|Year : 2015 | Volume
| Issue : 3 | Page : 82-88
Drug abuse among patients of Tanta university hospital outpatient clinic, Gharbia governorate, Egypt
Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
|Date of Submission||30-Apr-2015|
|Date of Acceptance||28-Apr-2015|
|Date of Web Publication||7-Aug-2015|
Dr. AAM EL-Sherbiny
Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta
The aim of this study was to assess the frequency of drug abuse among patients who attended Tanta university outpatient clinic for medical consultations, as well as to determine its sociodemographic predictors. A cross-sectional study was carried out on 218 patients who attended Tanta university outpatient clinic over a period of 3 months using the Drug Abuse Screen Test (DAST-10) to determine the frequency of drug abuse and its grades. The results revealed that 15.14% of this study group comprised drug abusers and most of the drug abusers used more than one drug. The majority of drug abusers in this study population could not discontinue drugs and suffered from withdrawal symptoms. Drug abuse was significantly higher in the male population than in the female population, among individuals with low educational qualifications than among university graduates and those with secondary education, in those between 18 and 25 years of age than in other age categories, in urban residents than in rural ones, in single than in married individuals, in cigarette smokers and alcohol users than in nonsmokers and nonalcohol users. Thus, I recommend (according to DAST-10 recommendations) the monitoring and reassessment of mild drug abusers, further investigation of moderate and substantial drug abusers, and intensive assessment of severe cases.
Keywords: drug abuse, Egypt, Tanta
|How to cite this article:|
EL-Sherbiny A. Drug abuse among patients of Tanta university hospital outpatient clinic, Gharbia governorate, Egypt. Tanta Med J 2015;43:82-8
|How to cite this URL:|
EL-Sherbiny A. Drug abuse among patients of Tanta university hospital outpatient clinic, Gharbia governorate, Egypt. Tanta Med J [serial online] 2015 [cited 2018 Jan 19];43:82-8. Available from: http://www.tdj.eg.net/text.asp?2015/43/3/82/162438
| Introduction|| |
Substance abuse, also known as drug abuse, is a patterned use of a drug in which the user consumes the substance in amounts or with methods that are harmful to themselves or others, and is a form of substance-related disorder  . It is common among patients in primary care settings. Although it has a substantial health impact, physicians report low levels of preparedness to identify and assist patients with substance use disorders. An effective approach to office-based treatment includes a coherent framework for identifying and managing substance use disorders and specific strategies to promote behavior change  .
The consequences of illicit substance use include increased morbidity and mortality, loss of productivity, and increased healthcare costs  . In the USA, the National Survey on Drug Abuse and Health (NSDUH) reported that new users of tranquilizers have been increasing since the mid-1980s, with the largest increase of 700 000 new users in 1999 to almost one million users in 2000  .
The WHO  reported that the prevalence of drug abuse in individuals between 15 and 64 years of age in Egypt was 0.8% (0.64 and 1.3% of drug abusers were found to be in the female and male population, respectively). Many consumers are under the impression that taking prescription pills is safer than taking other recreational drugs  . The truth is that just because something is 'prescribed' to a patient does not mean that it is not highly addictive or ultimately damaging to the person  .
Primary care workers are in a unique position to identify and intervene with patients whose substance use is hazardous or harmful to their health and well-being. Health promotion and prevention are important parts of the role of primary care, and primary care workers are engaged in many preventive activities including immunization, screening and early intervention for high blood pressure, obesity, smoking and other lifestyle risk factors. Patients view primary care as a credible source of advice about health risks including substance use  .
Screening and brief interventions aim to identify current or potential problems with substance use and motivate those at risk to change their substance use behavior  . Brief interventions in primary care can range from 5 min of brief advice to 15-30 min of brief counseling. These are valuable tools in the treatment of problematic or risky substance use. Brief interventions can also be used to encourage those with more serious dependence to accept more intensive treatment within the primary care setting, or referral to a specialized drug treatment agency  .
The Drug Abuse Screen Test (DAST-10) was designed to provide a brief, self-report instrument for population screening, clinical case finding, and treatment evaluation research. It can be used with adults and older youth. The DAST-10 yields a quantitative index of the degree of consequences related to drug abuse. The instrument takes ~5 min to administer and may be given in either a self-report or an interview format. The DAST-10 may be used in a variety of settings to provide a quick index of drug abuse problems  .
