ArticlePDF Available

Factors Influencing Vulnerability Towards Heroin Addiction in a Pakistani Cohort

  • Pir Mehr Ali Shah University of Arid Agriculture Rawalpindi
Factors Inuencing Vulnerability Towards Heroin
Addiction in a Pakistani Cohort
Shagufta Jabeen1, Muhammad Saqlain Raja1, Sadia Saeed1, Muhammad Mobeen Zafar1,
Rizwana Abdul Ghani1, Abid Mahmood1, Muhammad Fiaz2, Pakeeza Arzoo Shiaq1,
Shahid Mahmood Baig3, S.M. Saqlan Naqvi1 and Ghazala Kaukab Raja1*
1Department of Biochemistry, PMAS Arid Agriculture University, Rawalpindi, Pakistan
2Department of Medicine, Shaheed Zulqar Ali Bhutto Medical University, Islamabad, Pakistan
3National Institute for Biotechnology and Genetic Engineering, Faisalabad, Pakistan
Article Information
Received 10 August 2016
Revised 31 August 2016
Accepted 17 September 2016
Available online 02 November 2016
Authors’ Contributions
GKR, SMSN and SMB were involved
in study design, data analyses and
interpretation. SJ collected data and
drafted the manuscript. MS analyzed the
data. SS helped in manuscript writing.
All other authors participated in data
analysis and interpretation.
Key words
Drug, Stress, Peer pressure, Multifactorial
Addiction to opioids including other illicit drugs is a chronic, relapsing multifactorial disorder of brain and, if left untreated, major
medical, social, and economic problems arise. Drug addiction is among major health issues faced by the World including Pakistan
with an alarming annual increase in heroin addicts. The study was designed to identify the socio-demographic risk factors
contributing to increasing susceptibility to heroin addiction in Pakistani populations. In this epidemiological study subjects were
interviewed through a comprehensive questionnaire consisting of open and closed-ended questions. Data regarding key factors
such as age and ethnicity, communal domain, education level, employment status and demographic factors (drug route, drug dose)
have bearing upon heroin addiction was collected. Descriptive and inferential statistics were used for data analysis. Early age
of addiction onset, low literacy rate, peer pressure, occupation type, and stress are among risk factors increasing susceptibility
towards heroin addiction in our studied cohort. Drug abuse initiated at an early age seems to trigger transition to heroin addiction
under the inuence of environmental risk factors.
Drugs categorized as stimulants, sedatives, hallucinogens
and opioids are being abused throughout the world
including Pakistan. According to Koob and LeMoal (1997)
dsyregulation of the brain reward mechanism is induced by
repeated drug abuse with subsequent allostasis, the ability to
achieve stability through change. Opioids, the highly addictive
narcotics are clinically important analgesics and used for pain
management whereas their abuse often results in development
of tolerance, dependence, and overdose (Fischer et al., 2006a,
2006b). Mu-opioids receptors in central nervous system are
the target sites to award the effects of opioids that particularly
refers to natural, semi-synthetic, and synthetic chemicals
(Fornasari, 2012). Opioids addiction, a complex relapsing
brain disorder is characterized by compulsory drug seeking,
drug abuse, tolerance and physical dependence in spite of
harmful consequences (Krantz and Mehler, 2004). Different
internal and external environmental factors including an
addict’s mindset, social inuences like home environment,
peer pressure and response to stress and stressors may also
contribute to opiate addiction vulnerability (Kreek et al., 2012).
Multiple external/environmental factors with varying degree
of contribution at individual level results in increased risk of
opioid dependence development (Weinberg, 2001). Regarding
risk factors an early antisocial behavior, anxiety, depression,
socioeconomic status, academic failure, hyperactivity physical/
sexual abuse and history of substance dependence in family
* Corresponding author:
0030-9923/2016/0004-1161 $ 8.00/0
Copyright 2016 Zoological Society of Pakistan
are considered as the major contributing risks (Kilpatrick et
al., 2000; Ronel and Levy-Cahana, 2011; Zapata et al., 1998).
Moreover 1st drug attempt at an early age, poor academic
performance and psychiatric history are likely to increase the
frequency of substance use (Tsuang et al., 1999). In the context
of Pakistan opioids are commonly abused but heroin is one of the
major drugs of addiction in young boys and men, poses massive
personal and public health costs. Inter-individual variability
regarding vulnerability to addiction has been reported. Being a
complex disease it can be inuenced by a multitude of highly
entangled factors; behavioral, environmental, developmental
including gender and ethnicity, and genetics. However the
vulnerability towards addiction increases with an increase
in the number of predisposing risk factors clustering in an
individual while protective factors reduce the risk of addiction
development (NIDA, 2014). Though the magnitude and
severity of problem varies, Pakistanis are extensively exposed
to illegal opium, heroin tracking and abuse (Malik and Sarfaraz,
2011). Based on the data presented in United Nations Ofce on
Drugs and Crime, there are 6.7 million (aged 15-64 years) total
drug abusers while 0.8 million regular heroin users in Pakistan
with an annual consumption of 44 tons of heroin (UNODC,
2013). A report by Anti-Narcotics Force of Pakistan (2006-2007) has
focused on dierent factors responsible for increasing prevalence of
drug abuse in Pakistan. Some of the key factors include ease of access
of drug at very low prices, illiteracy/low education level, peer pressure,
social and family stress, etc. (Aslam, 2015; Aslam et al., 2011).
