علی فرهودیان

The industrialization and alteration of human life structure have led to some serious harms including substance use disorder. Over the past years, various treatment programs have been introduced for the treatment of addiction. The third wave of psychotherapy called Acceptance and Mindfulness based Therapies, came up with the hypothesis that mental harm is associated with trying to control or avoid negative thoughts and emotions. One of the ways to treat problems associated with substance use disorder like impulsivity is Acceptance and Commitment Therapy (ACT). In this regard the study aims to decrease impulsivity in patients with Methamphetamine use disorder by using Acceptance and Commitment Therapy.

The study is a quasi-experimental study with a pretest-posttest-follow-up-control group design.  The study population included all men with Methamphetamine use disorder in2019 currently avoiding any substance use, and all of them were attending narcotics anonymous association sessions in Yazd.  The sampling method was purposeful sampling and the sample size was determined according to the similar studies and also considered to be appropriate for group therapy sessions, ie, 8 to 12 sessions. Thus, among those who scored higher than the cut-point according to Bart's Impulsivity Questionnaire (1994), 12 were randomly assigned to the experimental group and 12 randomly assigned to the control group. Demographic characteristics questionnaire and Barratt Impulsivity Scale (1994) were used to collect data. Inclusion criteria were: 1) Good verbal communication ability 2) Minimum literacy (people able to understand and answer the questionnaire items) 3) Complete abstinence and non-consumption of methamphetamine during at least 6 months before the study. 4) Having passed 6 months after the end of treatment. 5) Being between the ages of 18 and 60 years. 6) Having no mental and physical disabilities (so as not to impede research and evaluation). Exclusion criteria included recurrence and substance use at the time of the study, and addicts with AIDS and Hepatitis C. Descriptive and inferential statistical methods including covariance analysis were used to analyze the data.

The results showed that the value of the parameter (F) belonging to the pre-test variable was 4.9 and it was significant. Therefore, there was a significant difference between the mean scores of impulsivity of the control and experimental groups in the post-test after the pre-test effect was gone  in patients with treated methamphetamine use disorder. The results also showed that the F value of the variable was statistically significant in the post-test. Further, the Wilk’s lambda value was 0.029 with a significance level of 0.000, this means that time has a significant statistical effect. This statistic indicates a difference and change in the impulsivity values of patients with methamphetamine use disorder in patients within the third, sixth and eighth sessions. Also, based on the results, each pair of time periods is compared with each other and indicates that all values ​​with a significant level of less than 0.05 And the impulse rates of patients with methamphetamine use disorder have always been different between the third, sixth and eighth sessions.

Finally based on the results of this study, it can be concluded that Acceptance and Commitment based Therapy as a new and emerging treatment of the third wave of behavioral therapy is a useful intervention for patients with methamphetamine use disorder to reduce their impulsive behaviors.  Given the increasing number of people with addiction, counselors and psychologists need to take non-pharmacological and psychological treatments to address the problems of people with substance use disorder. In particular, Acceptance and Commitment based Therapy for other substance use disorders can also be formulated and implemented to improve relationships between couples with substance use disorder and their relationship with their families.

The aim of this study was to evaluate the effectiveness of acceptance and commitment therapy on the increase of sexual satisfaction in recovered patients from methamphetamine use disorder.

The present study was quasi-experimental with pretest-posttest design with a control group. The statistical population of the study included all men with methamphetamine use disorder (approximately 1500 people) who were in the stage of abstinence from drugs and participated in the meetings of the Association of Anonymous Addicts in Yazd in 2018. Among these individuals, 24 individuals with a score lower than the cut-off point (score less than 67) on the index of sexual satisfaction were selected by purposive sampling method and were randomly assigned into the experimental (n=12) and control (n=12) groups. The experimental group received eight 60-minute sessions of acceptance and commitment therapy intervention. The index of sexual satisfaction was used to collect data. Data were analyzed using univariate analysis of covariance.

The results showed that acceptance and commitment therapy significantly increased sexual satisfaction in recovered patients from methamphetamine use disorder.

It can be said that the acceptance and commitment therapy is effective on addiction and the psychological damages caused by it, and this treatment can be used in the field of marital affairs, especially sexual satisfaction.

