Typology of Street Substance Users' Communities in Tehran, Iran

Background: There are different street substance users' communities (SSUCs). Typology of SSUCs in Tehran, Iran was approached in this qualitative study.Methods: Using content analysis and saturation principles, 22 street-outreach workers were recruited and interviewed. Data were analyzed using open, axial, and selective coding.Findings: Three types of SSUCs were identified. SSUCs were different in geographic location, the community hierarchy, roles of residents and its function during a 24-hour period. Type 1: surrounded naturally by trees, mountains etc. or located in places like canals that make them not simply reachable, a nonresident smuggler (or a small group of smugglers) has the most power in its hierarchy, works 24 hours with at least two shifts, structured with special roles (nonresident smuggler, the Balancer, sex-worker, seller, armed guard, resident substance users and nonresident costumers). Type 2: mostly located in the city gardens, several nonresident smugglers with limited power, works 16 hours or less in a day, semi-structured with roles of nonresident drug dealer, sex-worker, resident substance users and nonresident costumers. Type 3: houses that their landlords are the resident drug dealers and let the costumers to use drug in the house. The substance users have to leave the house after using drug. The house is open less than 24 hours a day.Conclusion: Strategies for delivering harm reduction services in different types of SSUCs should be modified according to characteristics of these communities

Social Work Guidelines for Street Children with Substance Use Disorders

This study was designed with the purpose of providing organized instructions on how to improve the psychological, medical, and social circumstances of street children with concurrent substance use disorders. Due to the special vulnerabilities of these children, customized guidelines are required in order to maximize the treatment outcomes. Systemic review of literature was applied on a large number of national and international journal articles available on the phenomenon of substance use among street children. The literature review was followed by a qualitative study using in-depth interviews in order to record and analyze the experience of experts working in this field. The preliminary draft was reviewed by the experts and final modifications were applied. The ultimate guideline presents practical recommendations for different stages of providing service for the target population including case finding, motivational interventions, assessment, care and intervention planning, and follow-ups. Street children face various physical, psychological, and social complications. Substance use disorders can exacerbate their circumstances and add to the complexity of their problems. The current guideline is an initial step to better understanding and treating street children who use drugs. Further research is required to investigate the effectiveness and long term results of this guideline .considering the fact that Iran is one of the many countries dealing with this phenomenon, adjustments should be made for application in different cultures

Designing and Evaluating the Validity and Reliability of the Persian Gambling Disorder Screening Questionnaire

Background: Gambling disorder (GD) and substance use disorder (SUD) have mutual impact and each couldaggravate the effects of the other. This is the first study on GD among Iranian substance users to develop andvalidate a GD Screening Questionnaire-Persian (GDSQ-P).Methods: Iranian male adults (n = 503) with SUDs were recruited via clustered sampling. Problem gamblingscreening instruments and Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5)criteria for GD were used to develop the tool which was sequentially assessed for face validity, contentvalidity index (CVI), content validity ratio (CVR), and reliability (Kuder-Richardson coefficient). To establishconstruct validity, interviews based on DSM-5 as a gold standard method were used. A receiver operatingcharacteristic (ROC) curve was conducted to determine sensitivity and specificity.Findings: After removing items with low CVI values, 27 final items remained in GDSQ-P with impact scoregreater than 1.5. Card games (33.8%), dice gambling methods (26.6%), betting on sports teams and players(24.1%), and betting on horseback, rooster, pigeon, dog, or other animals (16.7%) were common gamblingmethods among participants. Overall Kuder-Richardson coefficient was 0.95. Cut-off threshold for GDSQ-Pwas calculated as 4.5 with 98.9% sensitivity and 98.3% specificity. The interviewers confirmed GD forparticipants based on DSM-5 as the gold standard. The prevalence of GD among participants was 17.9%based on GDSQ-P and 19.1% based on DSM-5 criteria.Conclusion: GDSQ-P is a valid and reliable tool to screen for GD in SUD treatment centers and probably inthe general population