Like many common disorders with multifactorial etiology,
external factors play an important role in development of heroin
addiction. Therefore, present study was designed to investigate
the factors associated with heroin addiction vulnerability in
Pakistani populations.
Pakistan J. Zool., vol. 49(1), pp 95-99, 2017. DOI:
We conducted the study to explore the external
environmental/socioeconomic aspects of heroin addicts in
Pakistan. The study is approved by the Ethics Committee of
Pir Mehr Ali Shah Arid Agriculture University Rawalpindi,
Pakistan for the Use of Human Subjects. Data was collected
using a comprehensive questionnaire and a written
informed consent was obtained from all study subjects.
To investigate the environmental factors we included a
random sample of 540 male heroin addicts admitted in
different drug rehabilitation centers/hospitals. Among
socio-demographic/external characteristics of studied
population; age (onset of drug addiction), literacy level,
daily drug dose, ethnicity, communal domain and stress in
case group were computed. The subjects were divided into
three age groups; <20 years, 21-40 years and >40 years.
The daily drug dose was grouped into <250 mg, 250-
1000 mg and >1000 mg/day and ethnicity was recorded
under three major ethnic groups; Punjabis, Pakhtoons
and “Others” (include miscellaneous ethnic groups). The
external/environmental risk factors were also categorized
as communal domain, stress and “others”. Though all cases
included in study were heroin addicts, the frequencies of
different drugs being used in different age groups before
transition to heroin addiction was also investigated.
Table I.- Descriptive statistics of study population.
Frequency (%)
<20 21-40 >40
Onset age for Heroin use 39.61 57.49 2.90
Tobacco smoking 84.91 14.79 0.30
Marijuana use 80.50 19.20 0.31
Alcohol drinking 75.81 24.19 0.00
Daily drug dose <250 mg 12.4
250-1000 mg 23
>1000mg 64.5
Ethnicity Punjabi 64
Pakhtoon 27.05
Others 8.95
Risk factors
(External /
Communal domain 73.95
Stress 18.14
Others 7.91
Statistical analysis
Descriptive and inferential statistics were used to draw
the conclusions. Onset of addiction in different age groups,
daily drug dose, prevalence of addicts in different ethnic
groups and risk factors were estimated using frequency
estimation. Association of addiction with age, ethnicity, and
literacy level and employment type was computed using
multinomial logistic regression and odds ratio (OR) was
calculated. Signicance level for all analysis was ≤0.05.
SPSS v.21 software was used for analysis.
As presented in Table I, the frequency of addictive
drugs abuse is higher in <20 years age group as compared
to the 21-40 and also >40 years. Among total study subjects
64% were Punjabis, 27.05% Pakhtoons, and 8.95% were
from “Other” ethnic groups. The frequency of the onset
of drug abuse in <20 years group is as follows; tobacco
smoking (84.91%), marijuana use (80.50%), alcohol
drinking (75.81%) and heroin (39.61%). In case of 21-40
and >40 years age groups, the drug abuse frequency for all
other drugs was low as compared to <20 years age group
except for heroin. However among heroin addicts, the
highest frequency (57.49%) was found in 21-40 years old
subjects (Table I). As for literacy levels the details of study
population are as follows: Primary 33%, Middle 24.9%,
Secondary 19.6%, Higher Secondary 10.7%, Graduation
5.2%, and Postgraduate 4.2%, respectively (Table II).
Table II.- Distribution of study subjects based on
literacy level, drug route, and daily drug intake.
Variables Frequency (%)
Literacy level
Primary 33
Middle 24.9
Secondary 19.6
Higher Secondary 10.7
Graduation 5.2
Postgraduate 4.2
Drug route
Smoking 60
Snifng 14
Injections 23
Snifng plus injections 5
Daily drug intake (Number of times)
Once/day 10.7
Twice/day 22.8
Thrice/day 66.1
>Thrice/day 41.1
Data related to the route of drug administration
indicates smoking 60%, snifng 14%, injections 23%,
snifng plus injections 5% (Table II). As for the frequency
of daily drug use, 41.1% were using >3 times/day, 66.1%
were using thrice in a day, 22.8% were on a twice use/day
whereas 10.7% were on a single time use/day. As for the
contribution of external/environmental risk factors, stress
contributed 18.4% towards drug addiction and 7.9 % in case
S. Jabeen et al.
of category “others”. It is worth mentioning that category
“others” is a combination of multiple factors including; urge,
company, poverty, unawareness, anger, drug trafcking,
home environment, and curiosity for experiencing drugs
while stress is also a part of it (Table I). The analyses
of demographic variables with drug addiction showed
high prevalence of drug users among individuals having
occupations like eld workers (laborers), shopkeepers and
drivers. Analysis also indicated strong association among
addiction and occupations: eld workers/laborers (OR=
2.07 CI = 1.24-3.44, p=0.005), shopkeepers (OR= 1.93
CI=1.06-3.54, p=0.003) and drivers (OR= 1.44 CI=1.77-
2.66, p=0.04) (Table III).
