Evaluation of an Educational Intervention Based on Theory of Planned Behavior to Reduce Suicidal Ideation and Attempts in Drug Addicts Receiving Methadone: A Quasi-Experimental Study

BACKGROUND

Drug addiction can lead to suicidal ideation or suicide attempt so that half of those who attempt suicide have a history of substance abuse. The purpose of this study was to investigate the effect of educational intervention based on Theory of Planned Behavior (TPB) on reducing suicidal ideation and suicide attempt of addicts.

METHODS

A longitudinal quasi-experimental educational intervention was conducted on 200 methadone-treated addicts with suicidal ideation under the auspices of government addiction centers of Shiraz city from 2021 to 2022. Baseline data on demographic characteristics, suicidal ideation, and TPB questionnaire were collected from two groups at the beginning of the study and then three months after the intervention. The experiment group received educational intervention including sessions of individual and group counseling, training and organizational supports. The questionnaire was completed by both the experimental and control groups before the educational intervention and three months after the educational intervention. Data were analyzed using SPSS 22 software through independent t-test, Chi-square and paired t-test (p = 0.05).

RESULTS

The mean age of addicts in the experimental and control groups was 38.80 ± 11.64 and 39.41 ± 11.18 years, respectively (p = 0.206). 22% of the experimental group and 18% of the control group had a history of suicide. According to the results, there was no significant difference between the experimental and control groups in terms of knowledge, attitude, subjective norms and perceived behavioral control before the educational intervention, however, the mentioned variables increased significantly in the experimental group three months after the educational intervention. There was no significant difference in suicide attempt and suicidal ideation between the experimental and control groups before the educational intervention, however, there was a significant change in the experimental group after the educational intervention.

CONCLUSION

The results of the present study showed the effect of educational intervention on the knowledge, attitude, subjective norms, perceived behavioral control, suicidal ideation and suicidal attempt of addicts, thus confirming the effectiveness of the TPB-based intervention on reducing suicide of addicts.

Comparison of the effect of hostility on the level of depression of drug addicts and non-addicts and the mediating role of sense of life meaning between them

BACKGROUND

The level of depression among drug addicts is generally higher than normal. Hostility and sense of life meaning may influence depression and become risk factors for depression. This study has three research purposes. First, to analyze whether drug use can aggravate hostility and depression levels. Second, to assess whether the hostility has different effects on depression among drug addicts and non-addicts. Third, to examine whether the sense of life meaning has a mediating role between different groups (drug addicts and non-addicts).

METHODS

This study was conducted from March to June 2022. 415 drug addicts (233 males and 182 females) and 411 non-addicts (174 males and 237 females) were recruited in Chengdu, Sichuan Province. After signing informed consent, their psychometric data were obtained using the Cook-Medley Hostility Scale (CMI), Beck Depression Inventory (BDI) and Meaning in Life Questionnaire (MLQ) questionnaires. Linear regression models were used to assess the impact of hostility and depression among drug addicts and non-addicts. Bootstrap mediation effect tests were used to further test the mediation effect of sense of life meaning between hostility and depression.

RESULTS

The results showed four main outcomes. First, compared with non-addicts, drug addicts had higher levels of depression. Second, hostility exacerbated depression in both drug addicts and non-addicts. Compared with non-addicts, hostile affect had a greater effect on depression in drug addicts. Third, the sense of life meaning among females was higher than males. Fourth, for drug addicts, the sense of life meaning showed a mediating effect between social aversion and depression, while for non-addicts, the sense of life meaning showed a mediating effect between cynicism and depression.

CONCLUSIONS

Depression is more severe in drug addicts. More attention should be paid to the mental health of drug addicts, because the elimination of negative emotions is conducive to reintegration into society. Our results provide a theoretical basis for reducing depression among drug addicts and non-addicts. As a protective factor, we can reduce their hostility and depression by improving the sense of life meaning.

Evaluation of blood lead levels in opium addicts and healthy control group using novel deep eutectic solvent based dispersive liquid-liquid microextraction followed by GFAAS

Today, drug dealers and sellers add lead compounds to these substances to get more profit. As a result, drug users are heavily exposed to lead, and lead poisoning is clearly seen in most of them. Therefore, it is especially important to check the blood lead levels in these people. In this research, an efficient and eco-friendly pretreatment method was established by deep eutectic solvent for dispersive liquid-liquid microextraction (DES - DLLME) followed by graphite furnace atomic absorption spectrometry (GFAAS) analysis. The selected hydrophilic deep eutectic solvent consists of l-menthol and (1S)-( +)-camphor-10-sulfonic acid (CSA) at a 5:1 molar ratio as a green solvent instead of traditional toxic organic solvents. Under the optimal extraction conditions, the introduced method exhibited good linearity with coefficient of determination (r²) 0.9975 and an acceptable linear range of 0.3-80 µg L^-1. Accordingly, the detection limit was 0.1 µg L^-1 (S/N = 3) for lead ions, and the high enrichment factor (240) was obtained. The proposed method was successfully applied to analysis lead ions in real blood samples, which is a promising technique for biological samples. The case samples were classified and analyzed based on age, duration of consumption, and type of substance. The results showed that there was no significant difference between blood lead levels in different age groups and different duration of use, while blood lead levels were higher in opium residue (shireh) users than in opium users.

