Drug Use among Residents of Juvenile Correctional Center in Kerman, Iran, and its Relationship with Personality Dimensions and Self-concept.

BACKGROUND: Identifying the status of substance misuse and its psychosocial correlates among residents of juvenile correctional centers, as a high risk group, could potentially illuminate the roadmap to prevention of drug use in this group.
METHODS: In this cross-sectional study, 93 individuals aged 13 to 18 were enrolled. A self-administered questionnaire was completed and dropped in a sealed box. It consisted of 4 parts of Piers-Harris Children's Self-Concept Scale, NEO Personality Inventory, drug use questions, and demographic variables. All questionnaires were well adapted in the Persian language. MANOVA was used to compare the subscale scores between the drug users and nonusers.
FINDINGS: All respondents were male and 40% were illiterate. More than 40% had drug dependent fathers. Use of cigarette, opium, and alcohol in the previous 30 days was reported by 31.9, 52.2, and 15.9% of respondents, respectively. In this population, the score of 3 of the 5 personality factors (i.e., neuroticism, extraversion, and openness) were higher than in the general population (P < 0.001). More than 88% of subjects had negative self-concept. Both the scores of personality and self-concept showed no significant difference based on the status of drug use.
CONCLUSION: Prevalence of lifetime and last-month drug use was found to be high. Regarding the profiles of personality and self-concept, more comprehensive evidence-based interventions are needed for improvement of their mental health.

Introduction

Although statistics regarding drug use in Iran show different figures, from their total, it can be concluded that the extent of drug use in Iran is alarming.1 Some even consider it the most dangerous threat to Iran.2 Moreover, studies performed in high school adolescents also suggest a high prevalence of drug use in this age group. According to a recent review article, among 4.4% to 12.8% of the students that smoked every day, out of every 10 student one had a history of alcohol abuse.3 Drugs, in addition to physical and psychological complications, also have a negative impact on quality of life, have high costs for control measures, and cause unemployment, crime, and other social problems that will impose a burden on society.4

According to Iran's vulnerability to the spread of drug use, in order to fight this social disease, comprehensive scientific studies seem necessary. Studies on the etiology of addiction, especially for vulnerable adolescents, are of particular importance, because one way to combat the spread of this social problem, is to develop scientific frontiers in this area.5 Predisposing factors for substance use can be categorized to three areas of individual factors (such as genetics, personality characteristics, and psychological factors), micro-social factors (such as family and friends), and macro-social factors (such as poverty and legislation).5 Antisocial personality and conduct disorders are associated with drug abuse.6 Teenagers who use drugs have an external source of control, and compared with those not taking drugs, they are less confident.6 Psychological pressure such as peer pressure, lack of coping skills, aggression, and sensation seeking behaviors are associated with substance abuse.6,7

Juvenile crime, according to their age, social situation, different etiology, and motives for crime, compared to adult crime, necessitate different approach. This has led to the consideration of arrangements for the maintenance, education, and improvement of children and juvenile offenders with special rules. In Iran, correctional centers are responsible for this task. In juvenile correction and rehabilitation centers, children and teenagers are held due to negligence, ignorance, and irresponsibility of parents, who have been involved in adverse conditions. In addition, studies show that 10.0% of children and adolescent offenders who are kept in correction and rehabilitation centers have an addiction history.8 According to the vulnerability of these groups and that a considerable portion of these people enter the society in the near future, it is important to assess the prevalence of substance use among them and explain their personal and psychological characteristics.

Self-concept is one’s judgment about oneself in different areas of success, values, and abilities. It may be related to motivations that create such behaviors as drug use.9 Since a person's opinion of their own character widely determines their perception towards their environment, and these two factors design the kind of behavior he/she has, self-concept is important for mental health professionals.9 If the self-concept is positive and relatively balanced, the person has a healthy mental state, and if on the contrary the self-concept is negative and unbalanced, he/she is known to be mentally unhealthy and it could cause wrong behaviors such as substance abuse.9 Character has a decisive role in the conspicuous behavior of the person, and personality traits can motivate drug abuse. Therefore, identifying personality characteristics is important and has a decisive role in the prevention and treatment of substance abuse.6

Although relatively numerous studies have been conducted on the relationship between personality characteristics, and in a lesser extent the self-concept, and taking drugs, no research has been conducted on these two factors and their association with drug use in vulnerable children and adolescents in correction and rehabilitation centers as far as we are aware.10-14 Information about the drug use status and its correlation with some psychological factors can help further identification of risk factors in these groups and help in designing preventive measures. This study aimed to explore the situation of drug use in children and adolescents in one of the correctional centers of Iran, and to draw out their personality characteristics and self-concept.

