on the history surrounding the burn event and the physical findings. The factors used to determine the presence of inhalation injury included burns sustained in an enclosed space, presence of facial burns, requirement of mechanical ventilation, carboxyhaemoglobin levels, and presence of carbonaceous sputum. We do not use bronchoscopy and the Xenon lung scan in our institution. There is no accepted way of quantitating the severity of inhalation injury other than by determining whether inhalation injury is present or absent. We chose to use the clinical criteria demonstrated by Shirani et al. Fluid requirements were estimated using the Parkland formula. Urine output was used as the principal resuscitation guideline. Burn cause was determined by history. Follow-up was obtained by examination in clinic. Follow-up examination was scheduled in all patients from 12 to 72 months. The findings were entered on a computer by means of a SPSS The statistical analyses were used to assess the relative predictive power of percentage TBSA burn, age, inhalation injury, type of opium, and cause of burn, as well as different combinations of these five variables, as predictors of mortality. The level of significance was set at 0. During the five years of the study, patients were admitted, of whom were drug addicts 9. In addicted patients, the mean age was The largest single group of patients was the yr age group in both addicted and non-addicted patients. The most common cause of burns among the addicted patients was flame Of the burn cases, There were 47 The mean burn size was The mean fatal size was The mean length of hospital stay was The mean length of hospital stay in addicted burn patients was There were 60 deaths, with an overall mortality rate of Sixty patients There were 31 deaths among the patients without inhalation injury mortality, Inhalation injury was present in 29 of the 60 deaths Inhalation injury was present in All patients with flame burns had associated inhalation injuries. However, inhalation injury was strongly associated with large burns. The distribution of patients by age group, average burn size, presence of inhalation injury, and mortality is shown in Table I. The distribution of patients by mean burn size, presence of inhalation injury, and mortality is shown in Table III. The mortality rate was significantly higher in multi-drug abuse than in single drug abuse Large burn size was the strongest predictor of mortality, while inhalation injury, strongly linked to large burns, was found to be an independent predictor of death. Patient gender when matched with burn size, age, type of agent used, and cause of burn was not predictive of mortality in either addicted or non-addicted patients. There was no difference between males and females according to the type of agent abused. The distribution of patients by type of agent used, inhalation injury, and mortality is shown in Table IV. This figure is more than five times the estimate 0. The government of Iran seems particularly concerned over the sharp increase in intravenous drug abuse. Most observers place the number of drug users in Iran at about 2,,, the great majority males. Opium smoking is the traditional manner of drug of abuse in Iran, but opium is also drunk, dissolved in tea. Opium and its residue are also injected, dissolved in water, by a small number of addicts. Heroin is sniffed, smoked, and injected. Ninety-three per cent of opiate addicts are male, with a mean age of In Iran the situation is exacerbated not only by rampant unemployment but also by general apathy and lack of confidence in the future. The quality of Iranian education is high compared to that of western countries, and the despair of highly skilled young graduates forced to accept menial jobs in small shops is thus reflected more in the drug addiction rates than in employment statistics. One study found that in a group of patients who were substance abusers or who were neurologically or mentally impaired, in-patient care was more costly, more complicated, and more protracted. To determine whether substance users SU differed from controls, burn patients were studied, of whom had a positive drug screen for ethanol, cannabinoids, cocaine metabolites, amphetamines, phencyclidine, or benzodiazepines. In our prospective study, the SU were significantly younger than non-addicted patients The greater incidence of inhalation injury in non-abusers may be due to the greater incidence of suicide in our patients, which presented a higher mean percentage of TBSA burned Burns in opiate-addicted patients have frequently been reported in the literature, which indicates in relation to opiate addiction that men are more likely to become addicts than women, as in our study. As expected, we found that increased burn size led to an increased risk of mortality among addicted and non addicted patients, a finding confirmed by other studies. The non-survivors with small burns in this series are an important reminder that addicted burn patients can die from small burns. The mortality in our overall patient population Like other researchers, 13 , 14 , 16 , 18 we found that the incidence of inhalation injury rose with increasing burn size, but not with advancing age. This is not surprising since, as has already been suggested, larger burns and inhalation injury are more likely to be seen in less mobile patients burned in fires. In the addicted burn population, most burns are flame burns and most are associated with inhalation of smoke. In addition, we demonstrated that in our series of addicted burn patients, the most important predictor of mortality following thermal injury was TBSA burned, with inhalation injury adding little to the accuracy of this in addicted patients. In our study, the mortality rate was significantly higher in multi-drug abusers than in single drug abusers. The most important factors influencing the incidence of thermal injuries are age, sex, and economic status. Addicted patients are the most prone to thermal injury. The greater