The cultural turn in understanding 'addiction'.

In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' - as in 'addiction' - has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions.

Effectiveness of information technology assisted relapse prevention program on relapse among people who live with severe mental disorders.

BACKGROUND: Severe Mental Disorders (SMDs) cause mental health worldwide challenges because of several relapses and extensive recovery periods of hospitalization, which put a lot of economic and social burden on families and governments. Therefore, interventions are necessary to decrease the relapse of these disorders. AIM: This study was conducted to investigate the effect of Information Technology Assisted Relapse Prevention Program (ITAREP) on relapse among people who live with SMDs. METHOD: This study was a randomized clinical trial with intervention and control groups. ITAREP is a remote intervention based on monitoring the Early Warning Signs (EWS) to decrease the number of potential relapses. Using convenience sampling, people with SMDs admitted to Sina Juneqan Psychiatric Hospital and their caregivers were recruited in this study and randomly allocated to the control and intervention groups. Two checklists of the EWS for the patient and the patient's caregiver were used for monitoring the relapse signs. Data were collected at baseline and 90 days after discharge and were analyzed using t-test and Chi-square statistical tests and linear regression in SPSS software. RESULTS: Fifty-two patients who lived with SMDs participated in this study (26 in the intervention group and 26 in the control group). The two groups were homogeneous regarding age, gender, type of mental disorder, and duration of the disorder. Forty-two males and ten females participated in this research. Most of the participants were diagnosed with schizophrenia. The results showed that the number of relapses in the intervention group was significantly lower than in the control group in the post-test. CONCLUSION: Social workers, as the case managers and a member of the interdisciplinary psychiatric team, can actively perform follow-up measures after discharge using ITAREP, and it can be expected that these interventions will reduce the number of relapses among patients who live with SMDs.

Social work post-disaster response in Iran: A case study of the 2019 mass flooding in Poldokhtar, Lorestan.

Flash-flooding affected Iran in March 2019 causing the displacement of thousands of people. Social workers established a Child Friendly Space (CFS) and applied comprehensive case management to provide psychosocial support for people who were affected by flooding (PWAF) (n = 565) in a community in Poldokhtar, covering a period of 3 months. Outreach services, involving community-volunteers, providing counseling, establishing CFS, training PWAF for reducing violence, and preventing child abuse were essential social work post-disaster interventions to support vulnerable populations. The article reflects upon the often-neglected role of social workers in post-disaster settings, and brings new material for discussion from the unexplored field of Iranian social workers.

Mental Health System Responsiveness during COVID-19 in People with Pre-Existing Psychiatric Disorders: Experiences from Iran.

Mental health system responsiveness (MHSR) is one of the important indicators in measuring the performance of mental health systems. Recognizing this function can be effective in responding appropriately to the needs of People with Pre-Existing Psychiatric Disorders (PPEPD). This study aimed to investigate MHSR during the COVID-19 period in PPEPD in Iran. Using stratified random sampling, 142 PPEPD who were admitted to a Psychiatric Hospital in Iran one year before the onset of the COVID-19 pandemic were recruited for this cross-sectional study. Participants completed a demographic and clinical characteristics questionnaire as well as a Mental Health System Responsiveness Questionnaire through telephone interviews. The results show that the indicators of prompt attention, autonomy, and access to care were reported as the worst-performing and the confidentiality indicator as the best-performing. The type of insurance affected the access to care and the quality of basic amenities. MHSR has been reported to be poor in Iran in general and this problem worsened during the COVID-19 pandemic. Considering the prevalence of psychiatric disorders in Iran and the degree of disability of these disorders, structural and functional changes are needed for adequate MHSR.

Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study.

BACKGROUND: Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM: This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD: A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS: The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION: The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.

The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran.

BACKGROUND: People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran. AIMS: To determine an ideal model for a community-based RPIs for PLS. METHODS: A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions. RESULTS: In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI. CONCLUSIONS: Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.

Changes in Child Discipline Strategies in Iran During the Outbreak of COVID-19.

During the prolonged COVID-19 pandemic, anxiety and depression were common among caregivers and parents more prone to adopt harsh disciplinary techniques when angry or stressed. The purpose of this study was to investigate if there are any differences in parents' disciplinary strategies following social distancing efforts during the COVID-19 pandemic. An online questionnaire was completed by a convenience sample of parents (N = 605) and mothers (n = 533; 88.1%) aged 37.80 years old (SD = 5.66; range = 20-59) who lived with children aged 6-12 years in Iran during the COVID-19 pandemic. Iran's Multiple Indicator Demographic and Health Survey questionnaire was used to gauge child discipline. There was an increase in shaking (1.8%), shouting and yelling (15.5%). The findings of this study serve as a reminder to researchers and government officials that child abuse and violence are more likely to occur during stressful times and provide the scientific foundation for the development of tailored psychological treatment.

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.