Methods

This cross-sectional study was conducted in 2012. The researcher obtained permission from the organization of prisons, and then attended the correctional center (Kerman province, Iran). The researcher explained the research objectives to the subjects, and then obtained consent from them, and the patients anonymously completed the questionnaires as groups. For illiterate people the questionnaires were completed through interviews. All the clients covered by the correctional center of Kerman (93 people) were enrolled in this study, and therefore census was used. For the assessment of self-concept, Piers-Harris scale of self-concept was used, which was designed to measure self-concept of children and adolescents. The scale consists of 60 questions that are graded in positive and negative direction.15

Each question had either a yes or no answer, and for the positive questions that had yes as the answer code +1 was assigned, and for negative answers code -1 was given. For the negative questions the coding was reverse versa. Finally, each individual’s score ranged from -60 to +60; scores higher than 30 were considered as positive self-concept and less than 30 as negative self-concept. The questionnaire had 6 subscales including behavioral adjustment (13 questions), intellectual and school status (13 questions), physical appearance and attributes (6 questions), freedom from anxiety (9 questions), popularity (11 questions), and happiness and satisfaction (8 questions). The reliability and validity of the questionnaire in Persian was approved.16

To measure personality traits, the NEO-Five Factor Inventory (NEO-FFI) was used. NEO-FFI is a questionnaire with 60 questions, and it is used to assess 5 main personality factors.17 These 5 factors are: five dimensions of neuroticism (the tendency of people to experience anxiety, depression, and low self-esteem); extraversion (the tendency of individuals to enjoy interacting with others); openness (responsive to beauty and having no tendency to variety in life); agreeableness (tendency for people to respect others); and conscientiousness (tendency of merit, discipline, and striving for progress). The questions included 5 options (totally disagree, disagree, no opinion, agree, and totally agree). The validity and reliability of NEO-FFI for ages over 10 years was proven in Persian.18,19 Cronbach's alpha coefficient of the above mentioned questionnaires were, respectively, 0.78 and 0.64.

On the history of substance abuse, a questionnaire was used the reliability and validity of which were proven in school setting.20 It was about the use of cigarettes, hookah, marijuana, opium, crack, heroin, alcohol, and glass, at least once during life time and during the last 30 days. In order to realize the false answers, cocaine was included in the answers the consumption of which had almost zero possibility (dummy drug).

To compare the personality dimension scores between the two groups of users and non-users MANOVA test was used. For comparison of the percentage of people who had a positive self-concept between the two groups, chi-square test was used, followed by Bonferroni adjustment.

Results

At first, the questionnaire was completed by 93 people, but after the initial analysis, those who reported cocaine use (n = 24), due to their false response, were excluded from further analysis. Thus, 69 patients were included in the subsequent analysis. The mean age of these people was 16.3 years, the minimum age was 13 years and maximum age was 18 years. All of the participants were male and 39.9% were illiterate. Regarding the educational qualification of parents, most of the fathers (53.6%) were illiterate or attended primary school, and the mothers’ education level was mostly secondary school or diploma (59.4%). 42.1% of the respondents reported addiction in their fathers. Details of baseline characteristics are shown in table 1.

Table 1

The frequency of baseline characteristics of residents of Correction and Rehabilitation Center (69 cases)

Characteristics	Number	Percentage
Age
Less than 15 years	25	36.2
Between 15 to 18 years	44	63.8
Education
Illiterate	22	39.9
Primary	25	36.2
Secondary	21	30.4
No answer	1	1.5
Father’s education
Illiterate	18	26.1
Primary	19	27.5
Secondary	28	40.6
University	4	5.8
Mother’s education
Illiterate	8	11.6
Primary	10	14.5
Secondary	49	71.0
University	2	2.9
Father’s drug dependency	29	42.1
Mother’s drug dependency	10	14.5

The most common reason (43.5%) for being arrested was robbery, and the least common (2.9%) was murder or taking part in murder. Smoking was reported in 50.7% of the participants. Of these, 31.9% had smoked in the past 30 days. Among the studied subjects, 49.3% had a history of smoking shisha, but only 11.6% had a history of smoking in the past 30 days. Among the studied subjects, the most used drug was opium. In fact, 65.2% of subjects had a history of lifetime history of opium use and 52.2% had used it in the past 30 days. Regarding alcohol consumption, 40.6% had a history of use, and 15.9% had consumed alcohol in the past 30 days (Table 2). Using MANOVA test, there were no significant differences among each of the 5 dimensions of personality between consumers and non-consumers of substances (P = 0.490). Moreover, 5 dimensions of personality were compared with the general population and in all cases, except conscientiousness, significant differences were observed (Table 3). Comparing measures of positive self-concept among consumers and non-consumers of substances within the past 30 days showed no significant difference in any of the subscales (P > 0.05). In most of the 6 dimensions of self-concept, more than two thirds of the patients had a negative self-concept, and in total 88.4% had a negative self-concept (Table 4).

Table 2

The frequency of drug use in residents of Correction and Rehabilitation Center, 2012

Drug	Lifetime history of use		Use during the past 30 days
	Number	Percentage	Number	Percentage
Cigarette	35	50.7	22	31.9
Shisha	34	49.3	8	11.6
Hashish	26	37.7	11	15.9
Opium	45	65.2	36	52.2
Heroin	14	20.3	7	10.1
Alcohol	28	40.6	11	15.9
Crack	24	34.8	7	10.1
Shisheh	20	29.0	5	7.2

Table 3

Mean characteristics of the residents of Correction and Rehabilitation Center compared with the general population20

Personality components	Subjects	General population
	Mean ± SD	Mean ± SD
Neuroticism	35.9 ± 5.4	22.90 ± 9.5
Extroversion	32.4 ± 6.1	26.89 ± 6.1
Openness	35.4 ± 5.1	32.90 ± 7.0
Agreeableness	33.4 ± 5.7	37.94 ± 4.9
Conscientiousness	30.8 ± 8.0	31.62 ± 5.6

SD: Standard deviation

Table 4

Status of self-concept in residents of Correction and Rehabilitation Center

Scale	Positive		Negative
	Number	Percentage	Number	Percentage
Happiness and satisfaction	14	20.3	55	79.7
Reputation	14	20.3	55	79.7
Behavior	12	17.4	57	82.6
Intellectual and academic	19	27.5	50	72.5
Anxiety	24	34.8	45	65.2
Appearance and attitude	18	26.1	51	73.9
Total	8	11.6	61	88.4

Discussion

This study showed that a significant percentage of patients, despite physical limitations, used drugs. This was the first time that this study took place in this target population, in Iran. The baseline characteristics of the patients showed their vulnerability towards drug use; most of them were either illiterate or had primary school education and their fathers also had a history of addiction. In addition, 42.1% of the participants’ fathers and 14.5% of their mothers were drug addicts, these figures were several times higher than in the general population.21 On the other hand, the history of drug use, at least once in their lifetime, was high, so that 65.2% of them had the history of opium consumption, one-third of them smoked cigarettes, and 40.0% reported a history of alcohol abuse. These figures were higher than in a similar study that was conducted on high school students.20 The most commonly used drugs during the past 30 days were opium and cigarettes. Although the statistics of drug use in these centers are not available, the assessment of drug abuse in Iranian prisons showed that the prevalence of opioid abuse was 30.7%.22 However, comparing these two populations in terms of age, living conditions, time, and type of questions does not seem logical, but it reminds us of the point that in prisons, which have a secure and controlled system, controlling the use of opioid is not possible. In the present study, those who claimed to have used cocaine were excluded; however, we should bear in mind that self reports may not be sufficiently accurate compared with biological measures.23