Table III.- Association of study variables with heroin
Study variables Heroin addiction p-value
OR (95% CI)
Age in years (21-40 years as reference group)
<20 1.23 (0.58-2.66) 0.58
>41 1.10 (0.6-1.8) 0.69
Ethnicity (Punjabi as reference group)
Pakhtoon 1.03 (0.53-1.99) 0.94
Other Ethnicity 1.26 (0.62-2.57) 0.52
Occupation (Ofce employee as reference group)
Field worker (laborer) 2.07 (1.24-3.44) 0.005
Shopkeeper 1.93 (1.06-3.54) 0.003
Driver 1.44 (1.77-2.66) 0.04
Signicance levels p-value ≤0.05.
Opioids addiction is interplay of extrinsic and intrinsic
factors an individual is exposed to and may contribute
towards addictive risk phenotypes/behaviors. In current
study the contribution of key socio/demographic factors
towards heroin addiction vulnerability was explored. This
study found supporting evidence for a critical role of traits
like age, communal domain, low literacy level, employment
status and stress as predisposing risk factors of heroin
addiction in Pakistani cohort. In addition invasive heroin
administration route contributed towards higher risk of
health threatening blood borne disease/infections. Besides
a trend towards overdose is another key factor related to
heroin addiction. Among demographic risk factors of
heroin addiction, individuals starting addictive drugs at
an early age especially adolescence is considered amongst
heightened risk for substance use disorder (Schepis et al.,
2008). Though ethnic background of an individual has not
been generally considered among demographic factors
predisposing to drug addiction, our results tend to indicate
higher proportion of Punjabi ethnicity in our study cohort.
Although study subjects were sampled randomly but a
higher frequency of Punjabi group may be due to the reason
that samples were collected from regions heavily populated
with Punjabis. As for age, overall our results emphasize
that younger subjects (<20 years) are highly prone to
drugs of abuse as compared to the older age groups. A high
prevalence of marijuana, alcohol and tobacco encountered
among adolescents clearly highlights this age group is
highly susceptible to early onset of substance abuse. Our
results also support previous ndings that individuals
starting drug use in young age are also at increased risk of
substance dependence (Adriani et al., 2003; Swartzwelder
et al., 1998). However, the onset of heroin abuse was higher
in adult population (21-40 years age) group as compared
to the <20 years. The age specic varying trends of heroin
addiction could be attributed to multiple factors including
the type of drugs (tobacco, marijuana, alcohol, opium)
an individual rst attempted before transition to opioids.
Another important factor is easy access to addictive drugs
other than heroin and their availability. Furthermore, the
high price of heroin might be resulting in its use at later ages
rather than adolescence and variation in daily drug dose. It
is evident from literature that heroin overdose is one of the
major reasons of deaths among addicts (Darke and Duou,
2016; Darke and Hall, 2003; Rudd et al., 2016). About 65%
of heroin addicts use average daily drug dose between 150-
250 mg (Rehab-International, 2016). A smaller fraction
of our addicted population (12.4%) was at <250 mg daily
drug dose, 23% were within the range of 250mg-1000mg
while majority of the subjects (64.5%) were at multiple
daily doses >1000mg. The continued use of high drug
doses several times a day leads to the development of drug
tolerance leading to drug overdose (Kosten and George,
2002). A large proportion of our study subjects addicted to
higher heroin doses is an alarming situation as they could
be at high risk of drug overdose. It is indicated by literature
that heroin users have a high risk of death, especially death
due to overdose (Buster et al., 2002). However our results
do emphasize that potential interventions are needed to
reduce the rate of heroin overdose and related morbidity.
Moreover, the route of drug administration has been
reported to play role in drug over-dose like drugs taken via
injections pose higher risk which reduces substationally
when smoked (Darke et al., 2000). Though, it is important
to emphasize that death can, and does, result from smoking,
snorting, and swallowing heroin (Gossop et al., 1996;
Neaigus et al., 2001; Swift et al., 1999). In our study cohort
different gures regarding routes of heroin administration
exist; Smoking 60.2%, Injection 22.6%, Snifng 13.6%,
while 4.8% were using the combined routs of injection and
snifng. According to a report on Drug Use in Pakistan
(2013) 0.4% of heroin addicts in Pakistan use injections for
drug administration (UNODC, 2013). Data from current
study cohort reports 22.6% of the total study subjects
administrating heroin through injections. Moreover, addicts
tend to share needles while injecting drugs. These health
threatening practices are becoming a leading cause of
communicable diseases/infections especially HIV-AIDS,
Hepatitis, and Tuberculosis are highly prevalent among
drug users. Though majority of the subjects were un-aware
Heroin Addiction in Pakistan 97
of the diseases they were being exposed to infectious diseases
HIV, Hepatitis, Tuberculosis. In addition subjects in our
study cohort are also reported to acquire asthma, kidney and
skin related problems during heroin addiction development.
