1. Background
Since Iran is on the way of one of the main routes for transporting opiates, it is one of the world's major drug victims (1). Drug dependency is one of the most important issues in our society, and it is among the most widespread health risk factors, which can be investigated from biological, psychological, and social perspectives (2). Some risk factors of drug abuse include high levels of family conflicts, educational problems, occurrence of simultaneous psychological disorders such as mood swings and depression, peer and parental drug abuse, and early onset of smoking. The greater the number of these risk factors, the greater is the risk of addiction (3). Drug dependency is a chronic problem, which is often associated with other mental conditions, and can be comorbid with decreasing quality of life both in physical and psychological aspects (4). Quality of life is a collection of physical, psychological, and social well-being, such as happiness, satisfaction, pride, health, economic status, and educational opportunities, which can be felt by a person or group of people (5).
Recent studies have examined the impact of drug dependency on the life of people and on their interactions and experience (6, 7). Some studies indicate the lower quality of life of drug dependent people compared to that of non-drug dependents (8-12). However, some studies have shown that the quality of life of drug dependent individuals improves with practical support and replacement therapies, such as methadone and buprenorphine, which are provided mostly in specialized centers under the supervision of physicians and nurses (7, 13).
2. Objectives
Given the importance of this issue, this study aimed at determining the quality of life of addicts, who received treatment in methadone maintenance treatment centers, and comparing it with the quality of life of non-addicts.
3. Materials and Methods
3.1. Study Design and Setting
In this comparative study, which was conducted in 2014, 6 Methadone treatment (MMT) centers were randomly selected from the registered centers in Shahroud, northeast of Iran.
3.1.1. Participants
In this study, 266 drug-dependent individuals from MMT centers were selected as cases and 541 non- drug dependent persons were also selected as controls. Friend controls were used as controls. They were selected from a list of friends or associates obtained from the cases and were matched for age and economic conditions, but were not drug- dependent.
3.1.2. Questionnaire
To measure quality of life, the Persian version of SF36 Questionnaire, which was previously validated in Iran by Montazeri et al. was used (14). The questionnaire included 10 items on demographic features and 36 on quality of life, which were administered to the participants. Illiterate individuals and those with limited literacy were interviewed to complete the questionnaire.
3.1.3. Ethical Considerations
After explaining the goals of the study and obtaining a verbal informed consent from the participants, the questionnaires were administered anonymously to the participants by trained interviewers. The methods and proposal of this study were reviewed by the Ethical Review Board and Research Committee of Shahroud University of Medical Sciences (No = 9071).
3.1.4. Data Analysis
The collected data were entered into SPSS-17 software and analyzed using chi square tests, t test, and ANOVA. Significance level was set at 0.05.
4. Results
The majority of the participants (77.1%) in both groups were male. Most of the participants (88.1%) were living in the city. Also, the majority of them were workers (26.2%). Education level of 77.6% of the participants in both groups was high school diploma or less. Moreover, 65.7% of the participants in the 2 groups were married. The monthly income of 70.4% of the participants was below $145.The mean age of drug- dependent participants was 37.6 ± 10.7 and that of non-drug dependents was 34.9 ± 11.9. The mean duration of drug abuse by the cases was 12.0 ± 9.3 years, and the mean duration of treatment in methadone maintenance treatment centers was 24.6 ± 22.6 months. As Table 1 demonstrates, there was no significant difference in any aspects of quality of life in the groups other than vitality (P = 0.001).
Comparisons of the mean QoL scores (SF-36) of the 2 with regards to sex, occupation, housing status, and place of living are presented in Table 2, showing no significant differences in levels of independent variables between the 2 groups (P ≥ 0.05).