amount of addiction in burn patients in our study may be due to the higher incidence of addiction in Iran, for various reasons: land routes across Iran constitute the single most important conduit for south-west opiates en route to European markets. The relationship between median family income and burn rate is strong and linear. Addicted burn patients from poor or low-to-middle income families are exposed to burns. We determined that the cause of burns was not an independent predictor of mortality i. We were surprised by the finding that there was no mortality among the 22 patients with scalds presenting a mean burn size of Other studies 13 , 16 , 17 , 18 concluded that the presence of inhalation injury significantly increased mortality and suggested that inhalation injury was the single most important determinant of mortality following thermal injury. In the present study, we too found that inhalation injury was important and that inhalation injury was significantly associated with mortality following thermal injury. However, we found that although inhalation injury was a significant predictor of outcome, it was less important than the size of the burn in predicting mortality. In our study, one key finding was that after burn injury more problems were associated with multi-drug use than with single drugs. The mortality rate was significantly higher in multi-drug abusers. We conjectured that personality traits in drug-abuse dependent persons accounted for the prevalence of the injury to a greater extent than the consumption itself. This is a clear finding, but the issue will require further study. Such individuals constitute a prime opportunity to focus on burn injury prevention within the confines of treatment programmes directly linked to substance abuse. The recognition of the burns centre as place to offer prevention is a unique contribution to this particular field of study. This includes educating patients about the risks of injury as well as making assessments of their living conditions, in order to prevent burn injuries. Identifying patients with depressive symptoms and impulsive behaviour may also be beneficial, so that additional counselling sessions can be provided. Future studies should look at the various prevention strategies offered in detoxification programmes in order to verify their capacity to decrease the consumption of abused drugs and the burn injury rate. In conclusion, our data suggest that although increases in the percentage of TBSA burned and the presence of inhalation injury were associated with increasing mortality, the most important single predictor of mortality in drug-addicted burn patients was the percentage of TBSA burned, while the presence of inhalation injury added little to the possibility of predicting mortality. In no addicted burn patient, no matter how large the burn, what sort of abuse agent, or what type of inhalation injury, could an accurate prediction be made at the time of admission as to whether the patient would live or die. Despite some differences in demographics, the same general rules for rehabilitation apply to the opiate abuser. The basic strategy includes detoxification and general family support. It is also important to establish realistic patient goals and a programme of counselling to increase motivation toward abstinence. A long-term commitment to rebuilding a life-style without the substance is essential for preventing recidivism. Since , public awareness campaigns and the attention of two successive Iranian Presidents, as well as cabinet ministers and the Iranian parliament, have given appeals for reduction of drug abuse a significant boost. Eighty-eight out-patient treatment centres are now operational. Some 30, people are treated per year, and some programmes have three-month waiting lists. Narcotics Anonymous and other self-help programmes can be found in almost all districts as well, and several NGOs focus on drug demand reduction. Understanding how opiates cause addiction could lead to greater insight into the brain processes of addiction to other dependence-producing drugs, and to discovering how to prevent dependence from occurring. Also, research into opiate addiction could increase understanding of the brain networks involved in pain, as opiates and opiate receptors in the brain and spinal cord are involved in pain processes. With a better knowledge of addiction and of pain - another urgent public health issue - scientists will be able to develop specific medication to treat these distinct disorders. Only continued funding for research will help develop better treatments that are selectively targeted, helping more addicts to stay drug-free. Health care practitioners - particularly family physicians and trauma personnel - play a valuable role in detecting substance-abusing patients, intervening on their behalf, and referring them to appropriate care. Addiction is a brain disease. There are many things that can place someone at risk of developing an addiction, and we now know that it can have a genetic basis. It is a chronic disease, just like heart disease, diabetes, and other diseases, and we should bring it out into the open, just as we have done with diseases such as breast cancer and heart disease. Owing to the wide variety of causes of burn injuries related to drug abuse, diverse interventions targeted at those at highest risk e. As public health workers are the most important people involved in such programmes, using them to their full capacity and also using the full capacity of the health system network in Iran are advised if these injuries are to be reduced. As a library, NLM provides access to scientific literature. Ann Burns Fire Disasters. Show available content in en fr. Find articles by H Maghsoudi. Find articles by R Raghifar. Received Sep 2; Issue date Dec Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

availability of drugs may be one reason for drug abuse among Iranians. After all, Afghanistan—Iran's eastern neighbor—is the world's biggest producer of.