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 could aggravate the effects of the other. This is the first study on GD among Iranian substance users to develop and validate a GD Screening Questionnaire-Persian (GDSQ-P). METHODS: Iranian male adults (n = 503) with SUDs were recruited via clustered sampling. Problem gambling screening 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, content validity index (CVI), content validity ratio (CVR), and reliability (Kuder-Richardson coefficient). To establish construct validity, interviews based on DSM-5 as a gold standard method were used. A receiver operating characteristic (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 score greater 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 gambling methods among participants. Overall Kuder-Richardson coefficient was 0.95. Cut-off threshold for GDSQ-P was calculated as 4.5 with 98.9% sensitivity and 98.3% specificity. The interviewers confirmed GD for participants 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 in the general population.

Islam and cannabis: Legalisation and religious debate in Iran.

Iran is currently discussing cannabis and opium regulations, which could bring a legalisation of drug consumption through a state supervised system. The article engages with the question of cannabis by looking at the legal interpretation of religious authorities in the Islamic Republic of Iran. The choice of Iran is justified for several reasons: firstly, Iran has a long history of drug use and cannabis has been part of the country's intoxicant traditions since times immemorial; secondly, the Iranian state is unique in that it combines religious exegesis with political machination through official channels; finally, among all Middle East and Islamic countries, Iran is at the avant-garde in experimenting in the field of drugs policy which makes an excellent case for the study of cannabis regulation. The article is the result of a direct engagement with Iran's leading Shi'a authorities, the maraje'-e taqlid, 'source of emulation'. The authors redacted a list of eight questions (estefta'at) about the status of cannabis in Iranian society. It questioned cannabis' legality in Islam, its potential medical use, the feasibility of domestic production and other relevant aspects of its social-religious life. Based on the responses, the authors analysed the difference in opinions among the religious scholars and speculate on the possibility of policy reform. Given the dearth of scholarly work about illicit drugs in the Islamic world, about which many readers might not be familiar, the article opens with an overview of the place of cannabis in the history of Islamic societies. It discusses terminological ambiguities, references in religious texts and traditions, and the general interpretations within Muslim religious schools of thought. Then, it discusses the status of cannabis in contemporary Iran before tackling the responses provided by the religious scholars. Eventually, the paper puts forward reflections about the potential implications for future policy developments on cannabis.

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.

Effectiveness of Satir-Informed Family-Therapy on the Codependency of Drug Dependents' Family Members in Iran: A Randomized Controlled Trial.

PURPOSE: Social workers in substance abuse treatment settings are responsible for involving families in treatment program to improve family functioning. The effectiveness of available interventions in treating codependency of family members of drug users in Iran is not well explored. We evaluated the effectiveness of the Satir communication family therapy (CFT) in healing codependency of drug dependents' family members in Tehran, Iran. METHODS: The intervention group participants (n = 27) received a seven-session social work intervention with CFT approach and the control group (n = 26) received treatment as usual. We used the Holyoake Codependency Index to measure participants' codependency at baselines, end of intervention, and 90 days post intervention. RESULTS: Codependents enrolled in the intervention had a significantly lower codependency score than controls at the end of intervention and 90 days post intervention. DISCUSSION: CFT is an effective strategy to reduce codependency in Iranian population and can be explored as a population-based strategy.

Effectiveness of a Brief Home-Based Social Work Motivational Intervention for Male Methamphetamine Users in Tehran: A Randomized Clinical Trial.

UNLABELLED: Methamphetamine, a highly addictive psychostimulant drug, is widely used by substance users who are not motivated to undergo treatment throughout the world, including Iran. This research was conducted to evaluate the effectiveness of a brief home-based social work motivational intervention (HSWMI) to encourage male methamphetamine users to participate in a treatment program. METHOD: Fifty-six unmotivated male methamphetamine users participated in a randomized controlled trial. The case group received the HSWMI in addition to the usual consulting services in the clinic; the control group just received the usual consulting services. Data were collected 7 and 90 days after the intervention to evaluate participation and retention in a treatment program. Data were analyzed using the chi-square test. RESULTS: Drug users with a mean age of 32.55 years and mean duration of drug use of 7.73 years, participated in the case (n = 28) and control (n = 28) groups. The case group participated in treatment programs significantly more than the control group and the retention rate for the case group was significantly higher than for the control group. CONCLUSION: This brief HSWMI was effective to increase the motivation of methamphetamine users to participate and remain in treatment programs. This intervention can be implemented by social workers in substance use treatment centers.

Sexual and Drug Use Risk Behaviors of Internal Long Distance Truck Drivers in Iran.

