Responsible of Socio-economic Factors with Addiction in Yazd, Iran: An Opinion Survey.

BACKGROUND: Addiction has a long history in Iran and it is one of the social problems that create psychological and social conflicts for addicts and their families. Addiction just like other social deviations affects young who are the most valuable assets of a nation. Recognition of socio-economic factors responsible for addiction can help planning and management of programs to fight against addiction.
METHODS: This cross-sectional study was conducted using a questionnaire on 261 spouses of addicts referring to the detoxification centers of Yazd, Iran who were selected randomly. Their perspectives regarding factors thought to be effective in addiction were examined. Statistical tests included chi-square and Kruskal-Wallis tests.
FINDINGS: Economic problems, divorce, marital problems, lack of familial supervision, unemployment, psychological and physical problems had a statistically significant relationship with the income of the family (P < 0.05), such that with an increase in income of the family these factors played a lesser significant role in addiction.
CONCLUSION: Control of surrounding factors and increase in self-esteem are two important factors that can help effectively control addiction in the young population. After addiction, though environmental and surrounding factors play a role in preventing return to addiction, their role is reduced.

Introduction

Use of narcotics has a very old history in Iran and its psychological effects have been known since ages. It is believed that the massive production of drugs in neighboring Afghanistan could be responsible for the high rate of addiction in the country.1

Some studies showed that the rate of addiction in Iran is one of the highest in the world.2 Official statistics state the rate of addiction has risen from 2000000 in 1998 to 3700000 in 2005.3 Approximately, 11 million people including addicts and their families are suffering from the problem.4

Addiction just like other social deviations destroys the young who are the main assets of a country. Some studies showed that irresponsible parents, easy access to drugs, lack of guardianship, absence of recreational activities, familial discord, unemployment, and psychological pressures are effective factors responsible for addiction.5 Considering the psychosocial problems following addiction, recognition of responsible factors from the spouse’s viewpoint who are the nearest individuals to the addicts can be useful and important. This can be used to plan programs for treatment and prevention against addiction in society.

Methods

This was a cross-sectional study on spouses of male addicts referring to the detoxification centers of Yazd, Iran. By a simple random sampling method, 261 women filled a questionnaire by interview. The addicts were asked to get their wives along during their next visit. In the present study, those with economic problems and debts were considered as low income group, those with lesser economic problems and no debt were considered as moderate income group and those without economic problems were considered as high income group.

The validity of the questionnaire and relation of the questions with the aims of the study was determined by two specialists. The reliability of the questionnaire was determined by Cronbach’s alpha test which was 0.8. It is worth mentioning that factors thought to be effective in addiction were scored between 1 and 5 such that score 1 was for the least effective, while 5 was the most effective factor. The data was analyzed using SPSS software version 13 (SPSS, Inc., Chicago, IL, USA). Chi-square and Kruskal-Wallis tests were employed.

Results

The mean age of the addicts was 34.7 ± 8.3 years. Regarding the income group according to self-declaration, 98 (37.5%) were in the low income group, 152 (58.2%) in the moderate income group, and 11 (4.3%) in the high income group. Of the total, 155 addicts (59.4%) lived in rented houses, while the rest had their own houses. Of the families, 54.8% had at least one addict in the family of which 37.6% were first degree members. The most frequently abused substances were opium (49.7%).

Table 1 shows the rate of effect of each of the factors responsible for addiction. It shows that easy access to drugs and addict friends play the most important roles in addiction (mean scores of 4.42 ± 0.83 and 4.41 ± 0.84 from a total of 5). Inability to refuse offer of drug use was the third leading factor (4.35 ± 0.92).

Table 1

Socio-economic factors responsible for addiction

Ranking	Factor responsible for addiction	Mean	Standard deviation
1	Easy availability of drugs	4.42	0.83
2	Friends who are addicts	4.41	0.84
3	Inability to refuse friends offer to use drugs	4.35	0.92
4	Unemployment	4.31	0.92
5	Lack of familial supervision	4.29	0.88
6	Marital problems	4.07	1.01
7	Economic problems	4.01	0.99
8	Divorce	3.98	1.07
9	Lack of recreational facilities	3.93	1.02
10	Religious beliefs (in prevention of addiction)	3.87	1.20
11	Addicts in family	3.75	1.27

Economic problems, divorce, marital problems, lack of familial supervision, unemployment, psychological and physical problems had a significant relationship with the income of the family (P < 0.05), such that with an increase in income of the family, these factors played a lesser significant role in addiction according to the spouses of the addicts (Table 2).

