Factors Affecting Tendency for Drug Abuse in People Attending Addiction Treatment Centres: A Quantitative Content Analysis

Background and Objectives: Addiction is an unpleasant social phenomenon that has destructive consequences for the addicted individual himself, his family and the entire community. Studies show the increasing prevalence of drug addiction in Iran. The present study was conducted to identify the factors affecting the tendency for drug abuse. Materials and Methods: The present quantitative content analysis was conducted on 32 patients presenting to an addiction treatment centre in Shahin Shahr, Iran, in 2014. The study participants were selected through purposive sampling and data were collected through interviews. The interview content was transcribed and analysed using quantitative methods. Results: The collected data are presented in four main categories, including (1) environmental factors (friendly gatherings and socializing with drug users), (2) family factors (the presence of a drug user in the family, loneliness and separation from the family and family problems and disputes), (3) personal factors (attracting the opposite sex, wealth, being an athlete, curiosity and a source of energy, the ignorance and arrogance of youth and illness), and (4) social factors (having a hard job, unemployment, the lack of access to recreational facilities and an easy access to drugs), in the order of frequency. Conclusion: The most frequent factors affecting the tendency for drug abuse included environmental and family factors. Reducing the tendency for drug abuse in Iran thus requires preventive measures to be taken in the community through the implementation of education programs in families, schools and universities.


Introduction
Drug addiction is a major problem in the modern society that destroys millions of lives and wastes national resources for the fight against addiction and the treatment of its subsequent harms [1]. Drug addiction is associated with great biological, psychological and social problems and harms to the society and undermines its safety [2].
The global problem of addiction and drug abuse is responsible for 5 million deaths and about 42 million new cases of HIV every year [3]. Iran is also afflicted with a pervasive problem of drug abuse [4]. The State Welfare Organization Deputy of Prevention reported the annual growth rate of drug addiction in Iran as 8%, while the population growth rate is 2.6% [5]. There are about 1,200,000 addicts and 800,000 recreational drug users in Iran [6]. Drug abuse is followed by loss of life and property, social and economic costs, death, suicide, heavy offenses, unsuccessful marriages and the risk of sexually transmitted diseases such as HIV and hepatitis [7]. As suggested by the findings of extensive population-based studies on drug users, the relatively high prevalence of drug use and the changes in the trend of drug use (toward the use of impure drugs) increase the mortalities caused by drug use [8].
Addiction treatment centres tend to use brief interventions for relieving the patients of their addiction; for instance, training programs for anger management, motivational programs for reducing drug use and drug dependence, cognitive behavioural therapy and programs for preventing relapse into addiction [9].
Studies show that a variety of factors affect drug use, including social factors (such as the influence of friends, acquaintances or family members, the influence of the media and advertisements for drug use and cigarette smoking and a poor resistance to peer pressure) and interpersonal factors (such as low self-esteem, high anxiety, frustration, low self-control and sensation-seeking) [10]. The social and cultural factors contributing to the tendency for drug use include the sociocultural domain (including the availability of drugs and the nonscientific advertisement of beauty products and athletic supplements), the family domain (the presence of a drug addict in the family, the parent-adolescent relationship and parental control variables), the domain of peers and friends, the adolescent's personal characteristics, emotional functioning and social attachment [11]. In a study

Journal of Addiction Research & Therapy
conducted on drug addicts, the most frequent causes of the tendency for drug use included, in the order of frequency, having addicted friends, unemployment, lack of respect for religion, economic problems, marital conflicts, poor access to recreational facilities, the availability of drugs and not having the power of saying 'no' to others [12].
Despite the studies conducted on the causes of the tendency for drug use, some of the factors contributing to this phenomenon remain to be identified through further studies. Given that they vary from one society to another and are influenced by the specific cultural, social and structural features of the societies concerned, the present study was conducted to investigate the factors affecting the tendency for drug abuse in patients presenting to an addiction treatment centre in Shahin Shahr, Iran.