Among infectious diseases, Hepatitis C was highly prevalent
(16%) among our local addicts especially those using
needles with the company/fellows through whom they were
introduced to drug use. Besides a number of social factors
may also contribute either directly or indirectly contribute
towards the vulnerability of an individual towards drug
Among social factors, peer pressure, illiteracy/low
education, employment status/occupation and related stresses
are been generally found to inuence substance abuse. It
is worth to mention that our data supports social inuence
(communal domain) being the leading cause of heroin
abuse in our population. A local study has also emphasized
peer pressure being the major factor of drugs abuse among
youth (Aslam et al., 2011; Mubeen and Sharif, 2007). These
ndings also highlight strong inuence of company at work
place or educational institution an individual is exposed to
and drug use.
With regards to the role of employment status/
occupation, we found signicant association of occupation
type with drug addiction in our study population. Our
results are in accordance with a previous report focused
on drug addict youth in Pakistan whom were not attending
any school/educational institutes (Mehdi et al., 2014).
It was mentioned that social factors especially working
environment rich in drug users are contributing signicantly
towards an increase in the number of drug addicts among
non-student youth of Pakistan. Among occupations, driving,
hawkers, factory employees and carpenters are highly prone
to cigarette smoking/drug use. It is worth to mention that
the peer pressure, already exposed to addiction, might
have more inuence on individuals with immature mental
approach and varying psychological pressures. Another
general trend commonly observed among addicts in Pakistan
is an initial start from tobacco smoking with a gradual
switch towards opium, cocaine, heroin including other
addicted substances (Nizami et al., 2011; Smart et al., 1982).
However stress has been shown to overpower all other social
factors. According to data collected from respondents, our
analysis revealed that stress is a major external risk factor
for an individual indulging in drug abuse in our population.
The population and epidemiological studies have conrmed
stress as an eminent marker increasing vulnerability towards
drug addiction and a major cause for higher relapse rate in
individuals previously treated for drug abuse (Sinha, 2008).
This is the rst study from Pakistan exploring
association of social and demographic factors increasing
vulnerability towards heroin addiction. It provides the
evidence that age, communal domain, employment type,
low literacy level, stress are signicant external contributing
risk factors for heroin addiction in our study cohort.
However drug administration routes and trend towards
higher drug dose contributed towards increased health risks
among addicts. Being complex and multifactorial disorder,
heroin addicts require multi-level intervention strategies to
address the biological, social and psychological elements of
the disorder. In order to effectively prevent and treat heroin
addiction cases understanding of the basic mechanisms
including comprehensive study of sociodemographic factors
contributing for its vulnerability is further required in
Pakistani population. Although our ndings are somewhat
similar to those previously reported in other populations,
we attempted to evaluate the factors that may help to design
better strategies for the prevention, control, and treatment
of illicit heroin use in Pakistani populations. In addition the
high risk addiction associated sociodemographic factors
identied in presented study could be highlighted to create
awareness at individual, family, peer, and government levels.
We are thankful to Higher Education Commission
Pakistan for funds for this study under 5000 Indigenous
Scholarship Scheme. We are also thankful to all the drug
rehabilitation centers and hospitals enrolled and assessed
subjects for this study.
Conict of interest statement
We declare that we have no conict of interest.
Adriani, W., Spijker, S., Deroche-Gamonet, V., Laviola,
G., Le Moal, M., Smit, A.B. and Piazza, P.V., 2003.
Evidence for enhanced neurobehavioral vulnerability
to nicotine during periadolescence in rats. J.
Neurosci., 23: 4712-4716.
Aslam, N., Kamal, A. and Ahmed, I., 2011. Demographic
prole and etiological factors of starting drugs among
patients with drug addiction. J. Coll. Phys. Surg.
Pak., 21: 125-126.
Aslam, N., 2015. Horrendous situation of substance abuse
in Pakistan: A bird’s eye view on socio-demographics.
J. Alcohol Drug Depend., 3: 201. http://dx.doi.
Buster, M.C., van Brussel, G.H. and van den Brink, W.,
2002. An increase in overdose mortality during the
rst 2 weeks after entering or reentering methadone
treatment in Amsterdam. Addiction, 97: 993-1001.
Darke, S., Ross, J., Zador, D. and Sunjic, S., 2000. Heroin-
related deaths in New South Wales, Australia, 1992–
1996. Drug Alcohol Depend., 60: 141-150. http://
Darke, S. and Hall, W., 2003. Heroin overdose: research
and evidence-based intervention. J. Urban Hlth., 80:
S. Jabeen et al.
Darke, S. and Duou, J., 2016. The toxicology of heroin
related death: estimating survival times. Addiction,
Fischer, B., Rehm, J., Patra, J. and Cruz, M.F., 2006a.
Changes in illicit opioid use across Canada. Can.
med. Assoc. J., 175: 1385-1385. http://dx.doi.
Fischer, B., Rehm, J., Patra, J. and Cruz, M.F., 2006b.
Illicit opioid use and its key characteristics: a select
overview and evidence from a Canadian multisite
cohort of illicit opioid users (OPICAN). Can.
J. Psychiat., 51: 624-634.
Fornasari, D., 2012. Pain mechanisms in patients with
chronic pain. Clin. Drug Investig., 32: 45-52. http://
Gossop, M., Grifths, P., Powis, B., Williamson, S. and
Strang, J., 1996. Frequency of non-fatal heroin
overdose: survey of heroin users recruited in non-
clinical settings. Br. med. J., 313: 402. http://dx.doi.
