See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/305267115

A comparative study of the effectiveness of drug addiction treatment

methods used at the drug addiction treatment center of Jahrom in 2014

Article · January 2016

DOI: 10.13005/bbra/2030

CITATIONS READS

0 336

4 authors, including:

Marzieh Kargar jahromi Farzad Poorgholami

Gerash University of Medical Sciences Jahrom University of Medical Sciences
63 PUBLICATIONS   320 CITATIONS    37 PUBLICATIONS   146 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

EVALUATING THE APPROPRIATENESS OF THE MEDICAL ETHICS QUESTIONER OF JAHROM UNIVERSITY OF MEDICAL SCIENCES WITH THE STUDIES OF MEDICAL
ETHICS FROM THE VANTAGE POINT OF EXPERTS IN MEDICAL ETHICS View project

effect of spiritual therapy training on the level of hope and self-steem in multiple sclerosis patients View project

All content following this page was uploaded by Farzad Poorgholami on 21 August 2016.

The user has requested enhancement of the downloaded file.

BIOSCIENCES BIOTECHNOLOGY RESEARCH ASIA, March 2016. Vol. 13(1), 273-278

A Comparative Study of the Effectiveness of Drug Addiction

Treatment Methods Used at the Drug Addiction Treatment
Center of Jahrom in 2014
Razieh Parniyan1, Abdoreza Kazemiane2,
Marzieh Kargar Jahromi3 and Farzad Poorgholami4
1
Department of Nursing, Faculty of Nursing and Midwifery,
Jahrom University of Medical Sciences, Jahrom, Iran.
2
Practitioner of Medical University, Jahrom University of Medical Sciences, Jahrom, Iran.
3
Community Health Nursing, Jahrom University of Medical Science, Jahrom, Iran.
4
Medical-Surgical Nursing, Jahrom University of Medical Science, Jahrom, Iran.

http://dx.doi.org/10.13005/bbra/2030

(Received: 19 January 2016; accepted: 27 February 2016)

In recent years, a lot of efforts have been made toward developing new methods
for treating drug addicts. The present study aims to compare the effectiveness of the drug
addiction treatment methods used for the addicts at the drug addiction treatment center
of Jahrom, Iran in 2014. The present study is a retrospective cohort study whose population
consisted of all the individuals who were undergoing treatment at the medical center of
MMT in Jahrom. Sampling of the files of the entire patients (150) was based on the census
method. The researchers studied each treatment group separately. The data collected
from the patients’ files were included their personal and medical information and level
of improvement. The results of the patients’ treatment plans (MMT, BMT, and opium
tincture) were collected, compared and analyzed. For the statistical analysis of the data,
the researchers used descriptive indexes (frequency and percentage), the chi-square test,
Pearson’s correlation coefficient, and SPSS v. 24. Based on the collected data, the
effectiveness of the treatments was as follows: weak (30%) in 6.0% of the BMT cases and
12.0% of MMT cases; moderate (50%) in 72.0% of the BMT cases and 27.8% of MMT cases;
and satisfactory (60%) and above in 22.0% of the BMT cases and 60.3% of MMT cases, all
of which values were statistically significant. The results of the study show that using
methadone is a more effective method for treating drug abuse compared to other
treatments.

Keywords: treatment, drug addiction, drug addicts, drug treatment center.

Drug abuse and addiction is a multi- million people in the world are addicted to
faceted universal issue believed to be caused by a substances other than alcohol, 162 million of whom
variety of factors, among them social, economic, are addicted to the less harmful hashish. In Iran,
personal and environmental factors. Studies show however, opium and heroin addiction prevail1.
that the number of individuals addicted to illegal Presently, there are approximately 3 million
drugs is on the rise across the world, and Iran is drug addicts in Iran, including casual drug users.
no exception. According to the ministry of health Studies show that the majority of the more than 1
of Iran and the drug abuse treatment protocol, 200 million and 2 hundred thousand of the individuals
addicted to illegal drugs in Iran are dependent on
synthetic drugs rather than traditional drugs, and
* To whom all correspondence should be addressed. heroin addiction poses the most serious threats to
Tel.: 98-71-5434-1501; addicts and the society: compared to opium addicts,
E-mail: [email protected] heroin addicts are much less capable of quitting
274 PARNIYAN et al., Biosci., Biotech. Res. Asia, Vol. 13(1), 273-278 (2016)

