Drug addiction

955 Pages·2015·5.02 MB·English

Invited
Oral
Presentations

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Subgroups of Substance misuse among medical university Students: a Latent Class
Analysis
Abbas Abbasi-Ghahramanloo1, Afarin Rahimi-Movaghar2, Akbar Fotouhi3, Hojjat Zeraati3
1 School of Public Health, Iran University of Medical Sciences, Tehran, Iran
2Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical
Sciences, Tehran, Iran
3 School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Introduction: Substance use is one of the major causes of preventable disease and premature
death in the world. The aims of the present study were to determine subgroups of substance
misuse among medical university students based on pattern of prescription drugs and
substance use with Latent Class Analysis (LCA).
Method and material:A cross-sectional study was done on a randomly selected sample of
1992 students of medical sciences in 2012-2013. Data analysis was done using Chi-square
test in SPSS. The LCA were performed in SAS 9.2 by using proc LCA.
Results: The prevalence of cigarette smoking(last year), hookah smoking(last year),
prescription drug misuse (use of opioid medications and sedatives or tranquilizers at least 3
times a week for the last month or last year use of methylphenidate), last year alcohol use,
and ever illicit substance use was 8.8, 17.3, 4.9%, 6.9%, and 2.9%, respectively. ،Twelve
dichotomous variables were used to assess latent classes. Three latent classes were
identified: (a) low risk, (b) hookah smoker, and (c) high risk. About 83 % of students are
“Low risk”, 14.5 % of them are “Hookah smokers” and 2.2 % of them are “High risk”.
Conclusion: Our results suggested that the prevalence of some substance use is relatively
low, though still significant, among students. Also in categorize of students with LCA, illegal
drugs have no essential role. The findings of this research can be used for planning and
evaluating interventions in universities.
Key words: substance misuse, substance use pattern, medical university students, latent class
analysis.

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The Effect of Substance Legalization on Drug Prices

Amin Afshar, MD, PhD Candidate, Tehran University of Medical Sciences

The criminalization approach to drugs has always followed the policy to further rise the drug
prices with harder sanctions on availability of drugs and, therefore, further limit tendency to
drug use. Decriminalization and legalization policies, however, do not seem to automatically
lead to lower prices and further encouraging people to use drugs. The economic explanation
of how this dynamic would take place and the available evidence are discussed in this
presentation.

ATP-dependent potassium channels are involved in opioid-induced hyperalgesia

Shamseddin Ahmadi and Fatemeh Miraki
Department of Biological Science, Faculty of Science, University of Kurdistan, Sanandaj,
Iran

Background and Objective: Opioid-induced hyperalgesia is a state of nociceptive
sensitization which is induced by repeated exposure to opioids and is believed to be different
from tolerance in some aspects. This response limits the utility of opioids, as well as our
ability to control chronic pain. Mechanisms of opioid-induced hyperalgesia remains to be
understood. ATP-dependent potassium (K ) channels are involved in some actions of
ATP
morphine. Therefore, the aim of this study was to examine possible involvement of K
ATP
channels in opioid-induced hyperalgesia.
Method: We used male NMRI mice in these experiments. Opioid-induced hyperalgesia was
established under a regimen of morphine treatment including injections of morphine 20
mg/kg, i.p. twice per day on days 1–3 and 40 mg/kg twice per day on day 4. Opioid-induced
hyperalgesia was assessed on day 5 with a hotplate test of analgesia after injections of
different doses of morphine (0, 2.5, 5 and 10 mg/kg). Then, effects of diazoxide, an opener of
K channels and glibenclamide, as a blocker of K channels on opioid-induced
ATP ATP
hyperalgesia on day 5 were examined.
Result: The results showed that opioid-induced hyperalgesia was established with the
regimen of four days injections of morphine as revealed by decreases in antinociception of
different doses of morphine on hotplate test. Diazoxide at dose of 5 mg/kg and glibenclamide
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at dose of 10 mg/kg along with morphine 10 mg/kg prevented, at least partly, the
hyperalgesia induced by the opioid.
Conclusions: In can be concluded that K channelshave modulatory effects in induction of
ATP
morphine-induced hyperalgesia.

Keywords: Opioid-induced hyperalgesia, Diazoxide, Glibenclamide

Psychological Emergency Effects of Alcohol Abuse

Abdolkarim Ahmadi Livani
Assistant Professor of Psychiatry, Psychiatry and Behavioral Sciences Research Center,
Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
[email protected]