Regarding the personality dimensions in residents of the Correction and Rehabilitation Center, the area which showed the most difference with the general population was the personality dimension of neuroticism.19 Tendency to experience negative emotions, anxiety, aggression, depression, negativity, impulsiveness, vulnerability, and low self-esteem were the main characteristics of neuroticism (which is also known under the title neurosis). The compatibility scores (agreeableness and conscientiousness) were lower than the general population, although the latter did not show significant difference (Table 3). Agreeableness is a dimension of interpersonal tendencies, and trust in others, confidence, optimism, and sincerity are its important characteristics. Conscientiousness is a dimension of personality which is characterized by confidence, determination, hard work, objectivity, and thoroughness.18 Bakhshipour et al. also concluded that drug users, compared with a normal group, had a higher score in the personality dimension of neuroticism, and achieved lower scores in the dimensions of agreeableness, conscientiousness, and flexibility.24

One of the factors that influence drug addiction is individuals’ personality traits. In other words, personality traits, such as rejection of traditional and common values, the strong need for independence, severe aggression, low self-esteem, and inability to reject bad suggestions from friends and acquaintances, are among the factors that affect people’s attitudes towards drug problems.9 There is a reciprocal relationship between personality and addiction. This means that some personality traits, increase vulnerability to substance use. On the other hand, drug use has deleterious effects on brain structure and function. Overall, there was no significant difference observed in the score of the 5 personality dimensions between the 2 groups of consumers and non-consumers. The reason for this finding might be that essentially the subjects had a common general personality character, which was committing crimes, and this feature greatly helps in bringing them closer together. Meaning that, consuming or not consuming drugs due to this common feature does not distinguish them from one another.25

Regarding self-concept of the clients in the Correction and Rehabilitation Center, the highest percentage of negative self-concept was found in the behavior, and the vast majority of them (90.0%) had negative self-concept. These results were consistent with similar studies.12,14 Fuentes et al. concluded in their study that there was a correlation between self-concept and drug abuse, and negative self-concept appears to be effective in attracting young people toward addiction.14 Self-concept is a judgment that the person has regarding their own success, values, abilities, importance, and personal credibility. The importance of self-concept for those who are dealing with education and training is a quite clear and obvious matter; because the individual’s attitude towards himself/herself is one of the various issues that deeply affect that individual’s behavior and attitudes.9 This result was consistent with the findings of the study by Giugliano on the loss of self-concept and the emergence of drug addicts.26 People who do not have a positive opinion about themselves often have low functioning levels, and have problems in intimate relationships. Some of these people have difficulties in managing their emotions due to their poor self-concept, and they have a greater tendency to become addicts. The more persistent the adolescents’ problems are in their perception and self-image, the greater their problems in educational, social, and legal fields will be.27 Sense of negative self-concept is revealed with issues such as depraved thoughts, and feelings of unworthiness, disgust, and despicable, harsh ugliness, and stupidity. Moreover, it is usually caused by weakness in facing problems, and hatred of self and others. Having these thoughts and feelings may push the person towards drug use, crime, deviance and transgression, rebellion against restrictions or social preventive powers. A person who has a negative attitude does not feel dissonance and discomfort towards foolish and immoral acts, because in his constructed knowledge the concept of contrary action is consistent with the concept of being arrogant and insouciant. Such a person is expected to do wrong deeds. In other words, for those who have negative attitudes towards themselves committing fraud is not hard, because for them committing an immoral act is consistent with a negative self-concept. Conducted research has also confirmed the relationship between negative self-concept and criminal behavior. Given the underlying criminal behavior associated with negative self-concept, perhaps it can be said that this relationship has caused no differences in the proportions of negative self-concept among consumer and non-consumer groups.25

However, the fact should be acknowledged that despite the traditional image, the experts have come to the conclusion that strict and legal actions are not considered the first and most important approach toward drug abuse. On the contrary, preventive approaches and reduction of harm should be priorotiesed.28 In this regard, educational approaches, particularly life skills training based on previous knowledge of the profile and personality of the individual, are of special importance. The application of this study was to clarify this profile.

Conclusion

This study showed that despite the surrounded and closed environment of the training center, a significant percentage of the inmates have access to drugs. In addition, most patients had a negative self-concept, and in terms of personality, especially neuroticism dimension, they do not have a good condition.