A Path Analysis Model Examining Factors Affecting the Caregiving Burden Experienced by the Family Caregivers of Drug Addicts in Egypt

BACKGROUND

Although the caregiving burden experienced by the family caregivers of drug addicts is receiving increased attention, there is still a need to study the possible predictors of the care burden, especially with the increasing numbers of addicts in Egypt and the important role of family caregivers in the support and treatment of addicts.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted at Minia Hospital for Mental Health and Addiction Treatment, Egypt. Data was collected during interviews with addicts and their family caregivers. The caregiver burden was assessed using the Family Burden Interview Schedule (FBIS). The path analysis was used to assess the interrelationships between the burden and characteristics of addicts and caregivers.

RESULTS

Based on the results, 96.7% of addicts were males, and their mean age was 28.8 ± 8.1 years, while their caregivers aged 39.7 ± 10.4 years and included 58.7% males. The caregivers reported a severe burden of care which was predicted by the addict's drug-related problems (B = 0.25, P = 0.0003), financial hardship (B = 0.46, P < 0.0001), and the caregiver's occupation (B = -0.16, P = 0.017). Financial hardship had an indirect association with the burden of care (B = 0.06, P = 0.041) mediated through drug-related problems score, which was predicted by the severity of dependence, admission for treatment, and the level of social support.

CONCLUSION

The burden of caring for addicts depends on patient-related problems, as well as caregivers' situations and income. Strategies to provide social support, financial aid, and problem-solving skills should be provided to the addicts and their caregivers as a part of treatment programs to help reduce the caregiving burden.

Health-related quality of life and influencing factors in drug addicts based on the scale QLICD-DA: a cross-sectional study

BACKGROUND

Drug abuse has many negative effects not only on individuals but also on society. Nowadays, researchers pay a lot of attention to quality of life of drug addicts. However, there are few scales available to measure quality of life of drug addicts. The scale QLICD-DA (quality of life instrument for chronic diseases-drug addition) developed by modular approach could be used to measure quality of life of drug addicts with good validity, reliability and sensitivity.

OBJECTIVE

This study is aimed to understand the quality of life status and influencing factors in drug addicts by suitable sensitively scale, with the hypothesis of the quality of life in drug addicts being different from that of other peoples and possibly being influenced by many factors.

METHODS

By cluster random sampling method, 192 drug addicts at Kunming compulsory drug rehabilitation center were recruited to take part in the investigation. All participants completed the general information questionnaire and the scale QLICD-DA. We used a t-test to compare the scores of the quality of life of the participants with the norm (QOL scores from 1953 patients of 10 chronic diseases). A stepwise regression method was applied to explore the influencing factors of the quality of life in drug addicts.

RESULTS

192 participants ranged in age from 19 to 59 with an average age of 34.86. Most of them were male (70.3%), high school education level (67.7%) and of Han nationality (82.8%). The quality of life of drug addicts was lower than the norm in the physical domain, psychological domain, social domain, and general module, and the differences were statistically significant (p < 0.001). Sex and mode of drug abuse were the influencing factors in total score (p = 0.006) and specific module (p = 0.019). Past family atmosphere and the mode of drug abuse were the influencing factors in the general module (p = 0.027, p = 0.037).

CONCLUSION

The quality of life of drug addicts was worse than that of patients with other chronic diseases, and the influencing factors of the quality of life of drug abusers were sex, mode of drug abuse, and past family atmosphere.

Factors associated with suicidal ideation in drug addicts based on the theory of planned behavior

BACKGROUND

Several studies have attempted to understand the link among drug addicts and suicidal ideation. The purpose of this study was to investigate the factors associated with suicidal ideation in drug addicts based on the Theory of Planned Behavior (TPB).

METHOD

This cross-sectional study was conducted with 2160 of drug addicts in private and public clinics for quitting addiction through methadone treatment in Shiraz city, Fars province, Iran from October 2018 to June 2019. Data gathering tools were a questionnaire on demographic characteristics, the Beck Scale for Suicidal Ideation and a questionnaire based on constructs of TPB. Data were analysed by SPSS 22 using descriptive statistics (mean, standard deviation, and frequency) and statistical tests (independent t-test, Pearson correlation coefficient, and linear regression). The significance level was considered 0.05.