One of the issues that led to the development of increasing concern in the field of healthis
alcohol abuse and dependency. According to the Iranian Ministry of Health, about one
million people everyyear consume alcohol at least once, and the prevalence of alcohol abuse
in societyis 1.7%. Ofthis percentage, 0.7% had alcohol dependency and only 0.3
percentposed a threat ofalcohol abuse.One of the concerns about alcohol abuse is
emergencies associated with it. Although,the actual number of alcohol-related visits is
probably higher. Comorbidity of substance use disorders and other mental illnesses is
common too.About 30% of patients with a mental illness consume either alcohol or other
addictive drugs. Morethan 35% of alcohol abusers and 59% of drug abusers have oneor more
serious mental health disorders.Mood disorders, personality disorders, anxiety disorders, and
schizophrenia are the most common, to name but a few. Emergency departmentshold a
potentially pivotal position to detect and refer to patients who misuse alcohol. The effects of
alcohol vary according to the level of consumption: low dosespromote mild euphoria and
uninhibited behavior, while substantial consumptionmay trigger irrational thinking,
problematic behavior, psychomotor difficulties, andin rare cases, coma. The first step in
evaluating a patient with a drinking problem isto identify possible predisposing factors for an
episode of withdrawal. Thesefactors include high blood alcohol levels, history of withdrawal
or seizure,concurrent use of sedating agents, and co-occurrence of acute or chronic
medicalproblems.Most people with alcohol dependence will experience mild signs and
symptoms ofwithdrawal within 24 hours after their last drinking episode. These usually
includerestlessness, anxiety,tachycardia, tremors, GI discomfort, and insomnia.Symptoms
may last for about a day and usually remit without major consequences.
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If done properly, the assessment of alcohol and substance use disorders in theemergency
department (ED) or psychiatric emergency service can be the first steptoward recovery. A
proper assessment, however, can be extremely taxing for boththe clinician and the patient.

Populations Size Estimation Using Zero Truncated Count Data (Single Source CRC)
Hossein Akbari1, Kamran Yazdani1
1 School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Sufficient and accurate information on the population size and its distribution is one of the
most important and challenging aspects of Public Health policy-making especially in
sensitive issues such as drug abuse. Epidemiologic studies for Population Size Estimation
(PSE) are usually conducted in two ways: Direct estimation by sampling or census in source
population and indirect estimation from the same or other data sources. Although general
population surveys (as a direct method) are considered as Gold Standard for Population Size
Estimations, but it is known that most of them are inaccurate and underestimation of real
population size, so indirect methods for PSE are established for coping with these
inadequacies [Under-coverage (inaccessibility of addicts as hidden population) and Under-
reporting].
Generally indirect methods for PSEs could be categorized in two main categories 1) Primary
Data based Methods which are based on Sampling and collecting data from hard to reach
population and 2) Secondary data based methods which are based on modeling and
correcting registered or existing data. One of the well-known and accepted indirect methods
of PSE based on secondary data is using registered count data sources that is statistically
distributed as zero-truncated Poisson distribution (such as number of attending persons to
methadone maintenance therapy centers) which also known as single source Capture-Re-
Capture data. The most popular method for dealing with this type of data is zero-truncated
Poisson model which is based on estimation of distribution parameter and using that for
calculating the hidden population by a population size estimator such as Horvitz-Thompson
estimator. This approach is developed recently to involve uncertainty and population
heterogeneity (observed and un-observed heterogeneity) by using regression models such as
robust model of Z.T Zelterman regression and heterogeneous models such as Z.T Negative
Binomial Regression which should be elected depending on appropriateness and fitness with
data.
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Key words: indirect estimation, single source, capture-re-capture.

Using local strengths for substance abuse prevention
Leila Arshad
Social worker active in social NGOs
It is constantly heard that there aremany obstaclestoworkagainstaddiction. We social workers
are taught to focus not on barriers but on little strengths and legal loophole to assist at-risk
people. We also work to improve quality of life for people who are not normally defined as
social injured. With a strengths-based perspective, social workers avoid wasting time on
negative points and, instead, search for assets which can be applied for making life better.
Social workers believe that even in high-risk communities and neighborhoods numerous
resources can be found. Strengths are assumed at micro to macro level. For example, working
with young drug-users, community social workers scrutinize any neighborhood to find, build
and support social groups to strengthen collective spirit, social integration, and social
identity.

Drug Use Prevention Strategies Among Street Children
Hamed Bahari
Substance Abuse and Dependence Research Center, University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran

Definitions &Goals
Addiction prevention means how to prevent the factors and processes which can lead to
addiction such as drug use tendency, tentative use, between times use, drug abuse and
dependency. Reduction of the incidence rate of addiction and at least 40% coverage of
population by standard preventive programs during 2011-2015 have been determined in
national preventive document. Our goal is to define evidence-based preventive methods for
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street children and select the most practicable interventional packages based on them and
offer them to authorities to come in to effect.
Prevention Principles
Addiction preventive programs among street children are selective but the main targets of
almost all of them are the protective and the risk factors. We can use the following formula to
define addiction preventive models.
Protective factors: stress + Normalization of Drug Use+ Drug Effect
Risk for Drug Use = ---------------------------------------------------------------------------------------
----------
Risk factors: Attachments+ Coping Strategies+ Resources
According to the formula, an increase of the denominator and a decrease of the numerator
decrease the risk of drug use and conversely.
1) Attachments: contact with family, presence of adult mentor, …
2) Coping strategies: problem solving, …
3) Resources: information, health, recreation, …
4) Stress: major life events, …
Planning
In addition to the information of street children in Iran and also review of other countries'
activities, we should also pay attention to the following points:
1) Negative effects of programs on children's revenue
2) In the moment living of these children
3) Major problems in emotional discharge
4) No specific or permanent place for training
Different public, individual and selective addiction prevention programs for family, schools,
peer groups and society have been done up to now which were evidence-based and were
actually so effective:
a. Life Skills Training
b. Skills, Opportunity, And Recognition (SOAR)
c. Project ALERT
d. Project STAR