permanently and returning to a normal life2. method of treatment are quite promising; however,
Statistics show that the rate of deaths due to individual difference between addicts and
caused by drug abuse, especially overdose, is their reasons for drug abuse and the occasional
increasing is Iran. According to one study, if the launch of designer drugs, it is necessary that new
cost of heroin used by an addict is 5000 tomans a methods of treatment be developed and employed.
day and supposing that there are 250 thousand With the spread of drug abuse treatment programs
heroin addicts in Iran, the total cost of heroin used under various names, each clinical system claims
by these addicts will come to 37.5 billion tomans a to offer effective plans with unique features9, 10.
month and 450 billion tomans a year3. Among such institutes are the drug addiction
The worst type of addiction in Iran is treatment clinics that are affiliated to the Ministry
associated with drugs that are administered of Health of Iran and aim to attract and help drug
intravenously. Unfortunately, drug abuse by addicts by offering them new methods of treatment.
villagers is on the increase and an increasing The most popular drugs used in Iran for
number of younger individuals and females are the purpose of maintenance therapy are
becoming addicted to illegal drugs. According to methadone, buprenorphine, and opium tincture.
the chief of the Welfare Institute of Iran, the growth Among the features of these drugs that make them
rate of drug abuse (8%) is three times as fast as the good choices are: they are administered orally and
birth rate (2.6%). Moreover, many divorces are there is no need for injection; they are pure and do
attributed to drug abuse and official statistics show not contain secondary chemicals with unknown
that at least 6 million individuals in Iran suffer effects; they have long-lasting effects and do not
directly or indirectly as a result of drug abuse by a need to be taken frequently; they have a clearer
second party4, 5. absorption and excretion cycle compared to opium
According to WHO, drug abuse has the and heroin and can, therefore, be administered
three following characteristics: safely with a low risk of toxicity11.
1. A tendency and need for obtaining and Moreover, since the above-mentioned
using the drug in question in any possible way, dugs can be acquired at clinical centers under a
2. An inclination to use a larger amount of doctor’s supervision, they reduce drug addicts’
the drug in question every day, dependence on drug dealers and consequently
3. Physical and mental disorders caused by decrease the social, penal, and economic costs
drug abuse6, 7. associated with illegal drugs. Replacing illegal
Obviously, the first and most important drugs with legal medical chemicals will cut drug
step toward preventing social harms is fighting dealers’ profits and hinder the expansion of drug
drug abuse; after all, prevention is better than cure. sales and trafficking. Also, as these medical drugs
Despite the many efforts made by researchers and are heavily subsidized and are available at low
various international organizations, a fully effective costs, drug addicts will not need to rely on anti-
method for treating drug abuse has not been social activities to make enough money to buy
discovered yet (2, 4). Fortunately, in recent years, drugs. Overall, the above-mentioned advantages
there has been an increase in the acceptance of of maintenance therapies make them the corner
the belief that drug addiction is a disease, not a stones of drug abuse treatment in developed
crime, and a variety of approaches have been countries12, 13.
employed to treat drug addicts8. A review of the available studies reveals
Treating drug abuse is a complicated that, despite attempts at comparing the
process: on the most obvious level, this is a two- effectiveness of various methods of treatment, it
dimensional disease, i.e. it involves both physical is not clear which method(s) is the optimum choice.
and psychological dependence. A treatment plan Moreover, the present study is the first attempt at
that fails to consider either of these factors is an comparing the impact of the methods of treatment
incomplete and reversible cure. The efforts that currently used at the Drug Addiction Treatment
have been made in the domains of medicine and Center of Jahrom, Iran on improving the conditions
psychology toward finding the most effective of drug addicts and determining the best method.
 PARNIYAN et al., Biosci., Biotech. Res. Asia, Vol. 13(1), 273-278 (2016) 275