To self-medicate substance dependence, many substance users consume herbal medicines delivered in herbal medicine shops which are prepared through non-standard methods using a variety of different materials. Hence, the present study was carried out aiming to investigate and analyze the content of such herbal medicines. Four herbal medicine shops were selected from each of the 22 zones of Tehran City, Iran, and a total of 95 samples were purchased. A package containing 6 types of medication that was advertised by a satellite TV channel, was also purchased. Using high-performance liquid chromatography (HPLC) method, the samples were analyzed in the laboratory to detect different types of materials. Findings: Among the samples, 23 and 72 samples were uncovered compressed pills (Dragon pills) and capsules filled with colored powders (handmade drug-quitting capsules), respectively. The package advertised in the satellite TV was prepared in 6 various forms. The most common substances present in all the samples were as follows: diphenoxylate, tramadol, opioids, acetaminophen, and codeine with values of 90%, 86%, 78%, 69%, and 68%, respectively. On average, 5 of the above mentioned substances were present in each sample; moreover, 63% of the samples contained 5 or more substances. In addition, 42 (41%) of the samples contained all the 5 main substances including opioids, codeine, tramadol, diphenoxylate, and acetaminophen. The findings of this study showed that handmade capsules and pills used for quitting addiction and also medicines advertised in the satellite TV channels contain different amounts of opioids, amphetamine, benzodiazepines, tramadol, codeine, and other substances that cause problems for substance users who are going to abandon substance abuse.

The awareness of sexual experiences could be an effective factor in preventing high-risk sexual behavior pertaining to relapse during the recovery period of substances. This research explored the role of sexual behaviors among Iranian methamphetamine (MA) users in relapse process.
The study was conducted with a qualitative approach using content analysis method. 28 participants were selected through purposeful and theoretical sampling. Data were collected based on face-to-face, in-depth, semi-structured interviews based on open-ended questions. Interviews continued until the data saturation had occurred. All interviews were examined in four stages of codes, sub-categories, categories and themes according to the content analysis of explanations and descriptions of sexual behaviors.
Findings: Two main themes were emerged from the analysis of interviews, including extreme pleasure seeking (including the main categories of sexual tunnel vision and sexual totalitarianism) and comprehended threat (including the main categories of internal conflict and external disorganization) as well as 10 subcategories.
The results indicated that sexual behaviors played an important role in relapse process among Iranian MA users and needed to be considered and managed properly in the planning of prevention, treatment, and rehabilitation.

We need a different approach for prevention of social problems such as addiction in university students. Medical students need more attention because they are more familiar with some of the drugs. This study aimed to develop a model for this group.
Along with an extensive literature review, we developed a preliminary model and used Delphi method to validate it. We collected comments of 30 social problems experts, who have good experiences in the field of prevention of substance abuse in students, by email from April 2014 to August 2015 during three rounds of Delphi study.
Finding: For the prevention of addiction and other social problems among the students we must consider these principles: Emphasis on quality of life, active participation of the students in the prevention programs, and considering cultural differences in planning. These are main principles in this approach.
Using opinions of a wide range of experts on prevention of addiction, using participatory approaches to cover the weaknesses of previous models are the most important strengths of this model.

The purpose of the present study was to examine psychometric properties of the Believability of Anxious Feelings and Thoughts Questionnaire (BAFT) in a students population.
To this end, 324 university students from Shahid Beheshti University of medical sciences were selected via cluster sampling method and participated in the present study through complete believability of anxious feelings and thoughts questionnaire, cognitive fusion questionnaire, acceptance and action questionnaire-II, social anxiety-acceptance and action questionnaire, social interaction anxiety scale, valued living questionnaire and quality of life. Factor analysis by principle component analysis method, internal consistency analysis, convergent and divergent validity was conducted to examine the validity of the BAFT. To calculate the reliability of the BAFT, Cronbach’s alpha and test-retest reliability were used.
Results from factor analysis yielded three factors that were named somatic concerns, emotion regulation and negative evaluation. The three-factor solution explained 50.72% of the variance. Evidence for the internal consistency was obtained via calculating correlations between BAFT and the subscales. Support for the convergent and divergent validity of the BAFT via its positive correlations with the cognitive fusion questionnaire, acceptance and action questionnaire-II, social interaction anxiety scale, and negative correlations with social anxiety- acceptance and action questionnaire, valued living questionnaire and WHOQOL-BREF was obtained. Cronbach’s alpha and test-retest coefficients BAFT were yielded 0.82 and 0.81, respectively.
The Iranian version of the BAFT has acceptable levels of psychometric properties. This questionnaire is a valid and reliable measure to be utilized in research investigations and therapeutic interventions.