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What are the barriers for Iranian Journals to improve their qualities and Indexing?
Nour-Mohammad Bakhshani
Zahedan University of Medical Sciences-, Zahedan, Iran
Abstract
Nowadays, journals contribute greatly to all dimensions of human life, especially in
development and directing scientific fields. They are also considered as the most important
methods of publishing original research. Thousands of journal titles are now published in
different areas that can be categorized into three groups:
1. Professional or commercial (trade) journals: They are dedicated to a profession or industry
where the practical advices, viewpoints and news are published.
2. Public journals: They mostly contain stories, viewpoints and editor-in-chief’s speeches.
Their main purpose is to inform and entertain the readers.
3. Scholarly journals: These include academic and scientific journals known usually as peer-
reviewed Journals. Some of their prominent properties include:
-Regular, periodical publication
-Focused on a particular field or subject
- Have an editorial board
-Have a publication policy and guidelines for both reviewers and authors
-Have an International Standard Serial Number (ISSN)
-Ascribe a Digital Object Identifier ( DOI )to each article
-Publish reviews, original etc. articles
-Adherence to international publication rules and guidelines
The academic scientific journals have four main functions:
A) registration , B)dissemination ,C)certification and D)archival record
Despite the above-mentioned functions, all journals are not equally valid in the
scientific community and many of them have little influence on knowledge boundaries.
Hence, journal publishers always seek mechanisms to be able to improve the ranking of their
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journals and index them in international indexes so that they would be more influential in the
scientific world.
Although much attention is paid to perform scientific research and publish different
types of scholarly journals in Iran during recent years, so that more than 1460 scholarly
journals are now published, authorized by both Ministry of Science, Research and
Technology (MSRT) and Ministry of Health and Medical Education (MOHME) of Iran, but
only about 150 journals are indexed in first and second-ranked indexes.
Evaluating the process, content and structure of Iranian scholarly journals indicates
that they are facing many problems and obstacles. The current article will discuss some areas
that are important factors for improving the quality of scholarly journals, indexing them in
first rank indexes and also increasing their Impact Factors:
-Title and language of journal
-Journal structure and its website
- Content and structure of articles
-Editor-in-chief and reviewer characteristics and qualities
-Financial status of journal
-Interaction with international authors and researchers
-Reviewers’ and authors’ guidelines
-Adherence to international publication rules
-Indexing journals
-Article citations and Impact Factor of journal

Substance abuse treatment in DK from a user point
Birgitte Thylstrup
Associate professor, Center for Alcohol and Drug Research, Aarhus University, Copenhagen
S, Denmark
[email protected]

Research has shown positive associations between treatment satisfaction and treatment
outcome. Despite the growing emphasis on consumer perspectives, studies that identify
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predictors of patient satisfaction mostly use structured instruments. By excluding the
patients’ subjective perception of service quality this approach risks overlooking areas and
processes that may not have been identified and addressed in treatment previously.
Consequently, some researchers argue that because user perspectives on treatment services
influence treatment outcome, it should be explored as a dimension of treatment.
This presentation concerns associations between measured treatment satisfaction and user
perspectives on substance abuse treatment services in Denmark. In Denmark, patient
satisfaction with treatment is in general high. However, there are still considerable challenges
to be met.
Based on results from mixed method studies on Danish outpatient treatment services, it is
discussed how the inclusion of user perspectives has the potential to generate important
information on whether the rationale and the means of treatment makes sense to the patients,
providing substance the organization of Danish abuse treatment services with valuable
information for future qualitative assurance strategies.
Addressing comorbidity and antisocial behaviour in substance abuse treatment
The keynote addresses the importance of targeting comorbid substance use and antisocial
personality disorder (ASPD) in substance abuse treatment. Patients with ASPD use a
disproportionate amount of resources in substance abuse treatment, and also drop out of
certain kinds of treatment, especially drug-free outpatient treatment, more often than other
patients. Available longitudinal evidence suggests that the prognostic significance of ASPD
is stronger than what short-term research suggests. Although ASPD constitutes a serious
disturbance that imposes a major burden on the individual, society and the clinic, there is still
much to be learned about how to improve substance abuse treatment for patients with this
disorder. However, there may be ways to include this challenging population in treatment and
reduce dropout from treatment. Providing psychoeducation within an outpatient setting may
increase the engagement of individuals with ASPD by raising their awareness and
understanding of the problems and dysfunctional beliefs related to their antisocial behaviour,
and it may support them in making informed decisions about seeking and receiving help for
their problems.

The Effect of Substance Legalization on Drug Use
Nader Charkhgard, MD, PhD Candidate, Tehran University of Medical Sciences
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