| Variables | Drug Dependent | Non-Drug Dependent | P.Values |
|---|---|---|---|
| Mean ± SD | Mean ± SD | ||
| Physical functioning | 71.1 ± 26.3 | 73.0 ± 26.9 | 0.344 |
| Physical role | 55.5 ± 37.8 | 58.8 ± 37.4 | 0.244 |
| Role emotional | 57.4 ± 40.9 | 54.0 ± 40.2 | 0.268 |
| Vitality | 56.1 ± 18.3 | 61.2 ± 20.0 | 0.001 |
| Mental health | 60.7 ± 18.8 | 62.9 ± 19.2 | 0.126 |
| Social functioning | 65.4 ± 23.4 | 67.9 ± 23.8 | 0.160 |
| Bodily pain | 70.3 ± 23.5 | 70.0 ± 24.6 | 0.859 |
| General health | 59.2 ± 18.2 | 61.6 ± 18.5 | 0.083 |
| SF-36(Quality of Life) | 62.5 ± 17.3 | 63.3 ± 18.4 | 0.555 |
| PCS (Physical component summary) | 64.1 ± 19.9 | 65.9 ± 20.9 | 0.240 |
| MCS (Mental component summary) | 59.9 ± 19.6 | 61.5 ± 20.6 | 0.289 |
Comparison of Quality of Life Subscale in Drug- Dependent and Non-Drug Dependent Participants
| Variables | Drug- Dependent | Non-Drug Dependent |
|---|---|---|
| Mean ± SD | Mean ± SD | |
| Sex | ||
| Male | 62.3 ± 17.27 | 62.9 ± 18.5 |
| Female | 64.2 ± 19.5 | 64.2 ± 18.0 |
| t | 0.606 | 0.615 |
| P-values | 0.528 | 0.446 |
| Education | ||
| Illiterate | 60.2 ± 18.0 | 59.0 ± 18.8 |
| ≤ Diploma | 63.4 ± 16.2 | 62.3 ± 18.0 |
| Academic | 62.6 ± 19.6 | 69.5 ± 17.4 |
| F | 0.734 | 0.481 |
| P-values | 11.257 | 0.001 |
| Job | ||
| Unemployed | 57.0 ± 17.5 | 61.6 ± 19.7 |
| Employed | 63.9 ± 17.1 | 64.2 ± 17.5 |
| t | 0.009 | 6.864 |
| P-values | 0.116 | 2.476 |
| Marital status | ||
| Single | 61.2 ± 17.4 | 65.7 ± 18.4 |
| Married | 63.2 ± 17.0 | 62.6 ± 18.3 |
| t | 1.126 | 5.418 |
| P-values | 0.326 | 0.005 |
| Home Status | ||
| Personal | 66.1 ± 15.7 | 63.3 ± 17.7 |
| Leased | 61.7 ± 17.8 | 63.0 ± 18.6 |
| Other | 60.5 ± 17.8 | 63.4 ± 18.8 |
| F | 2.299 | 0.026 |
| P-values | 0.102 | 0.974 |
| Residence | ||
| Urban | 62.8 ± 17.6 | 63.6 ± 18.6 |
| Rural | 60.0 ± 15.2 | 60.9 ± 16.4 |
| t | 2.802 | 1.909 |
| P-values | 0.419 | 0.270 |
Comparison of the Mean of Quality of Life Scores in Demographic Features in Between Drug- Dependent and Non-Drug Dependent Groups
Comparison of the mean QoL score in educational levels in cases revealed there was not any significant difference between the 2 groups, but there were significant differences between mean scores in educational levels of non-drug dependent participants, so that the mean score of quality of life in those with academic education was higher than other individuals (P = 0.001) (Table 2).
The relationship between marital status and quality of life in the drug- dependent group was not statistically significant (P ≥ 0.05), but the relationship between marital status and quality of life was significant in the non-drug dependent group, so that the man score of quality of life in singles was higher than others (P = 0.005) (Table 2).
As displayed in Table 3, no significant difference was observed between different aspects of quality of life of the drug- dependent group in methadone maintenance treatment duration (P ≥ 0.05).