Materials and Method
The present quantitative content analysis was conducted on 32 addicts presenting to Pars Addiction Treatment Centre in Shahin Shahr from March to May 2014. Participants were selected through purposive sampling and consisted of 29 men and three women. Data were collected through face-to-face interviews, each lasting about 15 to 20 minutes. The interview content was then transcribed and reviewed several times by participants to ensure their accuracy. Participants' statements about the factors contributing to their addiction were transcribed verbatim. Parts of the transcribed text that pertained to the factors affecting the tendency for drug use were then extracted and integrated into a single text that formed the unit of analysis. Each interview text was then reviewed as one unit of analysis and meaning units were extracted from them and summarized. The summarized meaning units were coded and the codes were then compared with each other based on their differences and similarities, yielding a total of four categories and 15 subcategories. The findings of the study were reported based on the frequency of the extracted codes and the categories developed.

Findings
The mean age of the participants was 37. The majority of them reported that they had begun drug use at the age of 20 to 24. In terms of the degree of education, 9% of participants had an associate's degree, 56.2% had a high school diploma and 34.3% had below high school education. In terms of occupation, 71.8% were self-employed, 6.2% held jobs in the public sector, 3.1% were unemployed, 12.5% were retired and 9.3% were housewives. Opium was the most commonly abused drug among the participants.

Category (Frequency)
On Thursday nights, we'd gather with my friends; I first took a puff upon their offer. During the first few months it was just for fun, but it gradually became a habit.
Friendly gatherings [20] Environmental factors [22] I socialized with drug users who kept asking me to join them, and I so began using drugs.
Socializing with drug users [6] At age 18, I saw my father and uncle using drugs, and my father's drug use created a friendly atmosphere at home, which I liked very much. So I wondered what substance could cause such friendliness, and I stole some drugs and began using with my friends.
The presence of a drug user in the family [5] Family factors [20] As a college student away from the family, I began using drugs at friendly gatherings.
Loneliness and separation from the family (3) At age 18, I had a lot of family problems, and my aggressive father would get very violent, so I began using drugs to relax as a suggestion made by my drugusing cousin.
Family problems and disputes [10] Since I was always in relationships with women, I began using drugs to attract them and increase my energy and eloquence.
Attracting the opposite sex [10] Personal factors [14] At age 20, since I had access to loads of money and socialized with rich people who were drug users, I began using drugs too.
Wealth [1] People suggested I use drugs to win this particular game, and so I did, for the first time, and then I won, and so I kept using drugs.
Being an athlete [1] Since everybody around me was a drug user, I began using drugs out of curiosity too, and then kept going for the energy and excitement that they offered.
Curiosity and a source of energy (5) The bad influence of friends and the arrogance of youth provoked my drug use.
Ignorance and arrogance of youth [2] I used to take strong painkillers for my back pain, then my husband -himself a drug usergave me drugs instead.
Illness [4] Getting tired with my job and napping at work, my friends suggested I use drugs to avoid sleepiness. It worked, so I continued using drugs.
Having a hard job [4] Social factors [7] Being unemployed, a relative of mine suggested I use drugs and so I did.
Unemployment [1] Being under psychological pressure and with the poor access to recreational facilities in my country, I began using drugs.
Lack of access to recreational facilities [1] My military service was spent in Sistan and Baluchestan Province, and with the abundance of drugs there, I began using to be more lively, euphoric and happy.
An easy access to drugs [1] Four main themes were extracted through the analysis of the data, including (1) family factors (the presence of a drug user in the family, loneliness and separation from the family and family problems and disputes); (2) social factors (having a hard job, unemployment, the lack of access to recreational facilities and the easy access to drugs); (3) environmental factors (friendly gatherings and socializing with drug users); and (4) personal factors (attracting the opposite sex, wealth, being an athlete, the ignorance and arrogance of youth, illness, curiosity and a source of energy) ( Table 1).
The findings of the study showed that environmental factors had the greatest effect on the tendency for drug use (38%), followed by family factors (28.5%), personal factors (22.2%) and social factors (11.1%). Environmental factors, including socializing with drug users and choosing bad company, have a strong role in the tendency for drug use. The participants also proposed family problems and the presence of a drug user in the family (the father, brother, etc.) as important causes of turning to drugs. According to a number of participants, other reasons of drug use included personal factors and personal characteristics such as greed, emotional deficiencies and low self-confidence. Some others referred to social factors as the main causes of their turning to drugs, including having a hard job, the lack of access to recreational facilities, unemployment and an easy access to drugs. Of all the factors proposed by participants, friendly gatherings were reported as the most influential one with a frequency of 18.