Kilpatrick, D.G., Acierno, R., Saunders, B., Resnick,
H.S., Best, C.L. and Schnurr, P.P., 2000. Risk factors
for adolescent substance abuse and dependence: data
from a national sample. J. Consult. clin. Psychol., 68:
Koob, G.F. and Le Moal, M., 1997. Drug abuse: hedonic
homeostatic dysregulation. Science, 278: 52-58.
Kosten, T.R. and George, T.P., 2002. The neurobiology of
opioid dependence: Implications for treatment. Sci.
Pract. Perspect., 1: 13-20.
Krantz, M.J. and Mehler, P.S., 2004. Treating opioid
dependence: growing implications for primary
care. Arch. Int. Med., 164: 277-288. http://dx.doi.
Kreek, M.J., Levran, O., Reed, B., Schlussman, S.D.,
Zhou, Y. and Butelman, E.R., 2012. Opiate addiction
and cocaine addiction: underlying molecular
neurobiology and genetics. J. clin. Invest., 122: 3387-
Malik, A. and Sarfaraz, S.F., 2011. Origin and development
of drug addiction in South Asia with special reference
to Pakistan. Pak. J. Commer. Soc. Sci., 5: 155-165.
Mehdi, S., Mehdi, S., Adil, A., Amin, M.H., Raza, M.J.,
Basharat, M., Maqbool, Q. and Virk, M.A., 2014.
Leading cause of addiction among teenagers of
Pakistan and the role of security forces regarding
their rehabilitation. J. Pharm. Alter. Med., 3: 1-5.
Mubeen, C. and Sharif, M., 2007. Drug addition among
females in district Lahore (Pakistan). J. Agric. Soc.
Sci., 3: 101-103.
Neaigus, A., Miller, M., Friedman, S.R., Hagen, D.L.,
Sifaneck, S.J., Ildefonso, G. and des Jarlais, D.C.,
2001. Potential risk factors for the transition to
injecting among noninjecting heroin users: A
comparison of former injectors and never injectors.
Addiction, 96: 847-860.
NIDA, 2014. Drugs, brains and behavior: The science
of addiction. Available at: https://www.drugabuse.
addiction/preface. (accessed 30 June, 2016).
Nizami, S., Sobani, Z.A., Raza, E., Baloch, N. and Khan,
J., 2011. Causes of smoking in Pakistan: An analysis
of social factors. J. Pak. med. Assoc., 61: 198.
Rehab-International, 2016. Get the facts 2016. Available
getthefacts/ (accessed 30 May, 2016).
Ronel, N. and Levy-Cahana, M., 2011. Growing-up
with a substance-dependent parent: development
of subjective risk and protective factors. Subst.
Use Misuse, 46: 608-619.
Rudd, R.A., Aleshire, N., Zibbell, J.E. and Matthew
Gladden, R., 2016. Increases in drug and opioid
overdose deaths—United States, 2000–2014.
Am. J. Transplant., 16: 1323-1327. http://dx.doi.
Schepis, T.S., Adinoff, B. and Rao, U., 2008.
Neurobiological processes in adolescent addictive
disorders. Am. J. Addict., 17: 6-23. http://dx.doi.
Sinha, R., 2008. Chronic stress, drug use, and vulnerability
to addiction. Annls. N. Y. Acad. Sci., 1141: 105-130.
Smart, R.G., Arif, A., Hughes, P., Navaratnam, V., Varma,
V. and Wadud, K., 1982. Drug use among non-student
youth. WHO Offset Publication No. 60. pp. 58.
Swartzwelder, H.S., Richardson, R.C., Markwiese-Foerch,
B., Wilson, W. and Little, P.J., 1998. Developmental
differences in the acquisition of tolerance to ethanol.
Alcohol, 15: 311-314.
Swift, W., Maher, L. and Sunjic, S., 1999. Transitions
between routes of heroin administration: a study of
Caucasian and Indochinese heroin users in south
western Sydney, Australia. Addiction, 94: 71-82. http://
Tsuang, M.T., Lyons, M.J., Harley, R.M., Xian, H., Eisen,
S., Goldberg, J., True, W.R. and Faraone, S.V., 1999.
Genetic and environmental inuences on transitions
in drug use. Behav. Genet., 29: 473-479. http://dx.doi.
UNODC, 2013. Drug use in Paskistan. Available at: (accessed 12 Jan, 2015).
Weinberg, N.Z., 2001. Risk factors for adolescent
substance abuse. J. Learn. Disabil., 34: 343-351.
Zapata, J.T., Katims, D.S. and Yin, Z., 1998. A two-year
study of patterns and predictors of substance use
among Mexican American youth. Adolescence, 33:
Heroin Addiction in Pakistan 99
... These findings are consistent with the results of Panebianco et al. (2016) who pointed that the majority of drug-addict people were polydrug addicts. On the contrary, Jabeen et al. (2017) demonstrated that more than 50% of substance-use disorder patients were monosubstance users. ...
... Although a number of risk factors might predispose one to addiction, however there are protective factors that can help to reduce the risk (Volkow, 2010). The prevalence of opioids and other illicit drugs are common in Pakistan., people are frequently exposed to opioids and other illicit drugs, such as heroin and opium, and though the effect and severity of the problems related to trafficking and misuse vary among the population (Heikkilä et al., 2021;Jabeen et al., 2017). Heroin is a major source of addiction in men and young boys, which subsequently results in both personal and public health burdens. ...