Object: This study conducted to identify the target groups of research center for psychology and special needs in psychological, social, spiritual and physical aspects. The study is a qualitative research with grounded theory method. After reviewing the relevant literature, 10 groups were purposed as individuals with special needs and 100 people were selected through a purposeful sampling. These groups included: children, aged people, people with a sensory motor disability, psychiatric patients and mental retards, people with special medical needs. Substance abusers, prisoners, marginated people or minorities, people with low socioeconomic status, pregnant women. Data was collected in semi-structured interviews and then was analyzed with Strauss & Corbin coding manner or continued comparison. Most important domains of special needs in our groups were: family, education, amusement, movement and transportation, building and places (houses and public places), social participation and occupation, treatment and rehabilitation services, and people's attitude toward their problems. "special need" term is related to disability, disability often is due to one's characteristics and obstacles caused from society. There are several barriers in obviating the needs and majority of them are occured by human such as non efficient systems and services, discriminatory policies, prejudice attitudes, etc. in order to enhancing social participation of disabled people and promoting their life styles as equal as other people, the public systems such as places and buildings, houses, transportation, educational and vocational opportunities and socio-cultural life (e.g. sport and amusement equipments) should be available for all people in a equal way and proper to their abilities and needs.

The aim of this study was to evaluate the status of substance abuse and dependence among women addicts in Iran. A descriptive study was conducted on women addicts. Thirty individuals were selected from women who had referred to rehabilitation centers for treatment and had been formally recognized to have had a 2-year history of addiction. They were then interviewed with an open-ended inventory. Most women were in the age range of 26-30 years. Crack (60%) and methamphetamine (46.6%) were reportedly most abused. The amount daily abused was 1-1.5 grams. The method of abuse was smoking (80%), inhaling (6.7%), and injection (13.3%). About 73.3% of women switched their drugs in the short time. The cause of drug change was mostly hedonism, and the cause of addiction was mostly having an addict spouse. The trend of drug abuse in women is more hazardous than in men, and is different too. Women addicts receive less emotional and financial support from their families and the society than their male counterparts. Among other results of this research are: changing patterns of substance abuse among women, their increased use of industrial substances, and earlier age of onset.

The aim of this study was to compare personality traits based on the temperament and character inventory (TCI) in opiate and stimulant users of Yasuj. In this descriptive –comparative study, 115 persons (91 opiate substance users and 24 stimulant substance users) were selected by simple and convenient sampling from persons who were admitted to substance abuse treatment centers (MMT centers), addiction treatment camps and self-help groups and Narcotics Anonymous (NA) of Yasuj. Subjects were controlled for age. The data collection tool was the ‘Temperament and Character Inventory’ (TCI). Data were analyzed by SPSS using Levene’s test, ANOVA and Pearson’s correlation coefficient. The findings showed significant differences in Novelty seeking, Harm avoidance, Persistence, Cooperativeness, Self-directiveness, and Self-transcendence between opiate and stimulant users. In all the abovementioned subscales the mean values of stimulants were higher than opiates. There were no significant differences in subscales of personality traits based on age. Based on the mean values of the TCI, personality traits reflecting personality disorders are detectable and predictable in substance abusers. This is important in the prevention and treatment of addiction.

This study aimed to evaluate the effectiveness of the Immunization program against addictive drugs in Isfahan’s preschool centers. To achieve the abovementioned objective, 60 children from preschool centers were selected through sampling. A quasi experimental pre-test post-test study was conducted. The Immunization Program (KADU packet) was administrated to the experimental group. The test used in this study was the ‘preschool children's knowledge, affects and behaviors toward addictive drugs’ checklist. Data were analyzed by Analysis of Covariance. According to the results, the Immunization program against addictive drugs in preschool children is effective. The overall results of the study showed the Immunization program to be effective. It increased children's knowledge, changed their attitudes toward addictive drugs, and shaped avoidant and assertive behavior.

This study was designed to examine the relationship between personality traits and substance use among college students in Tehran. This was a correlational prediction study. Subjects were 914 bachelors or masters students with a mean age of 23.13 years, selected from one of Tehran’s universities through cluster sampling. The ‘Big Five Inventory’ (Goldberg, 1999) and risk behaviors questionnaire (National College Health Risk Behavior Survey, 2007) were used to collect data. The criterion or dependent variable was ‘substance use’ and ‘personality traits’ was the predictor or independent variable. Data was analyzed through multiple regression analysis. Substance use had a positive correlation with ‘Agreeableness’ and ‘Openness’ and a negative correlation with ‘Extraversion’, ‘Consciousness’ and ‘Emotional Stability’. ‘Consciousness’, ‘Agreeableness’, ‘Emotional Stability’ and ‘Openness’ were important variables in prediction of substance use. This regression model can explain 30% of the total variance of substance use score. Results of this research indicate that personality variables are determinant factors of substance use. Likewise, with the possibility of prediction of substance use based upon personality traits, we can identify at risk individuals and focus on preventive interventions.