Discussion
Examining the factors affecting the tendency for drug abuse in patients presenting to an addiction treatment centre showed the crucial role of friends and acquaintances, the family and the individual himself, as the most frequent causes of the tendency for drug use included the influence of friends and acquaintances, family problems, personal characteristics and social factors. A study conducted by Shamsi Meymandi et al. also suggests that interaction with peers is one of the main factors contributing to the tendency for drug use among students [13]. As seen in the results obtained in the present study, the age at which drug use begins ranges from 20 to 24, indicating the important role of the family and educational institutions in determining the tendency for drug use. Some measures can help avoid addiction among the youth, including the parents having proper plans for their children's recreational activities and their training of the children on how to choose good company and friends, and plans implemented in schools, universities or military bases for teaching life skills to young men and women that intend to increase their selfconfidence and self-esteem.
The results of the present study showed that pursuing harmful activities with friends and socializing with drug users have a significant relationship with the tendency for drug use. The results of a study by Hajariyan et al. showed that 85% of addicts blame their friends and acquaintances for their addiction, 60% believe recreational drug use to lead to addiction and 75% believe their problems in life to have caused their drug use, which is consistent with the results obtained in the present study [14]. It is worth noting that strengthening the spiritual dimensions of life and benefiting from religious teachings play an important role in reducing drug abuse. Parents and school authorities should pay particular attention to the psychological needs of the youth. If students of both genders are formally trained on the prevention of addiction and the harms it causes before entering high school, their tendency for drug use decreases. The present study revealed that the presence of a drug user in the family is an important factor contributing to the tendency for drug use, which is consistent with the results obtained by Moulavi and Bagheiyani moughadam [15,16]. The present study also found that family problems and emotional deficiencies within the family can lead to the tendency for drug use, which is consistent with the results obtained by Ramezani et al. [17]. Strengthening the family foundation and nurturing the children with adequate love and affection prevents the youth from falling into the trap of unhealthy environments; parents are therefore recommended to spend more quality time with their children.
The results also suggest that unemployment and separation from the family are related significantly to the tendency for drugs. Ahmadi et al. also reported unemployment and separation from the family as the most frequent reasons for the tendency for drug abuse [4]. Another study showed that nearly 60% of the cases of addiction begin with a friend's offering. For students who spend most of their time in school dormitories in the company of their friends, peer pressure is at its highest rate; these findings are consistent with the results obtained in the present study [7].
The results of the present study also showed that illness and physical pain relief are related significantly to the tendency for drug use, which is consistent with the results obtained by Moudaberniya et al. [18]. Physicians are therefore recommended to advise their patients not to use drugs for pain relief and recovery from diseases. The results also showed a significant relationship between having a hard job and a heavy workload and the tendency for drugs. However, studies conducted by Bagheiyani moughadam and Kamran did not emphasize this variable as much [16,19].
Evidence suggests that the anxious attachment style constitutes a risk factor for addiction and requires psychopathological assessment to be overcome [20]. According to one study, the relationship between the genetic background and the clinical behavior is a risk factor for drug abuse and addiction, as Trescot et al. showed that genetics and the tendency for drugs are significantly related to each other, and that genetic testing can predict the tendency for drug use [21].
In recent years, drug use has increased dramatically in patients with chronic pain, and the risk of drug abuse and addiction in patients on long-term treatment is cause for concern [22]. Bears et al. found that religious activities, high levels of support and good parent-child relationships protect against the tendency for drug use in both American and Australian students [23].
One limitation of the present study was its failure to record the interviews due to the lack of cooperation on the part of the participants. The factors and preventive measures proposed in this study are recommended to be further investigated.

Conclusion
The most frequent factors contributing to the tendency for drug abuse among the population of addicts in Shahin Shahr were environmental and family related, and personal and social factors were less frequent though still significant factors. To prevent the tendency for drug abuse in Iran, the researchers recommend that preventive measures be taken for drug addiction in the community and among families through greater training within the family, school and university and in public environments where the target population is most easily accessible, such as military bases and dormitories.