At the national level, epidemiological data on drug use and related harms are rarely collected in Egypt. Although some studies have examined the prevalence of substance use within sectors of the population, these surveys are not routinely conducted and the quality of data is variable. Egypt also lacks a treatment reporting system  . Thus, the aim of the present study was to assess the frequency of drug abuse among customers of Tanta university hospital outpatient clinic, as well as to determine its sociodemographic predictors.
| Patients and methods|| |
A cross-sectional study was conducted on 218 patients who attended Tanta university outpatient clinic for medical consultations over a period of 3 months from the first of April to the end of June 2013 in outpatient clinics of Tanta University Hospital, Egypt, using the DAST-10 tool and exit interviews; data were collected from a total of 218 patients.
The dimensions of the DAST-10 model were used for measuring drug abuse  . The DAST-10 model instrument is a reliable and valid tool in the assessment of drug abuse ,,,,, . The DAST-10 model instrument was first translated into the Arabic language, as Egyptian citizens are native speakers of Arabic, by two specialists of English translation to ensure that the exact meaning was achieved.
| Sampling and data collection|| |
Sampling and sample size
Conscious patients who attended the outpatient clinic of Tanta University Hospital and who were 18 years or older were included in the study.
Patients younger than 18 years and patients unwilling to participate in this study were excluded from the study.
The minimal ample size was calculated using minitab statistical program, version 17 (Brandon Court, UK), for a single proportion and it was found to be 221 patients, taking into consideration that the hypothesized probability was 4.64%  and the comparative probability was 10% from pretest study (2 of 20 individuals) at the power of 90.0%. Ten percent (22 patients) was added for individuals who were unwilling to participate. Therefore, the total sample size was 243. Actually, 218 of 243 individuals completed the questionnaires with a response rate of 89.72%. Twenty-five individuals refused to complete the interview after they gave consents.
This study sample constituted 218 patients (8.77%) who were chosen randomly (each individual presented by card and sample was chosen blindly) from a daily register patient's tickets out of the total study population (2485 = 100%) who attended the outpatient clinic of Tanta University Hospital during the period between the first of April to the end of June 2013. About eight to 10 cases (out of about 100 individual on daily base) were chosen randomly every day, 2 days per week for about 3 months.
Each participant was interviewed for ~10-15 min using a structured questionnaire administered to 218 patients that recorded age, sex, educational level, residence, marital status, smoking habit, alcohol intake, purpose of drug intake during the past year, whether medical or nonmedical, and excess use of prescribed drugs or both.
Each patient was subjected to the DAST-10 (alcoholic beverage intake was excluded) during the past 12 months, which included 10 questions on the following: excessive use of prescribed drugs or nonmedical use of drugs; usage of more than one drug; difficulty discontinuing drug intake; occurrence of blackouts or flashbacks as a result of drug use; feelings of guilt about drug use; complaints from spouse (or parents) drug involvement; neglect of family due to use of drugs; involvement in illegal activities to obtain drugs; experience of withdrawal symptoms (felt sick) when discontinuing drugs; and medical problems as a result of the drug use (e.g. memory loss, hepatitis, convulsions, bleeding)  . Patients received 1 point for every 'yes' answer with the exception of question number 3, for which a 'no' answer receives 1 point  .
According to the DAST-10, drug abuse refers to the use of medications at a level that exceeds the instructions, and/or any nonmedical use of drugs. Drug dependence was diagnosed when the total DAST-10 score was above three. In contrast, the total DAST-10 score was calculated and categorized into the following grades: no problem (score was zero), low problem (score 1-2), moderate (score 3-5), substantial problem (score 6-8), and severe problem (score 9-10)  .
Data analysis was carried out using the statistical package for social sciences (SPSS), version 20 (IBM, USA). Frequency distributions for numbers and percentages of all variables were calculated. The χ2 -test was used to determine the association between drug abuse grade and drug dependence on one hand and study independent variables on the other. The likelihood ratio and Monte Carlo test were used when there was a limitation of use of the χ2 -test.
Verbal consent was taken from all participants in line with the Ethics protocol of medical research.