The purpose of this study was to examine the effectiveness of methadone maintenance treatment (MMT) on the mental health of harm reduction services’ recipients in Hamedan’s drop-in centers (DIC). This research was a quasi experimental study. The statistical population consisted of 200 subjects. Sixty individuals (30 MMT recipients and 30 harm reduction services’ recipients) were selected through convenient sampling. The data was collected with the SCL 90 Inventory. Data was analyzed with T-Test for independent groups. The findings showed significant differences between the mental health of MMT recipients and harm reduction services’ recipients in DIC. The mental health of MMT recipients was higher than harm reduction services’ recipients (P < 0/001). In conclusion, MMT is more effective than harm reduction services (DIC) in improving clients’ mental health status.

People may deny stress to get rid of it. In this case, they tend to exhibit high-risk behaviors. Inability to solve problems and emotional conflicts leads to high-risk behavior in addicts. This study was designed to investigate the relationship between risky behavior history (prison records and drug injection history) and emotion regulation in methamphetamine abusers. In this case-control study, 60 methamphetamine users (13 people with prisons records and 11 people with drug injection history) were selected purposefully from persons who had been admitted to convenient treatment centers (MMT center, addiction treatment camp and self-help groups and Narcotics Anonymous). Demographic data and risky behavior history were gathered. The ‘Cognitive Emotion Regulation Questionnaire’ (CERQ) was used to assess emotion regulation. Data were analyzed using multivariate analysis of variance (MANOVA). The findings revealed no significant difference in CERQ subscales between the groups. There was no significant relationship between emotion regulation and risky behavior such as prison records and drug injection history in methamphetamine users.

Service delivery through Community Mental Health Centers (CMHCs) is a strategy for improving urban mental health. The current paper presents the process of designing structure and planning the services for CMHCs through an evidence-based approach. Using a systematic review approach, the needs and available mental health services in urban areas, and effectiveness and cost-effectiveness of mental health services for addressing those needs were identified and accordingly urban mental health services plan was devised as CMHCs. Depression, schizophrenia and other psychotic disorders, bipolar disorders and anxiety disorders respectively comprise the top four psychiatric disorders, according to burden of diseases, in Iran. Urban areas have richer resources than rural areas in the country, though there are no out-of-hospital and out-of-office mental health services and the network system and the primary care for presenting mental health services are ineffective due to the current restrictions. Therefore, it was arranged that the CMHCs’ services being delivered to two groups of patients including patients with neurotic (depressive and anxiety) disorders and patients with severe mental and psychotic disorders. The services for neurotic patients were presented according to improving recognition style and the management of neurotic disorders conducted by general practitioners (GP) using collaborative care model and forming collaborative units. The services for patients with severe psychiatric disorders included home visiting and telephone follow up accompanied with the patient and the family psychological education provided by specialized team from the CMHCs. The CMHCs’ services based on scientific evidence available across the world and using national experiences and infrastructures was designed for two groups of disorders which comprised a large burden of disease in the country. These services are currently being piloted in Tehran and Zanjan.

The study aimed at reviewing evidence of effectiveness and cost-effectiveness of community-based services for psychiatric disorders. Cochrane and PubMed bibliographic databases and reference lists of relevant studies were investigated. Systematic reviews and controlled randomized clinical trials were analyzed. The inclusion criteria were having effectiveness and cost-effectiveness scales for community-based services models. These scales were compared for services delivered to patients with mild severe and mild psychiatric disorders. Provided services were assertive community treatment، case management، home visit، crisis intervention services، prompting، patient and family education and supported employment. The effectiveness and cost-effectiveness of assertive community treatment and family education had the strongest evidence and were effective on hospital admission rate، duration of hospital stay and maintaining contact with treatment system. The evidence for other services were insufficient or contradictory. For the mild psychiatric disorders، the service models included screening of disorders and feedback alone، continuous medical education، using practice guidelines، telephone-based intervention/care، referral system and consultation- liaison service، internet-based prevention and treatment programs، school-based prevention program and collaborative care. The most effective and cost-effective models were collaborative and internet-based care programs. Some of the positive outcomes of interventions were symptom reduction، patient’s satisfaction and decrease in economic burden of disease on family. The evidence for the models of delivering services to patients with mild psychiatric disorders mainly support collaborative models for delivering services and for more severe disorders support active follow-up and family education. These models are effective and feasible to clinical outcomes with a desirable cost - effectiveness.