Table 2

Rate of effectiveness of each of the factors responsible for addiction on basis of income status

	Income status						P
	High n = 11		Moderate n = 152		Low n = 98
	Mean	SD	Mean	SD	Mean	SD
Presence of an addict in the family	3.73	1.30	3.82	1.24	2.91	0.94	0.067
Economic problems	4.17	1.00	3.98	1.08	3.00	1.47	0.003
Divorce	4.11	1.00	3.96	1.06	3.00	1.48	0.005
Marital problems	4.16	0.97	4.05	1.00	3.36	1.28	0.043
Friends who are addicts	4.28	0.94	4.48	0.76	4.45	0.93	0.202
Lack of familial supervision	4.30	0.78	4.32	0.87	3.54	1.43	0.016
Easy access	4.44	0.86	4.40	0.81	4.27	1.00	0.784
Lack of facilities	3.98	1.04	3.90	1.00	3.63	1.29	0.523
Unemployment	4.53	0.80	4.26	0.83	2.90	1.70	< 0.001
Religious beliefs	3.92	1.14	3.83	1.24	3.72	1.34	0.777
Inability to refuse	4.31	0.91	4.40	0.91	4.00	1.00	0.334

SD: Standard deviation

Table 3 depicts the effect of each effective factor on addiction in families with another addict and shows that those with another addict in the family scored higher for all of the factors except the religious beliefs. These differences were significant for divorce, marital problems, economic problems, lack of familial supervision, and inability to refuse offer to use drugs according to the results of Kruskal-Wallis test (P < 0.05).

Table 3

Rate of effectiveness of each of the responsible factors for addiction in families with another addict in family

	Another addict in the family				P
	Yes (n = 163)		No (n = 118)
	Mean	SD	Mean	SD
Presence of an addict in the family	4.00	1.19	3.44	1.29	< 0.001
Economic problems	4.16	1.00	3.83	1.17	0.018
Divorce	4.14	0.98	3.77	1.16	0.006
Marital problems	4.20	0.91	3.89	1.10	0.013
Friends who are addicts	4.44	0.78	4.36	0.91	0.469
Lack of familial supervision	4.39	0.77	4.15	0.98	0.024
Easy access	4.48	0.78	4.33	0.90	0.168
Lack of facilities	3.97	1.03	3.87	1.03	0.438
Unemployment	4.37	0.88	4.22	0.97	0.171
Religious beliefs	3.75	1.28	4.00	1.08	0.102
Inability to refuse	4.50	0.74	4.16	1.07	0.003

SD: Standard deviation

Discussion

According to the results of the present study, 54.8% of the families of the addicts had at least one addict in the family of which 37.6% were first degree members. It can be stated that families are the main centers for controlling ones behavior and if families have problems, it can become a factor for addiction of children. According to Karimpour, addiction of parents or either one of them leads to this belief in their children that addiction is a normal act and one of the peculiarities of elderly people. Because of easy access to drugs and mode of use, the children are easily affected and become addicts.6

Easy access to drugs and addict friends were the most effective factors according to the wives of the addicts. In a study in Saudi Arabia, 26.5% of the population under study returned back to drugs and one of the important factors was presence of addict friends.7 Regarding easy access and its role in addiction, Karimpour stated that free availability of drugs and weak laws in certain countries results in overflow of drugs.6

Problems including economic problems, divorce, marital problems, addict friends, lack of family supervision, unemployment, physical disorders and psychological disorders had a significant relationship with the state of family income. With an increase in income, these factors played a less important role according to the wives of the addicts. Absence of cordial relations between familial members, tensions between parents and children and inappropriate familial atmosphere is more prevalent in the families of addicts.8 The results of the study by Amani et al. showed that unemployment and addiction have a direct relationship such that 20% of the addicts who had become unemployed had lost their job because of addiction.9 In general, it can be stated that unemployment and economical problems are important factors responsible for addiction resulting in social and familial problems and incapability to maintain standard living conditions which itself leads to addiction.

Regarding factors responsible for addiction on basis of presence of an addict in the family, all of the factors except religious beliefs were considered to be more effective by those who had another addict in the family as compared to those who did not have another one. These differences were statistically significant for economical problems, marital problems, lack of family supervision and inability to refuse or say 'no'. It could be stated that relation between stress, psychological problems and narcotics addiction is a biological one. In other words, when stress increases, divorce, economical and marital problems and other problems also increase resulting in tendency or return to narcotics addiction. In fact, addiction is a biological process and its start is related to the environmental factors. Cirakoglu and Isin state that attitude of individuals differs according to the substance abused and most negative attitudes are seen in heroin abusers.10

According to the results of the present study, it can be stated that easy access to drugs, presence of addict friends, and inability to refuse offer of drugs are the most effective factors responsible for narcotics addiction. As the maximum mean score from a total score of 5 was 4.42 ± 0.83, it can be concluded that other factors can also be responsible for addiction. Control of surrounding factors and increase in self-esteem are the two important factors that can help effectively control addiction in the young population. After addiction, though environmental and surrounding factors play a role in preventing return to addiction, their role is reduced.