METHOD treatment group—BMT, MMT, and opium

tincture—were selected for study based on their
Type of study number in their group.
The present study is a retrospective A summary of the implementation process of the
cohort study (file review). project
Population After the study project had been
The entire patients who were undergoing approved at Jahrom University of Medical
treatment at the MMT Clinical Center of Jahrom, Sciences, the required permit was submitted to the
Iran. treatment center and the files of all the patients
Sampling who had completed their treatment plans were
The sample was selected from the entire examined. At the center in question, method of
patients’ files (150) at the MMT Clinical Center treatment for each patient was determined thus:
using the census method. The patients in each based on the type and amount of the substance
used, method of administration, length of addiction,
Table 1. The demographic characteristics of the the number of attempts made to quit in the past
subjects and the doctor’s judgment, one of the three
methods of MMT, BMT, or opium tincture would
Variable Group Percentage be prescribed for each addict. Regardless of the
type of treatment prescribed, the treatment
Under 20 3.47
procedure is as follows: 1. Induction (the initial
Age (years) 21-30 26.25
31-40 34.36 administration of a certain amount of the prescribed
41-50 23.93 drug based on the patient’s symptoms and history);
Above 50 11.96 2. Stability (fixing the amount of the drug
Gender Male 95.83 administered based on the patient’s withdrawal
Female 4.47 symptoms); 3. Maintenance (regular administration
Single 47.29 of the prescribed drug); 4. Tapering (gradually
Marital status Married 50.39 decreasing the amount administered).
Divorced 2.32 The inclusion criterion was having been
Junior high school 79.54
a patient at MMT Drug Addiction Treatment
Education High school 16.99
Post high school 1.54 Center, and the exclusion criterion was not having
BA/BS 1.93 completed one’s treatment program. In the present
Jobless 11.81 study, the researchers studied the subjects in each
Employment State employee 4.72 treatment group separately. The data extracted from
Self-employed 83.07 the patients’ files included personal and medical
Retired 0.394 information and level of improvement. To evaluate
Income Low 37.45 the patients’ level of improvement, the researchers
Average 49.42 used medical and psychological checklists, their
Good 13.13
laboratory test results, and their doctors’ comments

Table 2. A comparison between the effectiveness levels of the three methods of drug abuse
treatment (MMT, BMT and opium tincture) as used at the MMT Drug Addiction Treatment
Center of Jahrom, Iran

Recovery Poor Moderate Satisfactory

Method Below 30% 30% to 50% Above 50%
F P F P F P Static P-value

MMT 25 12.0% 58 27.8% 126 60.3%

Tincture 1 25.0% 1 25.0% 2 50.0% 35.22 P≤0.001
BMT 3 6.0% 36 72.0% 11 22.0%
Total 29 11.0% 95 36.1% 139 52.9%
276 PARNIYAN et al., Biosci., Biotech. Res. Asia, Vol. 13(1), 273-278 (2016)

as recorded in the patients’ files. to achieve drugs and can direct their energies
To describe each patient’s improvement toward more productive highways6, 14.
status, the researchers used the two options of The results of the present study are
“recovered” and “unrecovered.” The recovered consistent with the findings of the study of Torrens
patients were those who tested negative for illegal et al. who report that MMT reduces social alienation
drugs, did not demonstrate addict-like behaviors, in addicts and improves their sleep quality, which
had mended their ways and reassumed their means that it reduces depression in addicts.
personal, family and social roles and, overall, were Likewise, Giacomuzzi et al. (2002) report that
judged to be in good physical and mental health. methadone improves drug addicts’ physical
Data analysis conditions: MMT enhances energy levels and
The data collected from each treatment physical performance and reduces pain in drug
group—MMT, BMT, and opium tincture—were addicts. Torrens et al. report similar findings.
compared and analyzed using descriptive indexes Evidently, MMT can not only reduce or eliminate
(frequency and percentage), the chi-square test, one’s dependence on drugs, but improves
and Pearson’s correlation coefficient in SPSS v. 24. psychological health and lowers the rate of social
crimes21, 22.
RESULTS On the other hand, administration of
buprenorphine is a much less popular treatment in
Table 1 shows the subjects’ demographic Iranian clinics: currently, out of the 500,000 drug
characteristics. The results of the chi-square test addicts who are undergoing maintenance therapy
(Table 2) show that there are significant differences in Iran, 430,000 (87%) are on methadone and 65,000
between the three methods of BMT, MMT, and (13%) are on buprenorphine15. Buprenorphine
opium tincture in terms of the level of recovery (Buprexin) is a partial agonist, meaning that, though
each brings about. Also, based on the collected it is an addictive substance and can cause the
data, the effectiveness of the treatments was as common effects and side effects associated with
follows: weak (30%) in 6.0% of the BMT patients other addictive drugs, such as shortness of breath
and 12.0% of MMT patients; moderate (50%) in and ecstasy, its maximum influence is weaker than
72.0% of the BMT patients and 27.8% of MMT the influence of such full agonists as heroin and
patients; and satisfactory and above (60%) in methadone. In small doses, buprenorphine can
22.0% of the BMT patients and 60.3% of MMT generate enough agonistic effects to enable a drug
patients, all of which values were statistically addict to quit drugs without experiencing the
significant. withdrawal symptoms.
The agonistic effects of buprenorphine
DISCUSSION (Buprexin) grow in a linear manner as doses increase
until they reach a plateau; at that point, an increase
In the present study, satisfactory (and in dose will not lead to stronger effects16. This
above) levels of recovery were found to have been condition is called the ceiling effect. Accordingly,
achieved by 60.3% of the patients who had been compared to full agonists, the use of buprenorphine
administered methadone, 22% of the patients who is less likely to result in abuse, addiction and side
had been administered buprenorphine, and 50% effects. In fact, buprenorphine can block the effects
of the patients who had been administered opium of full agonists and consequently cause serious
tincture. withdrawal symptoms in a drug addict. This is
Since 1964, methadone maintenance because of the high tendency of buprenorphine to
therapy (MMT) has been widely recommended cling to drug receptors: buprenorphine has a greater
based on the assumption that high doses of tendency to bind to drug receptors than other
methadone can eliminate one’s dependence on drugs do, which property helps it defeat other drugs
illegal drugs and, by creating a parallel source of in attaching to these receptors17.
satisfaction, prevents withdrawal symptoms. Thus, In the present study, only 50 of the 263
the users of addictive drugs will be freed from their patients who visited the clinic were found to use
mental occupation with drugs and desperate efforts buprenorphine. Some of the reasons why
 PARNIYAN et al., Biosci., Biotech. Res. Asia, Vol. 13(1), 273-278 (2016) 277