Tabriz where can I buy cocaine

Attention deficit hyperactivity disorder ADHD is a disorder that has become better recognized in adults during the past few years, with a reported prevalence of 1. Adults with ADHD suffer from attention and concentration disabilities, hyperactivity or internal restlessness, and impulsive behavior. Many people with ADHD also suffer from rapidly changing moods and irritability, resulting in academic and occupational underachievement and recurrent failures. Moreover, comorbidity is common among adults with ADHD. Substance use is particularly troublesome during this period as it often manifests in serious social, legal, academic, behavioral, and family-related problems 6. Adolescents with substance use disorders SUDs are also more likely to have co-occurring psychiatric diagnoses compared with adolescents without SUDs. For SUD more broadly ie, combining abuse and dependence , the lifetime prevalence in the same age range varied from In fact, there is a sizable body of research suggesting that ADHD is associated with elevated substance use and related disorders 8 , 9. Thompson et al. Similarly, ADHD was associated with severe substance dependence in a sample of clinic-referred male and female adolescents However, null associations between ADHD and substance problems have also been reported. In a sample of , 11 - 15 years old adolescents, ADHD was unrelated to substance use and related problems Similarly, in a prospective study of adolescents diagnosed with ADHD when they were 7 — 11 years old, maltreatment, but not childhood ADHD, independently predicted substance problems There are several reasons that ADHD and substance problems may be related. MPH, by virtue of activating positive attention networks and distilling task-irrelevant stimuli, improves attention, vigilance, and motivation Second, a recent review of neuroimaging studies of humans with ADHD and SUD found replicated evidence of blunted striatal DA release and disrupted neural circuitry between the anterior cingulate cortex and striatum with the prefrontal cortex Rodent and non-human primate models suggest the centrality of deficits in response inhibition, including dysfunctional circuitry in the ventro lateral frontal, cingulate cortices, and basal ganglia regions, in both ADHD and SUD Elevated substance use problems have also been frequently reported in parents of children with ADHD Finally, the prevalence of psychopathology, including SUD, is higher in first degree relatives of ADHD inclined than in healthy controls The research questions were as follows:. The aim of the present study was to predict tendency to use drugs accepting drugs l and alcohol potential by child and adult ADHD symptoms among adult students of Tabriz University. The method of this research is descriptive-correlational. Multivariate regression was used for the statistical analyses. The statistical population of this research was students in faculties of Tabriz University, the sample was selected from this population. The sample for the present study consisted of male students from the Tabriz University who were selected by stratified random sampling. The short form consists of only 26 items which are rated on a Likert scale from 0 not at all to 3 severe. A validation study tested internal consistency, test-retest reliability, concurrent validity, criterion validity, and the diagnostic utility of the CAARS in a clinical sample of adults 97 males and 70 females. All subjects were referred to an outpatient ADHD clinic for diagnostic assessment. Their mean age was All psychometric quality criteria reached highly satisfactory values Arabgol et al. In the current study, the reliability coefficient of the inventory with a sample size of subjects was 0. First a 61 item five-point Likert type self-assessment scale questioning ADHD symptoms in childhood was developed. Internal consistency and test-retest reliability after one month of WURS were reported to be high in university students Sarami-Froushani 32 obtained the coefficients of reliability of the scale 0. A high MAC-R Scale score is associated with substance abuse potential and other addictive problems such as pathological gambling. The scale seems to be effective with both men and women, as well as inpatients and outpatients Khodayarifard et al. Fourteen such items were found. Items not contributing to internal consistency were dropped and replaced by two items that improved scale internal consistency. The AAS is made up of 13 items. Research has shown that the AAS discriminates well between substance abuse samples and samples of either psychiatric patients or normal In this study Khodayarifard et al. In order to answer this question, the Pearson correlation and analysis of regression methods were used. Abbreviation: ADHD, attention deficit hyperactivity disorder. The second research question was examined by regression analysis, and the results are presented in Table 2 and Table 3. In Table 3 , which shows that child ADHD was the strongest predictor and entered the model first, followed by impulsivity. In explaining these findings we can say; child ADHD is a reliable predictor of negative outcomes across academic, social, neuropsychological, and affective domains. Hence, multi finality, where multiple negative outcomes share a common developmental origin, area defining features of ADHD To quantitatively characterize the association of ADHD on SUD and to strengthen a potential causal inference by establishing temporal ordering, we focused on prospective longitudinal studies That is, the reported effect sizes for ADHD and substance problems did not differ significantly by, average age at follow-up, gender, race, sample source clinic-referred vs school-population-based , or the DSM version used to determine ADHD. In addition to the statistical significance of the association between ADHD and substance problems, we emphasize the size of the effects; children with ADHD were at least 1. The association between adult ADHD symptoms and substance use disorders may reflect impulsivity, deviant peer groups, comorbid conduct or antisocial personality disorder, and self-medication of individuals with ADHD symptoms, in addition to shared genetic risks among subjects with both disorders It is uncertain whether early successful treatment of childhood ADHD reduces the subsequent risk of psychiatric disorders in adulthood, or whether treatment of adult ADHD affects the severity and course of comorbid disorders, although there is evidence that successful treatment of childhood ADHD reduces the risk of substance abuse 11 as well as childhood symptoms of comorbid disorders. Further studies are required to assess whether the treatment of childhood and adulthood ADHD affects the risk of comorbid conditions during adulthood. Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. Am J Psychiatry. Kooij JJS. ADHD bij volwassenen: inleiding in diagnostiek en behandeling. Central Boekhuis; Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. The prevalence of self-reported problems in young adults from the general population. Soc Psychiatry Psychiatr Epidemiol. Hawkins EH. A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents. Annu Rev Psychol. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. J Child Adolesc Psychopharmacol. The ADHD spectrum and everyday life: experience sampling of adolescent moods, activities, smoking, and drinking. Child Dev. Young adult outcome of attention deficit hyperactivity disorder: a controlled year follow-up study. A community-based case-control study. Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents. J Abnorm Child Psychol. Influences on adolescent substance dependence: conduct disorder, depression, attention deficit hyperactivity disorder, and gender. Drug Alcohol Depend. Psychiatric disorder and substance use in adolescence. Can J Psychiatry. J Clin Child Adolesc Psychol. Dopamine transporter gene variation modulates activation of striatum in youth with ADHD. Polymorphisms of the mu-opioid receptor and dopamine D4 receptor genes and subjective responses to alcohol in the natural environment. J Abnorm Psychol. Mechanism of action of methylphenidate: insights from PET imaging studies. J Atten Disord. Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: a decade of progress. Frodl T. Neurosci Biobehav Rev. Psychopathology in preadolescent sons of fathers with substance use disorders. Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives psychiatrically and pediatrically referred samples. Arch Gen Psychiatry. Behavioral disinhibition: liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. Weiss M, Murray C. Assessment and management of attention-deficit hyperactivity disorder in adults. J Attention Disord. Adv Cogn Sci. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Retrospective self-reported symptoms of attention-deficit hyperactivity disorder: reliability of the Wender Utah Rating Scale. Psychol Rep. Sarrami-Foroushani P. Isfahan: Isfahan University of Medical Sciences; MMPI characteristics of alcoholics: a review. J Consult Clin Psychol. Soc Welf. J Pers Assess. Cicchetti D. Development and psychopathology. Developmental psychopathology. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Clin Psychol Rev. Barkley R A. Child psychopathology. New York: Guilford Press; 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. Objectives: This study aimed to predict the tendency for drug use from child and adult ADHD symptoms in adults among male students from Tabriz University, Iran. Patients and Methods: For this purpose, students were selected via a stratified random sampling from different faculties of Tabriz University. Results: To analyze the data Pearson correlation and multiple regressions step by step were used. Conclusions: According to this result behavioral disorders, especially ADHD, have an effect on the tendency to use drugs and therefore the primary treatment of behavioral disorders could prevent future drug abuse. Background Attention deficit hyperactivity disorder ADHD is a disorder that has become better recognized in adults during the past few years, with a reported prevalence of 1. The research questions were as follows: 1 Is there any relationship between adult ADHD inattention, hyperactivity, impulsivity subtypes, problems with self-concept and child ADHD via addiction acknowledgment and alcohol potential? Objectives The aim of the present study was to predict tendency to use drugs accepting drugs l and alcohol potential by child and adult ADHD symptoms among adult students of Tabriz University. Patients and Methods The method of this research is descriptive-correlational. Research Instruments Four questionnaires were used in this study. Results Results are presented according to the research questions posed above. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. 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Though most abused drugs can cause some degree of physiologic dependence, the severity of withdrawal varies considerably among these drugs. Some.

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Among students (%, 95% CI: –) had ever used alcohol and 36 (%, 95% CI: –) had used drugs. The results.

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