Addiction is a problem of the modern world. In dealing with this problem، the approach of effective treatment is very important. One of the important issues in curing addiction is factors effective on the decision to quit. The aim of this study has been to explore effective factors on the decision to quit among substance abusers. This study is a part of a bigger one، which is a qualitative study undertaken with grounded theory approach. The Participants were 22 individuals (including 16 males and 6 females) who were substance abusers. Participants were selected using purposeful sampling and maximum variation. Data were gathered through face-to-face interviews and semi-structural questions. Data analysis was conducted using content analysis method. Two main categories were explored in this study. The first is «the need to survive» which includes three subcategories: 1- to get tired from the current condition، 2- to feel threatened، and 3- to reach the end of the line. The second category is «to set foot on the path» which includes two subcategories: 1- recourse to spirituality، and 2- searching for information. The results of this study show that deciding to quit drugs there are both facilitator and inhibitor factors. Therefore، it is necessary that governments and addiction treatment institutes provide social services on addiction by focusing on gender differences and education on quitting complications. In this way، they can make families show more compassion and support، and increase motivation for treatment and reduce the feeling of frustration in drug abusers. In addition، attention to spirituality as a facilitator factor on the decision to quit and completing the path to recovery through families and addiction treatment centers is of great importance.

Infertility is one of the most serious social problems. Illicit drug use can be an important cause of male factor infertility. Kerack which its use is rising up in Iran refers to a high purity street-level heroin (heroin Kerack). Heroin Kerack used in Iran is an opioid and has harmful effects on body organs. The aim of this study is to investigate the effects of Kerack used in Iran on fertility adult mice. In this study، 25 male mice were divided into five groups (control، sham and three experimental). Experimental groups of Kerack-dependent mice (received ascend-ing dose of Kerack for seven days) were divided into three categories، experimental I، II and III. Experimental I was given Kerack at a dose of 5 mg/kg، experimental II 35 mg/kg and experimental III 70 mg/kg، intraperitoneally twice a day for a period of 35 days. The sham group received normal saline and lemon juice (2. 6 µl/ml) whilst the control group just received water and food. Mice were then scarified and sperm removed from cauda epididymis were analyzed for sperm count، motility، morphology (normal/abnormal) and viability. Testes were also removed، weighed and processed for light microscopic studies. The results showed that fertility were significantly decreased in addicted mice compared with control groups (P≤0. 05). Epididymal sperm parameters and thickness of seminiferous epithelium were significantly decreased in experimental groups (dose-dependent) compared with sham and control groups (P≤0. 05). Gonadosomatic index was significantly reduced with high dose Kerack injected (70 mg/kg) in comparison with control testes (P≤0. 05). This study has shown the deleterious effects of Kerack used in addicted Iranian people on fertility for the first time. This effect is especially on epididymal sperm parameters in adult mice.

after sanction of «the rights of disabled people convention» United Nations Organization have been stressed more on dealing with this group''s needs. Therewith، most of countries in the world have been committed in this field. Therefore، with consideration of importance of identifying the needs in disabled people and making policies for them، this study conducted in order to identify the special needs in physically disabled people. this study is a part of a qualitative research with grounded theory method. Fifteen physically disabled people were selected through a purposeful sampling participated in study. The main method for collecting data was semi-structured interview that continued until theoretical saturation of information. Data was analyzed with Strauss & Corbin coding manner or continued comparison and the assessor''s viewpoints method is used for validity promotion of data. Totally، most important domains of special needs in disabled group were: family and relatives، education، movement and transportation، building and places (houses and public places)، social participation and occupation، treatment and rehabilitation services، and people''s attitude toward their problems. the results indicated that for promoting social participation and function independency in disabled people، should be emphasis on «equality of opportunities» in society rather than «disability». Thus، public systems and services should be available equally for all، such as physical environments and places، housing، transport system، educational and vocational opportunities، and socio-cultural life like equipments for sport and amusement. Then، physically disabled people can reach to a life with more quality and same with others.