RESULTS

The mean age of the participants was 39.24 ± 11.92; 80.28% of them had a history of quit and 43.19% of them had a history of arrest and imprisonment. According to the results, 19.63% of the participants had suicidal ideation and 10.97% had a history of suicide attempt during their lifetime. The constructs of attitude, subjective norms, perceived behavioral control, and intent predicted suicidal ideation in the subjects. Intent and perceived behavioral control constructs were the strongest predictors of suicidal ideation, respectively. In general, the studied variables predicted 54.8% of suicidal ideation.

CONCLUSION

The structures of attitude, subjective norms and perceived behavioral control and intent predicted suicidal ideation in the drug addicts, so the theory of planned behavior will be a good framework for educational interventions to reduce suicide in them.

Survey dataset on the prevalence of childhood maltreatment history among drug addicts in Malaysia

Studies have consistently shown that childhood maltreatment is a significant risk factor for the development of drug addiction across human lifespan. Yet, little is known about the prevalence of childhood maltreatment history among drug addicts in Malaysia. The dataset presented in this article provides demographic information on 200 drug addicts recruited from two rehabilitation centres in Malaysia, the prevalence of different types of childhood maltreatment history and the correlation between all types of maltreatments. Analyses of the data can provide insights into the prevalence of maltreatment history and development of drug addiction, therefore indispensable for mental health professionals designing appropriate interventions for the drug addicts. The data can also provide baseline data for comparative studies in terms of childhood maltreatment history and drug addiction across different countries.

Psychological well-being of substance use patient: Role of religious therapy as the treatment

OBJECTIVE

To evaluate the psychological well-being of substance use patients in comparison of combined religious therapy and pharmacotherapy effects with that of pharmacotherapy effects alone and also to assess the psychological well-being of drug addicts in comparison of demographics characteristics.

METHODS

This experimental study was conducted at Department of Psychology, University of Gujrat from July 5^th 2016 to July 25^th 2017. A sample of 140 drug addicted patients was taken from different hospital. The pre and post-test of experimental and control group was done. Experimental group received standard pharmacotherapy along with religious therapy while patients in the control group only induced standard pharmacotherapy. The effectiveness of therapy was judged on their psychological well-being using California Psychological Inventory Well-being sub-scale..

RESULTS

The results of the study confirmed that there was significant difference in the psychological well-being of control and experimental group (p-value <0.01). After the treatment a difference exists in the means of control and experimental (16.24 and 26.44 respectively) groups. An increase in the psychological well-being of those having religious therapy comparing to those not having religious therapy was observed. Further, comparing the demographic variables the means indicated that treatment affected all age groups, marital status and education level equally. Whereas, in the rural area (mean, 27.04) psychological well-being was better than the urban (mean=26.11) and with the income levels of 21,000 to 30,000 (mean, 27.57) there was more improvement as compared with other income levels (mean, 26.35 and mean, 26.03).

CONCLUSION

The religious therapy had a significant therapeutic effect on psychological well-being of the substance use patients and it is equally effective for all age group, marital status and educational level.

OHRQoL in a Sample of Alcohol and Drug Abusers

AIMS

To determine oral health related quality of life (OHRQoL) in a large sample of substance abusers and to evaluate the effect of dental treatment on OHRQoL.

DESIGN

A longitudinal observational study.

SETTINGS

A dental care clinic specialized in treating severely addicted patients.

PARTICIPANTS

A sample of severely addicted substance abusers.

MEASUREMENTS

OHRQoL was measured using the OHIP-14, which was filled out at baseline (T0), prior to the first treatment session (T1), after about 6 treatment sessions (T2) and on the last day of treatment (T3).

FINDINGS

Mean OHIP scores did not change from T0 to T1. At T1, a mean OHIP-14 total score = 37.1 (sd=12.4, N = 392) was found. The highest mean scores were observed for the subscales physical pain and psychological discomfort. Data from 129 patients was available on both T1 and T2. The mean OHIP-14 total score reduced significantly (mean difference = 5.63, 95% CI 3.76 - 7.51), t(128)=5.94, p <0.001. The highest reduction in mean score was found for the subscale physical pain (mean difference = 1.24, 95%CI 0.81 - 1.66). Also between T2 and T3 a significant reduction in OHIP-14 total score (mean difference = 2.41, 95%CI 0.06-4.76) took place.

CONCLUSION

The oral health status of substance abusers does have a substantial effect on their quality of life, which can be improved to a great extent by dental treatment based on a model tailored to addicted patients.

Comparing Time Perception among Morphine-Derived Drugs Addicts and Controls

BACKGROUND

The aim of the present study is to compare time perception among drug addicts and controls.