buprenorphine is not administered very often in the patients were more willing to use methadone
drug addiction treatment centers in Iran are as because of its lower cost.
follows: variety in the brands of buprenorphine,
patients and therapists’ reluctance to choose CONCLUSION
buprenorphine, the high costs and low profits of
the administration of buprenorphine at drug The findings of the study show that,
addiction treatment centers, the side effects of compared to the other methods of treatment under
buprenorphine and therapists’ lack of knowledge study, the administration of methadone can make
about how to deal with the side effects18. For new a greater contribution to the recovery of drug
methods of treatment to become popular, therapists addicts and is recommended as an effective
should accept that there are other drugs than method.
methadone.
According to Dr. Daneshmand, REFERENCES
therapists’ choice of drug is partly influenced by
the costs and medical subsidies; he states that the 1. Beigi, Ali. The Diagnostic Role of Quality of
cost of MMT is 1,164,000 rials per month, while Life and Hope in Anonymous Addicts and
the cost of BMT (with 10 mg tablets on average) is Addicts undergoing Methadone Maintenance
1,326,000 rials, and a non-medication treatment plan Therapy. The Journal of Clinical psychology.
Year 3, No. 3 issue 11. Fall 2011.
can cost 621,000 rials. He believes that with
2. Khayatipour, Atefeh. Comparing the
efficient management, more patients can be put on Effectiveness of Combined Cognitive-behavioral
buprenorphine and the profits of clinics can be Therapy in Community Therapy and Narcotic
increased19. Anonymous Groups on Their Tendency to
In the present study, the moderate Abuse Drugs. The Journal of Science and
recovery level achieved by buprenorphine was Medicine. 9(6). 2010.
found to be twice as much as methadone (70% 3. Yarmohammadi Vasel, Mosayeb. The Effects of
versus 30%). The researchers recommend that Therapeutic Community on Improving Male
medical universities and the ministry of health Drug Addicts’ Life Skills and Reducing Their
Tendency to Relapse. The Journal of Kerman
choose the better-known brands of buprenorphine
University of Medical Sciences. 18(4). 2011. pp.
and improve its distribution process to encourage 358-368.
therapists and patients to select buprenorphine 4. A Comparison of the Effects of the Oral
for treatment. Buprenorphine often causes only a Administration of Harmal Seeds and Methadone
small number of side effects (its most common side on the Behavioral Indexes of Male Rats’
effect is headaches) which can be easily controlled Withdrawal Symptoms. Modares Journal of
if a patient cannot tolerate them. Recent studies Medical Sciences: Pathobiology. 2010; 13(1). pp.
recommend buprenorphine over methadone as the 37-46.
number one drug for treating drug addicts. If a 5. Akbari, Aliasghar; Peiman Ghadirjahrom. The
Effects of Alcoholic Drinks, Tea and Coffee from
patient with withdrawal symptoms and a serious
a Medical Viewpoint.
concurrent disease desires a long-term recovery 6. Kaplan H.I. MD, Saddock B.J. MD, Grebb J.A.
program, maintenance therapy with legal agonists MD. Comprehensive textbook of psychiatry.
should be suggested to him or her immediately. 7th ed. William and Wilkins; 1999.1055-57.
The fact that maintenance therapy with legal 7. A Clinical Guide to Treating Poisoning with
agonists is more effective than detoxification Stimulants. The Ministry of Health and Medical
methods in reducing the rates of side effects and Education. The Office of Mental-social Health
deaths has been proven beyond doubt17, 20,22. and Drug Abuse. Sepidbarg Publishing
Comparing the effectiveness of two Company. 2011. Tehran.
8. Norouzi, Alireza. The Principles of Treating
detoxification methods for opium-dependent
Substance Dependence. The Ministry of Health
patients, Taraghi et al. (2005) discovered that and Medical Education. The Office of Mental-
methadone and buprenorphine acted similarly in social Health and Drug Abuse. Sepidbarg
controlling the patients’ withdrawal symptoms; yet, Publishing Company. 2011. Tehran
 278 PARNIYAN et al., Biosci., Biotech. Res. Asia, Vol. 13(1), 273-278 (2016)