| Results|| |
About three-fifths (61.0%) of the study group was younger than 40 years and about two-fifths was older than 40 years. Drug abuse was significantly higher among individuals between 18 and 25 years of age (42.9%) than among those between 26 and 40 years of age, between 41 and 60 years, and above 60 years of age (6.0, 7.5, and 9.4%, respectively). About one-half of the study group comprised women (48.6%) and the other half comprised men (51.4%). Drug abuse was significantly higher in the male (21.8%) than in the female population (2.8%). Nearly half of study group was from the rural residence and the other half was from urban areas. Drug abuse was significantly higher among individuals of urban residence (24.1%) than among those of rural residence (6.4%). Less than one-fourth (22.5%) and less than one-third (30.7) of the study group comprised university graduates and those with secondary education, respectively, whereas only 5% and more than two-fifths (41.7) were illiterate and literate, respectively. Drug abuse among university graduates (4.1%) was significantly lower compared with that among illiterate (54.5%) and literate (27.5%) individuals. Less than two-thirds (63.8%) of the study group was married, whereas 22.5% was single. Drug abuse was significantly lower among married individuals (2.9%) compared with those who were single, widow, or divorced (42.9, 13.0, and 71.4%, respectively). The frequency of cigarette smoking in the study group was 31.7%. Drug abuse was significantly higher among cigarette smokers (53.5%) compared with nonsmokers (2.0%). An overall 9.6% of the study group comprised alcohol users. All alcohol users were drug abusers, whereas only 6.1% of nonalcohol users were drug abusers, with significant association between alcohol intake and drug abuse ([Table 1]).
|Table 1: Distribution of drug abuse grades on the basis of patient sociodemographic data and their habit|
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One-half and less than two-fifths study group had not used any recreational drug or drugs for medical purpose during the past year, respectively, whereas 5.5% had used both medical and recreational drugs. Less than one-tenth (9.63%) of the study group comprised drug abusers ([Figure 1]).
The frequency of drug abuse in the study group was 15.14%, and 1.39 and 7.34% had severe and substantial problem, respectively, whereas 1.83 and 4.59% had low and moderate problem, respectively ([Figure 2]). The frequency of drug dependence in the study group was 11.93% ([Figure 3]).
|Figure 2: Drug abuse grades according to the total Drug Abuse Screen Test (DAST-10) score.|
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|Figure 3: Drug dependence in the study group according to the total Drug Abuse Screen Test (DAST-10) score.|
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An overall 15.14% of the study group comprised drug abusers who abused at least one nonmedical drug, and 14.7% of the study group comprised drug abusers who abused more than one drug (97.0% of drug abuser) ([Figure 4]). An overall 9.6% of the study group could not discontinue using drugs (63.4% of drug abuser), 9.2% experienced withdrawal symptoms (60.8% of drug abuser), and 3.7% had medical problems due to the use of drugs (24.4% of drug abuser). An overall 3.7, 2.8, 7.3, and 6.9% of the study group neglected their family, was involved in illegal activity to attain drugs, their family complained of drug abuse and had feelings of guilt from using drugs (24.4, 18.5, 48.2, and 45.6% of drug abusers, respectively).
|Figure 4: Element of the Drug Abuse Screen Test (DAST-10) in the study group.|
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| Discussion|| |
Sociodemographic profile for the study population
About three-fifths of the study group was younger than 40 years and about two-fifths was older than 40 years. There were nearly equal percentages of men and women. Less than one-fourth and less than one-third of the study group comprised university graduates and those with secondary education, respectively, whereas about one-half had low educational qualification. Nearly half of the study group resided in rural areas and the other half was from urban areas. Less than two-thirds of the study group was married, whereas more than one-third of the study group was single (single, widow or divorced). About one-third of the study group comprised cigarette smokers and about one-tenth comprised alcohol users.
According to the World Drug Report, the high prevalence of substance-related problems poses a significant challenge to healthcare systems and societies. Effective national responses to these problems include the development and implementation of prevention and treatment policies and programs. To assist countries in effectively designing and implementing alcohol and drug services to meet population needs, information is required for each level of the health system. Such information can reflect gaps in service delivery and resource allocation, can aid in the strengthening of substance-related programs and policies, and can provide benchmark data for monitoring progress in meeting population needs  .
Less than one-half and less than two-fifths of the study group had not used any recreational drug or drugs for medical purpose during the past year, respectively, whereas 5.5% had used both medical and recreational drugs. Less than one-tenth (9.63%) of the study group comprised drug abusers ([Figure 1]). In agreement with this study, McCabe  stated that a total of 40.1% of his study population reported no lifetime use of drugs, 39.7% reported medical use only, 15.8% reported both medical and nonmedical use, and 4.4% reported nonmedical use only.
Several studies have reported increase in the prescription rates of abusable medications including stimulants, opioids, and benzodiazepines ,, . This increase is likely the result of many factors, including improved awareness on the signs and symptoms of several disorders, increased duration of treatment, availability of new medications, and increased marketing , . The increase in prescription rates have raised public health concerns because of the abuse potential of these medications and high prevalence rates of nonmedical use, abuse, and dependence, especially among young adults between 18 and 24 years of age ,, .