Objective The current study was conducted to determine the sociodemographic characteristics, such as age, gender, socioeconomic status, race, and education, that may predispose and increase the likelihood of individuals becoming addicted. Methods This retrospective study was conducted in February 2021 at the Institute of Rehabilitation and Drug Addiction Center (IRADA), Islamabad-Pakistan, to which individuals aged 17 years and above were referred for treatment. A total of 566 patient records from January 2019 to December 2020 were studied retrospectively. These records showed that individuals were admitted to the center for treatment of addiction. Result A total of 566 patients with substance user records were studied. Patients age range was 17–50 years. Results showed that majority of the patients initiated drug use at the age of adolescent and young adult. Further substance users had low level of education, approximately 86.1% of participants were below secondary school education whereas 69.9% patients were at secondary school level of education. Moreover, the results showed that cannabis was most used drug 29.2% followed by cigarette 26.1%. Peer pressure, fun, enjoyment and family dispute were the major reasons to start substance use. Conclusion The different socio-demographic characteristics were significantly positive associated with different opioid addiction.
... 14 Another study found that certain psychosocial factors like peer pressure, illiteracy/low education, employment status/occupation and related stresses influence substance abuse. 15 This is comparable to our study which documents severe opioid dependence was high and related with the middle income class and matric passed literate users. This finding suggests a significant role of income and education in precipitating severe opioid dependence. ...
Full-text available
Objectives: To determine the relationship between severe opioid dependence and psychosocial factors of users Study Design: Descriptive Cross Sectional study. Setting: Department of Psychiatry Nishtar Hospital Multan. Period: Nov 2018 to May 2020. Material & Methods: 196 participants were enrolled through non probability purposive sampling technique. Pearson chi square test was applied to identify significant relationship between severe opioid dependence and psychosocial factors. Result: Mean age of study cases was 30.86 ± 1.66. The frequency of severe opioid dependence was noted in 159 (81.1%) of study participants. Statistical significant relation of severe opioid dependence was noted with age, literacy status, literacy level, marital status, monthly income, route of opioid use, frequency of opioid use per day, previous detoxification treatment and encounters with law enforcement agencies Conclusion: The severity of opioid dependence was high in patients admitted for treatment of opioid use. Severe opioid dependence was related with certain psychosocial factors such as user’s age, literacy status, literacy level, marital status, monthly income, route of opiod use, frequency of opioid use, previous detoxification treatment for opioid use and encounters with law enforcement agencies. This suggests that optimal treatment of severe opioid dependence should include interventions based on individual’s psychosocial needs.
... Different internal and external environmental factors including an addict's mindset, social influences like home environment, peer pressure and response to stress and stressors may also contribute to opiate addiction vulnerability. Multiple external/environmental factors with varying degree of contribution at individual level results in increased risk of opioid dependence development [6]. Psychoactive drugs affect the central nervous system and act by altering a person's feelings, thoughts and behavior. ...
... These results are consistent with the findings of Panebiance et al. who revealed that the majority of drug addict people were polydrug addicts [25]. On the opposite side, Jabeen et al. found that more than half of drug addict people were single drug users [26]. ...
Full-text available
Background Several evidences from epidemiologic and treatment studies indicate that anxiety disorders, depression, and substance use disorders commonly co-occur, and the interaction is multifaceted and variable. Epidemiological studies and investigations within clinical substance abuse populations have found an association between anxiety disorders, depression, and substance use disorders . Results The mean age was 28.1 ± 6.5 years. The majority belonged to the moderate socioeconomic status (52%). Substance use disorder (SUD) patients expressed higher levels of anxiety and depression in comparison to the control group. Most of the study group (97%) expressed different levels of anxiety. Eighty percent of them expressed high and moderate anxiety levels, and 20% of caregivers were having mild anxiety levels. Ninety-three percent of the substance users expressed different levels of depression, either mild 12%, moderate 9%, or severe 72%. The Drug Use Disorder Identification Test scores were positively correlated with anxiety ( r = 0.256 and p = 0.010) and depression ( r = 0.330 and p = 0.001). Moreover, it was found that anxiety and depression are positively correlated with each other’s ( r = 0.630 and p = 0.001). Conclusion Substance use disorders are associated with high levels of anxiety and depression. More specifically, it is associated with severe depression and anxiety. There is an obvious association between the presence of anxiety and depression on the one hand and the severity of drug-related problems on the other hand. Depression and anxiety are commonly present together in patients with SUDs.
This article attempts to provide an insight into the experiences of drug addicts at a rehabilitation center, run by the provincial Social Welfare Department in Lahore, Pakistan, through a qualitative approach. The menace of drugs is increasing worldwide, including Pakistan. Effective treatment and rehabilitative services can lower the prevalence rate of drug addiction. The aim of this research was to understand/explore the experiences of research participants about the phenomenon of drug addiction and rehabilitation services provided in the field of social welfare. This research extends the current knowledge of individuals’ drug addiction by revealing the complexities and intricacies of this behavior.