9. Sadeghi, Maneli. (Trans.) A Guide to Treating 16. Poorgholami F, Abdollahifard F, Zamani M,

Methamphetamine Abuse. Sepidbarg Publishing KargarJahromi M, BadiyepeymaJahromi Z. The
Company. 2011. Tehran. Effect of Stress Management Training on Hope
10. Momtazi, Saeed. The Science of Addiction: Drug in Hemodialysis Patients. Global Journal of
Abuse, the Brain and Behavior. The Ministry of Health Science. 2016; 8(7).165-171
Health and Medical Education. The Office of 17. Poorgholami F, Mansoori P, Montaseri Z, Najafi
Mental-social Health and Drug Abuse. Sepidbarg K. Effect of Self-Care Education with and
Publishing Company. 2011. Tehran. without Telephone Follow-Up on the Level of
11. Taheri, Hammidreza. A Guide Book to Hope in Hemodialysis Patients; A Randomized
Psychological Interventions for Outpatients Clinical Trial. IJCBNM. 2016; 4(2):90-97.
Addicted to Stimulants based on the Matrix 18. Sabetgadam M, Poorgholami F,
Model. The Ministry of Health and Medical BadiyepeymaieJahromi F, Parandavar F, Kalani
Education. The Office of Mental-social Health N, Rahmanian E. Effect of Self-Care Education
and Drug Abuse. Sepidbarg Publishing by Face-to-Face Method on the Quality of Life
Company. 2012. Tehran. in Hemodialysis Patients. Global Journal of
12. Norouzi, Alireza. A Guide to Drug Abuse Health Science. 2016; 8(6):140-147.
Treatment of Inpatients. The Ministry of Health 19. Poorgholami F, RahmanianKoshkaki A,
and Medical Education. The Office of Mental- KargarJahromi M, Parniyan R. A Study of the
social Health and Drug Abuse. Sepidbarg Influence of Group-Based Learning of Stress
Publishing Company. 2011. Tehran. Management on Psychology Symptoms Levels
13. Soltani, Hadieh. (Trans.) Marijuana: Facts for of Hemodialysis Patients. Global Journal of
Parents and Adolescents. The National Institute Health Science. 2016; 8(11): 62-68.
of Drug Abuse. Sepidbarg Publishing Company. 20. Poorgholami F, Javadpour SH, Saadatmand V,
2012. Tehran. KargarJahromi M. Effectiveness of Self-Care
14. Ahmadpanah M, Mirzaei Alavijeh M, Allahver- Education on the Enhancement of the Self-
Dipour H, Jalilian F, Haghighi M, Afsar A, Gha- Esteem of Patients Undergoing Hemodialysis.
Ribnavaz H. Effectiveness of coping skills Global Journal of Health Science. 2016; 8(2):
education program to reduce craving beliefs 132-136.
among addicts referred to addiction centers in 21. KargarJahromi M, Javadpour SH, Taheri L,
Hamadan: a randomized controlled trial. Iranian Poorgholami F. Effect of Nurse-Led Telephone
J Publ Health 2013; 42(10): 1139-44. Follow ups (Tele-Nursing) on Depression,
15. Jalilian F, Allahverdipour H, Moinei BPh, Anxiety and Stress in Hemodialysis Patients.
Moghimbeigi A, Barati M, MirzaeiAlavijeh M. Global Journal of Health Science. 2016; 8(3):
Prevention of Anabolic Steroids use among Gym 168-173.
users: Application of Peer Education Approach. 22. Jahromi M. K, Poorgholami F, Rahmanian F,
The Journal of Toloo-e-behdasht 2011; 10(2): Rahmanian E. Effects of Self-Care Education
45-56. [In Persian] with Telephone Follow-up on Self-Efficacy level
in Hemodialysis Patients. Biosci Biotechnol Res
Asia 2016; 13(1)

View publication stats