METHODS

30 drug addicts were selected, and 30 non-addict individuals were selected as the control group. The two groups performed three tests of time reproduction, time estimation, and time discrimination.

FINDINGS

There was a significant difference between the addicts group and the control group regarding the error of time reproduction and time estimation. The addict group in comparison to the control group had a lower under-reproduction and a higher over-reproduction error, and also a lower under-estimation and higher over-estimation error. However, regarding time discrimination, no significant difference was observed between the errors committed by both groups. On the other hand, when showing images of drug consumption tools and normal images with same durations, the normal group believed that the images related to drug consumption tools were shown for a shorter period of time.

CONCLUSION

Time perception is different between morphine-derived drugs addicts and controls.

Evaluation of poly-drug use in methadone-related fatalities using segmental hair analysis

In Denmark, fatal poisoning among drug addicts is often related to methadone. The primary mechanism contributing to fatal methadone overdose is respiratory depression. Concurrent use of other central nervous system (CNS) depressants is suggested to heighten the potential for fatal methadone toxicity. Reduced tolerance due to a short-time abstinence period is also proposed to determine a risk for fatal overdose. The primary aims of this study were to investigate if concurrent use of CNS depressants or reduced tolerance were significant risk factors in methadone-related fatalities using segmental hair analysis. The study included 99 methadone-related fatalities collected in Denmark from 2008 to 2011, where both blood and hair were available. The cases were divided into three subgroups based on the cause of death; methadone poisoning (N=64), poly-drug poisoning (N=28) or methadone poisoning combined with fatal diseases (N=7). No significant differences between methadone concentrations in the subgroups were obtained in both blood and hair. The methadone blood concentrations were highly variable (0.015-5.3, median: 0.52mg/kg) and mainly within the concentration range detected in living methadone users. In hair, methadone was detected in 97 fatalities with concentrations ranging from 0.061 to 211ng/mg (median: 11ng/mg). In the remaining two cases, methadone was detected in blood but absent in hair specimens, suggesting that these two subjects were methadone-naive users. Extensive poly-drug use was observed in all three subgroups, both recently and within the last months prior to death. Especially, concurrent use of multiple benzodiazepines was prevalent among the deceased followed by the abuse of morphine, codeine, amphetamine, cannabis, cocaine and ethanol. By including quantitative segmental hair analysis, additional information on poly-drug use was obtained. Especially, 6-acetylmorphine was detected more frequently in hair specimens, indicating that regular abuse of heroin was common among the deceased. In conclusion, continuous exposure of methadone provide by segmental hair analysis suggested that reduced tolerance of methadone was not a critical factor among methadone-related fatalities. In contrast, a high abundance of co-ingested CNS depressants suggested that adverse effects from drug-drug interactions were more important risk factors for fatal outcome in these deaths.

Drug addiction and periodontal diseases

The prevalence of drug addiction is increasing globally. Drug abuse damages many parts of the body such as oral cavity, lungs, liver, brain, heart etc., Addicts suffer from physical, psychological, emotional and behavioral problems. Their nutrition is also compromised. There is certainly an impact of all these factors on the health of periodontium. Dentists should be aware of the effects of drugs while treating the drug addicts. This article correlates the studies done on the impact of abused drugs such as alcohol, tobacco, opiates, cannabis, amphetamines etc., on general and periodontal health.

Evaluation of metabolite/drug ratios in blood and urine as a tool for confirmation of a reduced tolerance in methadone-related deaths in Denmark

BACKGROUND

Methadone blood concentrations in fatal cases are highly variable and there is an appreciable overlap between therapeutic methadone concentrations and the concentrations detected in fatalities. As with other opioids, the background of these methadone-related deaths is unclear. The aim of this study was to investigate if short-time abstinence was contributing to the cause of death in methadone-related deaths by evaluation of the EDDP/methadone ratio in blood and urine.

METHODS

Samples of blood and urine were collected from 103 autopsy cases and analysed for the concentrations of methadone and its main metabolite EDDP. The cases were divided into three groups according to the cause of death: cases where methadone was the cause of death (N=67), cases where poly-drug poisoning including methadone was the cause of death (N=24) and cases where death were caused by other factors (N=12). Urine samples from 11 living persons receiving methadone were also included.

RESULTS

In general, a substantial overlap of the methadone concentrations in blood and urine was seen between the groups. There was a tendency of lower median EDDP/methadone urinary ratios in the methadone poisoning group (median: 1.0), poly-drug poisoning group (median: 0.94) and in the fatalities not related to methadone (median: 1.1) compared to the living subjects in methadone treatment (median: 1.6), although the differences were not significant.

CONCLUSION

It was not possible to reveal a possible abstinence period prior to death by using the EDDP/methadone ratio in blood and urine in methadone-related deaths.