Drug Craving Terminology among Opiate Dependents

Objective:Drug craving is defined as an urge to continue substance abuse. Drug dependents use different terms to express their subjective feeling of craving. This study was an attempt to generate an understanding of craving terminology among different groups of Persian speaking Iranian opiate dependents.Method:Terms used for the meaning of drug craving were listed by 36 ex-opiate dependents in focus group discussion meetings in the first phase of the study. These terms were composed from Craving Terms Questionnaire. In the second phase, 120 subjects in 3 groups of opiate dependents and a group of Current Opiate Abusers rated usage frequency of each term in the questionnaire under a Twelve-Step Program, Methadone Maintenance, and Other Abstinence-based Programs.Results:Eighty nine terms were categorized in stimulation and triggering, attention bias and obsession, decision making difficulty, information processing impairment, withdrawal induction, drug euphoric experience, mental urge, motor control problem, negative valancing and stigmatizing. Terms for the three categories of mental urge, attention bias and obsession and motor control problem were used more than others. Patients in Methadone Maintenance Treatment (MMT) group used different categories of craving terms in comparison to other groups. Abstinent cases reported higher total score for craving terms in comparison to other groups in Twelve-Step Program and other abstinence-based programs.Conclusion:Each craving-related term is associated with some aspects of the multidimensional concept of craving. A drug-craving thesaurus could provide a better understanding of craving nature from a drug dependent point of view. There are differences among abstinence vs. maintenance based treated opiate dependents in using craving terms. Addiction therapists will benefit from accessing drug dependents’ lexicon to assess and create therapeutic alliance with their clients

Coronavirus Outbreak and Stress in Iranians

Iran has faced one of the worst COVID-19 outbreaks in the world, and no studies to date have examined COVID-19-related stress in the general Iranian population. In this first population-based study, a web-based survey was conducted during the peak of the outbreak to assess stress and its correlates in the Iranian population. A 54-item, valid, and reliable questionnaire, including items on demographic characteristics and past medical history, stress levels, awareness about signs and symptoms of COVID-19, knowledge about at-risk groups and prevention methods, knowledge about transmission methods, trust in sources of information, and availability of facemasks and sanitizers, was deployed via social and mass media networks. A total of 3787 Iranians participated in the study where the majority of the participants were females (67.4%), employed (56.1%), from developed provinces (81.6%), without chronic diseases (66.6%), and with ≥13 years of formal education (87.9%). The mean age of study participants was 34.9 years (range = 12–73), and the average stress score was 3.33 (SD = ±1.02). Stress score was significantly higher for females, those who were 30–39 years old, housewives, those with chronic diseases, individuals who were aware that there is no vaccine to prevent COVID-19, those who could not get facemasks or sanitizers, and individuals with higher knowledge about at-risk groups (p < 0.05). There was a significant correlation of stress scores with knowledge about prevention methods for COVID-19 (r = 0.21, p = 0.01) and trust in sources of information about COVID-19 (r = −0.18, p = 0.01). All of the predictors, except knowledge of two important at-risk groups and education, had a significant effect on stress scores based on a multivariate regression model. The COVID-19 outbreak could increase stress among all population groups, with certain groups at higher risk. In the high-risk groups and based on experience with previous pandemics, interventions are needed to prevent long-term psychological effects. Professional support and family-centered programs should be a part of pandemic mitigation-related policymaking and public health practices

Social Work Guidelines for Street Children with Substance Use disorders

This study was designed with the purpose of providing organized instructions on how to improve the psychological, medical, and social circumstances of street children with concurrent substance use disorders. Due to the special vulnerabilities of these children, customized guidelines are required in order to maximize the treatment outcomes. Systemic review of literature was applied on a large number of national and international journal articles available on the phenomenon of substance use among street children. The literature review was followed by a qualitative study using in-depth interviews in order to record and analyze the experience of experts working in this field. The preliminary draft was reviewed by the experts and final modifications were applied. The ultimate guideline presents practical recommendations for different stages of providing service for the target population including case finding, motivational interventions, assessment, care and intervention planning, and follow-ups. Street children face various physical, psychological, and social complications. Substance use disorders can exacerbate their circumstances and add to the complexity of their problems. The current guideline is an initial step to better understanding and treating street children who use drugs. Further research is required to investigate the effectiveness and long term results of this guideline .considering the fact that Iran is one of the many countries dealing with this phenomenon, adjustments should be made for application in different cultures