Full-text available
The present research aimed to study self-reflection, self-importance of moral identity, self-forgiveness, and personal growth initiative as the psychological determinants of relapse prevention among the drug addicts. Study instruments include Self-Reflection and Insight. The whole study is divided into two phases. Phase I underlies translation and validation of the research instrument into Urdu language; such that, translated versions possess significant reliability and possess good construct validity. Phase II studies the relationship between self-reflection, self-importance of moral identity, self-forgiveness, personal growth initiative, and relapse prevention among 240 drug addicts (M = 29.3, SD = 8.2). Sample was approached at different rehabilitation centers of Islamabad and Rawalpindi. Results indicated that all translated instruments are valid for the sample. All the study variables are found to explain about 14% variance (R 2 = .14) in warning of relapse such that personal growth initiative is the most significant predictor. The values of total, direct, and indirect effects demonstrate existence of mediation; such that, self-importance of moral identity, self-forgiveness, and personal growth initiative act as serial mediators in order as mentioned for the relationship of self-reflection and warning of relapse.
Full-text available
Background: Substance abuse is one of the most challenging public health problem. Recent trends indicated that it has increased dramatically in developing countries. The present study explored the factors associated with substance dependence among male drug addicts in rehabilitation centres of Pakistan. Methods: This cross-sectional, multi-centred, comparative study was conducted in 2014 at 12 rehabilitation centres in four major cities of Pakistan. A total of 460 patients seeking treatment for substance dependence were included. A questionnaire was used after taking verbal informed consent. The study was approved by the institutional ethical committee. Data entered and analysed by SPSS version 20. Socio-demographic variables were presented in frequencies and percentages. Results: The majority 344(74.8%) of drug abusers in the present study were between 21 to 30 years of age and the frequency of literate and non-skilled was 321(69.8%) and 288(62.6%) respectively. Parents of most of drug addicts were illiterate (father 56.3 %; mother 85%). Heroine was most commonly used drug (38.8%) followed by cannabis (11.5%), opium (7%) and alcohol (3.9%). Drugs were taken by smoking (40.4%) while sniffing (17.6%), eating (4.8%) and injection (4.3%) were other routes used. Sixty-one percent started using drugs between 20-30 years of age. Addicted close friends were found in 87.8% cases. Conclusion: Substance abuse was observed in all demographic strata and segments in Pakistani population. A significant association of heroin addiction was found with age ≤ 19 years, and duration of its use.
Full-text available
What is already known on this topic? The rate for drug overdose deaths has increased approximately 140% since 2000, driven largely by opioid overdose deaths. After increasing since the 1990s, deaths involving the most commonly prescribed opioid pain relievers (i.e., natural and semisynthetic opioids) declined slightly in 2012 and remained steady in 2013, showing some signs of progress. Heroin overdose deaths have been sharply increasing since 2010. What is added by this report? Drug overdose deaths increased significantly from 2013 to 2014. Increases in opioid overdose deaths were the main factor in the increase in drug overdose deaths. The death rate from the most commonly prescribed opioid pain relievers (natural and semisynthetic opioids) increased 9%, the death rate from heroin increased 26%, and the death rate from synthetic opioids, a category that includes illicitly manufactured fentanyl and synthetic opioid pain relievers other than methadone, increased 80%. Nearly every aspect of the opioid overdose death epidemic worsened in 2014. What are the implications for public health practice? Efforts to encourage safer prescribing of opioid pain relievers should be strengthened. Other key prevention strategies include expanding availability and access to naloxone (an antidote for all opioid-related overdoses), increasing access to medication-assisted treatment in combination with behavioral therapies, and increasing access to syringe service programs to prevent the spread of hepatitis C virus infection and human immunodeficiency virus infections. Public health agencies, medical examiners and coroners, and law enforcement agencies can work collaboratively to improve detection of and response to outbreaks associated with drug overdoses related to illicit opioids. © 2016, Department of Health and Human Services. All rights reserved.
Full-text available
A national household probability sample of 4,023 adolescents aged 12 to 17 years was interviewed by telephone about substance use, victimization experiences, familial substance use, and posttraumatic reactions to identify risk factors for Diagnostic and Statistical Manual of Mental Disorders- (4th ed.; American Psychiatric Association, 1994) defined substance abuse/dependence. Age and ethnicity data were available for 3,907 participants. Major findings were (a) adolescents who had been physically assaulted, who had been sexually assaulted, who had witnessed violence, or who had family members with alcohol or drug use problems had increased risk for current substance abuse/dependence; (b) posttraumatic stress disorder independently increased risk of marijuana and hard drug abuse/dependence; and (c) when effects of other variables were controlled, African Americans, but not Hispanics or Native Americans, were at approximately 1/3 the risk of substance abuse/dependence as Caucasians. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Full-text available
Addictive diseases, including addiction to heroin, prescription opioids, or cocaine, pose massive personal and public health costs. Addictions are chronic relapsing diseases of the brain caused by drug-induced direct effects and persisting neuroadaptations at the epigenetic, mRNA, neuropeptide, neurotransmitter, or protein levels. These neuroadaptations, which can be specific to drug type, and their resultant behaviors are modified by various internal and external environmental factors, including stress responsivity, addict mindset, and social setting. Specific gene variants, including variants encoding pharmacological target proteins or genes mediating neuroadaptations, also modify vulnerability at particular stages of addiction. Greater understanding of these interacting factors through laboratory-based and translational studies have the potential to optimize early interventions for the therapy of chronic addictive diseases and to reduce the burden of relapse. Here, we review the molecular neurobiology and genetics of opiate addiction, including heroin and prescription opioids, and cocaine addiction.