| Variables | Methadone Maintenance Treatment Duration | F | P.Values | ||
|---|---|---|---|---|---|
| > 10 Month | 10 - 30 Month | < 30 Month | |||
| General health | 61.0 ± 18.3 | 58.0 ± 14.8 | 58.4 ± 20.98 | 0.747 | 0.475 |
| Bodily pain | 71.3 ± 22.5 | 68.2 ± 23.2 | 71.3 ± 25.19 | 0.500 | 0.607 |
| Vitality | 59.2 ± 15.9 | 52.6 ± 17.5 | 55.9 ± 20.99 | 3.000 | 0.052 |
| Mental health | 61.7 ± 17.77 | 58.6 ± 17.8 | 61.7 ± 20.8 | 0.779 | 0.460 |
| Social functioning | 64.4 ± 22.9 | 65.5 ± 22.1 | 66.5 ± 25.4 | 0.187 | 0.830 |
| Physical Role limitation | 71.1 ± 27.8 | 69.4 ± 24.6 | 72.8 ± 26.2 | 0.335 | 0.716 |
| Physical functioning | 55.3 ± 35.9 | 54.8 ± 38.5 | 56.5 ± 39.6 | 0.047 | 0.955 |
| Emotional Role limitation | 54.5 ± 40.5 | 59.0 ± 40.4 | 59.1 ± 42.1 | 0.380 | 0.684 |
| MCS (Mental component summary) | 59.9 ± 17.8 | 58.9 ± 18.5 | 60.8 ± 22.7 | 0.190 | 0.827 |
| PCS (Physical component summary) | 64.7 ± 18.8 | 62.6 ± 19.3 | 64.7 ± 21.7 | 0.317 | 0.728 |
| SF36 (Quality of Life) | 63.12 ± 16.2 | 61.3 ± 16.6 | 62.8 ± 19.4 | 0.272 | 0.762 |
Comparison of Quality of Life Subscale in Drug- Dependents According to Treatment Duration
4. Discussion
The results of this study revealed no significant difference between the quality of life of drug- dependent and non-drug dependent participants; this finding is not consistent with that of other studies conducted in Iran (2, 11, 12, 15) and those conducted in the world (7, 10). In these studies, it had been found that the quality of life of drug dependents was lower than that of non-drug dependents, which is not consistent with the results of this study. Perhaps one of the reasons for the insignificant difference between drug- dependent and non-drug dependent groups in this study was methadone maintenance treatment, which relatively improved quality of life in drug- dependent people. The present results suggest relatively good scores of individuals who received methadone maintenance treatment, which is consistent with the results of other studies done on the quality of life of people undergoing methadone maintenance treatment (9, 16-18).
In this study, 91.4% of the patients in maintenance therapy centers were male, and this is consistent with some other studies (9, 10, 13, 19-21). Some of the reasons for the higher percentage of males may be the higher prevalence of drug dependency among males and the lower number of females referring to methadone maintenance treatment centers (21).
The relationship between overall quality of life in drug- dependent and non-drug dependent groups and education level was significant, which is consistent with some studies (13) and inconsistent with the results of some other studies (10, 19).
No significant relationship was found between marital status and quality of life in the drug- dependent participants; however, in control participants, this relationship was significant, so that the quality of life in non-drug dependent singles was higher than the married; this is consistent with the study by Aghayan and et al. (13) and inconsistent with some other studies (10, 16).
Workers had the highest frequency in this study, and 20.3% of the participants were unemployed. Quality of life in both groups had no significant relationship with job, which is consistent with the results of some studies (16) and inconsistent with the results of other studies (13).
Although the mean score of physical function in non-drug dependent people was higher than that in drug dependent, no significant relationship was observed between the 2 groups, which is not consistent with the results of Hossienifar (12), but it is in line with the results of Fooladi and Lev-Ran (10, 11).
The mean score for physical role limitation dimension in drug dependent and non-drug dependent participants showed no statistically significant difference, which is not consistent with the results reported by Fooladi and Hossienifar (11, 12). Moreover, the mean scores of vitality in non-drug dependents were higher than that in the drug- dependent group, which does not correspond with the results of Hossienifar (12), but accords with the results of Fooladi (11).
One of the limitations of this study was the lack of relevant studies to discuss and compare the current findings with similar studies. Other limitations were the method of sample selection of non-drug dependent participants and type of study (cross- sectional).
4.1. Conclusions
Although most studies have indicated a low score of quality of life for drug- dependent participants, this study found a higher score of quality of life for drug- dependent participants; moreover, there was no significant difference between the scores of drug- dependent and non-drug dependent participants. Since all the drug- dependent participantsin this study were undergoing treatment in methadone maintenance treatment centers, it seems that maintenance treatment with methadone and buprenorphine can play an effective role in improving the quality of life of drug dependent participants.