BACKGROUND: Long Distance Truck Drivers (LDTDs) and their sexual health risk behaviors have been associated with greater prevalence of sexually transmitted Infections (STIs), HIV and hepatitis virus transmission. However, there is no information about Iranian LDTDs' high-risk behaviors. The aim of this investigation was to estimate the prevalence of high-risk behaviors in Iranian LDTDs. METHODS: This cross-sectional study was conducted in Jun 2014 with LDTDs from Tehran Province of Iran. LDTDs were recruited via convenience sampling and given a 43-item reliable and valid questionnaire to assess sexual health risk behaviors and demographic and background characteristics of study participants. RESULTS: A total of 349 LDTDs with the mean age of 36.91 yr (range, 19-65 yr) participated in the study. The average duration of staying away from home for participants was 5 d (SD=±1). Majority of the LDTDs were married (82.2 %) and had more than 5 yr (inclusive) of formal education (95.7%). Younger LDTDs reported more condom use with their partners (r=-0.170, P≤0.001), more extramarital sexual contacts (r=-0.157, P≤0.001), more pay for sex (r=-0.110, P≤0.005) and condom use in their extra-marital sex contacts (including with sex workers) (r=-0.176, P≤0.001). CONCLUSION: Iranian LDTDs have specific risk factors for unhealthy sexual behaviors. Prevention efforts must emphasize on specific high-risk groups.

Effectiveness of a Brief Psychosocial Intervention on Quality of Life of Primary Caregivers of Iranian Children With Cancer: A Randomized Controlled Trial.

UNLABELLED: Cancer in children has a great impact on primary caregiver quality of life (QOL). OBJECTIVE: This study examined the effectiveness of a brief psychosocial intervention (BPI) on QOL of Primary Caregivers of Children with Cancer (PCCCs). METHODS: Sixty-five PCCCs participated in a randomized controlled trial in Mahak Hospital and Rehabilitation Complex in Tehran, Iran. A 5-week long BPI (which comprised of counseling sessions and telephone follow-up) was delivered to the intervention group in addition to usual service, while the control group was provided with usual service. Data were collected using the Caregiver Quality of Life Index-Cancer-Persian version (CQOLC-P) prior to intervention, post-intervention, and at follow-up (i.e. 30days after the intervention). Repeated measures analysis of variance analysis (ANOVA) was used to evaluate outcomes. RESULTS: Majority of the participants were mothers (95%), between ages of 24-47 years (95%) with children between ages of 2-12 years. Most child cancer diagnoses were for brain tumors (n=31) and blood cancers (n=17). Significant improvement was found within the intervention group on QOL (p<0.001) including improvements on subscale measures of mental/emotional burden (p<0.001), disruption (p<0.001), and positive adaptation (p<0.001), compared with the control group over time. There was no difference between the intervention and control groups on the financial subscale measure after intervention (p>0.05). CONCLUSION: BPI was an effective strategy to improve the quality of life of PCCCs. Similar interventions can be planned by practitioners to reduce the burden of childhood cancer on PCCCs.

The effect of a family-based intervention with a cognitive-behavioral approach on elder abuse.

Elder abuse may become a health issue in developing countries, including Iran. The purpose of this investigation was to study the effectiveness of Family-Based Cognitive-Behavioral Social Work (FBCBSW) in reducing elder abuse. In a randomized clinical trial in Iran, 27 elders participated in intervention and control groups. The intervention groups received a five-session FBCBSW intervention and completed the Domestic-Elder-Abuse-Questionnaire (DEAQ), which evaluates elder abuse at baseline and follow-ups. Repeated measures of analysis of variance (ANOVA) and the Wilcoxon test were used to analyze the data. The repeated measures ANOVA revealed that FBCBSW was successful in reducing elder abuse. The Wilcoxon test indicated that emotional neglect, care neglect, financial neglect, curtailment of personal autonomy, psychological abuse, and financial abuse significantly decreased over time, but there was no statistically significant difference in physical abuse before and after the intervention. The findings from this study suggest that FBCBSW is a promising approach to reducing elder abuse and warrants further study with larger samples.

Community-based relapse prevention for opiate dependents: a randomized community controlled trial.

Relapse prevention (RP) programs mainly focus on patients and their families; however a patient's community can also play a significant role in RP. A randomized-controlled-trial was conducted among opiate-dependents discharging from residential abstinence-based treatment programs to assess the effect of a community-based relapse prevention program (CBRP) on the RP. Seventy-one participants were consented and randomized into CBPR (n = 35) or treatment-as-usual arms. Developing and implementing CBRP, social-workers and peer-group counselors facilitated and advocated thirty-six RP projects across 7 communities during a three-month follow-up period. Negative-drug-tests, 45 and 90 days after discharge from residential programs were considered as the main outcome. Abstinence rates were significantly greater for patients who received CBRP in comparison to the subjects in the treatment-as-usual arm at 45 days (27 and 20, P < 0.004) and 90 days (27 and 21, P < 0.007) after discharge. CBRP was an effective method for RP among opiate-dependents after being discharged from the residential programs.

Drug Craving Terminology among Opiate Dependents; A Mixed Method Study.

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.