Background and aims: The feasibility of intervention in heroin overdose is of clinical importance. The presence of 6-monoacetyl morphine (6MAM) in the blood is suggestive of survival times less than 20-30 minutes following heroin administration. The study aimed to determine the proportions of cases in which 6MAM was present, and compare concentrations of secondary metabolites and circumstances of death by 6MAM status. Design: Analysis of cases of heroin-related death presenting to the Department of Forensic Medicine Sydney, 1/1/2013-12/12/2014. Setting: Sydney, Australia CASES: 145 cases. The mean age was 40.5 yrs and 81% were male. Measurements: Concentrations of 6MAM, free morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G). Circumstances of death included bronchopneumonia, apparent sudden collapse, location and other CNS depressants. Findings: 6MAM was detected in 43% (CI 35-51%) of cases. The median free morphine concentration of 6MAM positive cases was more than twice that of cases without 6MAM (0.26 v 0.12 mg/L). 6MAM positive cases also had lower concentrations of the other major heroin metabolites: M3G (0.05 v 0.29 mg/L), M6G (0.02 v 0.05 mg/L) with correspondingly lower M3G/morphine (0.54 v 2.71) and M6G/morphine (0.05 v 0.50) ratios. Significant independent correlates of 6MAM were a higher free morphine concentration (OR 1.7), a lower M6G/free morphine ratio (OR 0.5) and signs of apparent collapse (OR 6.7). Conclusions: In heroin-related deaths in Sydney, Australia during 2013 and 2014, 6- monoacetyl morphine (6MAM) was present in the blood in under half of cases, suggesting that a minority of cases had survival times after overdose of under 20-30 minutes. The toxicology of heroin metabolites and the circumstances of death were consistent with 6MAM as a proxy for a more rapid death.
Understanding the neurobiological mechanisms of addiction requires an integration of basic neuroscience with social psychology, experimental psychology, and psychiatry. Addiction is presented as a cycle of spiralling dysregulation of brain reward systems that progressively increases, resulting in compulsive drug use and a loss of control over drug-taking. Sensitization and counteradaptation are hypothesized to contribute to this hedonic homeostatic dysregulation, and the neurobiological mechanisms involved, such as the mesolimbic dopamine system, opioid peptidergic systems, and brain and hormonal stress systems, are beginning to be characterized. This framework provides a realistic approach to identifying the neurobiological factors that produce vulnerability to addiction and to relapse in individuals with a history of addiction.
Reviews research on risk factors for adolescent substance use disorders (SUD) and discusses possible relationships between SUDs and learning disabilities (LD). Individual level factors (genetic, biologic, other familial, and psychiatric) emerge as very important in the risk equation, as well as the interaction between individual risk and environmental conditions. Commonalities between SUD risk and LD include prenatal substance exposure, family history of SUD, conduct disorder, social skills deficits, and academic failure; however, further research is needed to establish whether individuals with LD face a specific risk for SUDs, and if so, what the nature of that risk might be.
The use of legal and illegal drugs has a long history in Pakistan. This study was conducted to explore the socio- economic and cultural aspects of female addicts in Lahore. A random sample of 50 females aged 25 - 35 years was taken. A comprehensive questionnaire consisting of open and closed-ended questions was prepared. Pre-testing of the study was carried out with ten respondents to examine the workability and suitability of measuring instruments. Descriptive and inferential statistics were used to analyze the data for drawing conclusion. It was concluded that socio- economic characteristics in term of women's education, family income and demographic factors have bearing upon the drug addiction. People should be made aware of its merits and demerits. If they do so, drug using percentage can be substantially decreased.
Aim. To examine patterns and correlates of routes of heroin use among Caucasian and Indochinese heroin users. Design. A cross-sectional survey. Setting and participants. Two hundred heroin users resident in South West Sydney. The sample was divided between Caucasian and Indochinese users (each n="100)," with half of each group on methadone maintenance. Measurements. A semi-structured interview was administered, based on previous studies of transitions between routes of administration. Measures included patterns of drug use, transitions, social, health and legal issues and cultural correlates of use. Findings. Almost two-thirds (61%) had smoked heroin. Smoking was more common among the Indochinese (40% were predominantly or exclusively smokers), although injecting was the dominant route for both groups. More than one-quarter (29%) had made a transition from smoking to injecting, primarily due to drug effect and perceived cost-effectiveness. Reverse transitions were rare. Smoking appeared to be more culturally acceptable than injecting among Indochinese users. Among both groups, there was a small but significant risk for the transmission of HIV and other blood-borne viruses. Polydrug use and age were positively associated with having experienced a non-fatal overdose. Conclusions. This research documents the existence of smoking as a popular route of administration among both Indochinese and Caucasian heroin users in the study sample. There is an urgent need to provide smokers and injectors with information explaining the potential risks and ways to minimize harms associated with both routes of use.