The frequency of drug abuse in the study group was 15.14, and 1.39% and 7.34 had severe and substantial problem, respectively, whereas 1.83 and 4.59% had low and moderate problem, respectively ([Figure 2]). The frequency of drug dependence in this study group was 11.93% ([Figure 3]). In Egypt, Hamdi et al.  found that the lifetime prevalence of any substance use varies between 7.25 and 14.5%. One-month prevalence varies between 5.4 and 11.5% when adjusted to different population parameters. An overall 9.6% of the study group was identified to have used illicit substances at least once in their life: 3.3% took drugs for experimental reasons and during social settings, 4.46% took drugs at regular base, and substance dependence was found in 1.6%. The difference between our results and those of another study was due to different sociodemographic profile of both populations  .
Hamdi et al.  revealed that the prevalence of substance use in the male population was 13.2% and that in the female population was 1.1%. Our study found that drug abuse was significantly higher in men (21.8%) than in women (2.8%). Drug abuse among university graduates (4.1%) was significantly lower compared with that among illiterate (54.5%) and literate (27.5%) individuals. In accordance with our result, Hamdi et al.  found that the prevalence of drug abuse increased significantly in the male population with lesser levels of education and in certain occupations.
Drug abuse was significantly higher among individuals between 18 and 25 years of age (42.9%) compared with those between 26 and 40 years of age, 41 and 60 years of age, and those above 60 years. Hamdi et al.  revealed that individuals between 15 and 19 years of age showed the highest onset of substance use. Cannabis is the drug mostly misused in Egypt. Moreover, El-Sawy et al.  revealed that the majority of studied addicts were between 20 and 40 years of age (81.4%).
El-Sawy et al.  found that the prevalence of drug abuse was 70% in the male population, whereas it was 30% in the female population. Our results revealed that most of the drug abusers (91.0%) in our target group were male. The variation was due to the difference in the study population, as El-Sawy et al.  targeted only drug addicts, whereas this study targeted a group of the total population.
Our results revealed that drug abuse was significantly lower among married individuals (2.9%) than among single, widow or divorced individuals (42.9, 13.0, and 71.4%, respectively). El-Sawy et al.  reported that 60.6% of drug abusers were of single marital status.
Our series showed that drug abuse was significantly higher among cigarette smokers (53.5%) than among nonsmokers (2.0%). In agreement with our results, in Egypt, El-Sawy et al.  found that the majority of studied addicts were current smokers. The current study found that there was a significant association between alcohol intake and drug abuse. Kirby and Barry  found that alcohol represented the 'gateway' drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs.
About one-tenth of this study population could not discontinue drug abuse and suffered from withdrawal symptoms. The previous results show that this population was suffering from drug dependence and drug addiction that develops from repeated drug administration and results in withdrawal upon cessation of drug use and drug addiction, thus leading to compulsive and out-of-control drug use, despite negative consequences  .
Our series revealed that most of the drug abusers abused more than one drug. In agreement with this, El-Sawy et al.  found that the majority of studied addicts were abusing more than one drug (84.6%). In agreement, our results revealed that 14.7% of the study population abused more than one nonmedical drug, and this constituted about 97.0% of drug abusers  .
The present work found that 2.8% of the study population involved in illegal activity to buy drugs, and this constituted one-fifth of drug abusers. The common cause explanation of the drug-crime relationship posits that drug use and crime do not have a direct causal link, but instead are related by a number of common causes. These common causes include genetic or temperamental traits, antisocial personality disorder, parental alcoholism, and poor relationship with parents  .
Limitations of the study
The present study was an outpatient-based study that used the DAST-10 to screen for drug abuse and study some sociodemographic data as determinants of drug abuse, which gives an idea about the magnitude of the problem. The condition of drug abuse needs further community-based in-depth study to determine the exact situation and to determine the risk factors that lead to drug abuse.
| Conclusion and recommendations|| |
From the results of the present study, we conclude that 15.14% of this study group comprised drug abusers and most of the drug abusers abused more than one drug. The majority of drug abusers in this study population could not discontinue and suffered from withdrawal symptoms. Drug abuse was significantly higher in the male than in the female population, among individuals with lower educational qualifications than among university graduates and those with secondary education, in those between 18 and 25 years of age than those in other age categories, in urban residents than in rural residents, in single than in married individuals, in cigarette smokers and alcohol users than in nonsmokers and nonalcohol users. Thus, I recommend (according to the DAST-10 recommendations)  the monitoring and reassessment of mild drug abusers, further investigation of moderate and substantial drug abusers, and making intensive assessment of severe cases.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]