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Abstract
Drug dependence is the repeated use of a drug or chemical substance with or without physical dependence. Psychological dependence indicates an altered psychological state due to repeated administration of a drug, the cessation of which results in withdrawal syndrome.
Drug abuse and addiction are major burdens to society. Thus, Egyptian community leaders at all levels have demonstrated intense concern over the problem of drug abuse. The Egyptian Ministry of Health published an epidemiologic study at 2010 for prevalence of psychoactive substance use disorders. It revealed that 1.6% of the Egyptian population suffer from psychoactive substance dependence.
Along with governmental role lies the crucial family role. In light of these high rates, and the significant role of families in determining whether or not a child will engage in substance use, it is important for parents to understand what they can do to help prevent their children from using tobacco, alcohol or drugs. Drug dependence shows a familial pattern. The increased risk is partly due to environmental factors but genetic factors are also important.
Even the most extreme environmentalists along the nature now acknowledge that genes often contribute to individual differences in behavior. Genetic vulnerability, or predisposition, to substance dependence is likely to be tied to several distinct genes (or multiple alleles), each producing a small effect, which might increase risk of developing substance dependence by 2–3 folds.
Family, twin and adoption studies can be used to determine whether or not there is a genetic contribution to psychoactive substance use and dependence, but they do not provide evidence to determine which particular gene is involved. Twin and adoption studies also help to dissociate environmental factors from genetic factors. Family studies examine the inheritance of traits through a family, in order to find out about patterns of inheritance and the relative risk of inheriting a disorder. Linkage and association studies are used to identify regions of DNA that may be involved in the expression of a trait such as substance dependence.
Genetic factors play an important role in the initiation and persistence of substance use disorders. The task for identifying such genes is made more arduous because it is likely that variation in substance-dependence susceptibility results not only from genotypic differences and environmental influences, but also from their interactions. Thus, genetic factors are background sources of variance that can be minimized or exaggerated by environmental factors before the phenotype (substance dependence) can be expressed.
The developmental stage of adolescence is characterized by dramatic change and readjustment, new stresses, anxieties and increased vulnerability to peer pressure. Risk taking increases during adolescence, and adolescents engage in risk taking both for experimentation and exhilaration.
To be able to study risk factors properly, the criti¬cal and interactive roles played by host, agent and environment must be known. When the agent is relatively inexpensive, rapidly acting on the brain and efficient then abuse will increase. Drug abuse may increase whenever the host is demoralized or susceptible to the influence of peers who are heavily involved in drug use: or when the host has a high genetic predisposi¬tion to abuse the agent or to personality disorder; or when the host is poorly socialized into the culture. In all of these situations, addiction may increase.
Focusing on families is critical to understanding and preventing the destructive intergenerational cycle of substance abuse and addiction. Family is the first institution of children’s socialization and one of the most influential agents, determining the formation of a personality; the family transmits values, improves morality and proper behaviour.
Disturbed family structure, child physical and sexual abuse, cultural and racial/ethnic differences, living with a substance-abusing parent, negativity in the family, defective parenting styles, bad role models and poor children monitoring are all family factors leading to have offsprings with significant risk of developing substance use disorder.
Several researches have studied personality disorders in patients of substance abuse which were found to be significantly prevelant. Yet, studying personality disorders in families of substance abuse patients has received limited research attention, thus this study will be of great interest as it would provide much progress in understanding etiology and improving management plans of patients with substance abuse.
Our study hypothesized that personality disorders are more prevalent among parents of patients with substance dependence disorder compared to parents of healthy individuals (without substance dependence disorder).
This study was aiming to find how prevalent are personality disorders in a sample of parents of patients with substance dependence disorder, to find if some personality disorders common than others between parents of patients with substance dependence disorder and also to find if there is gender difference regarding personality disorder among parents of patients with substance dependence disorder.
A matched case-control research strategy was adopted to fulfill the aim of the study. In this study 100 parents of substance dependent patients (using DSM-IV diagnostic criteria) represented the ”cases” while 100 parents of non-drug dependent patients represented the ”controls”. The study was conducted in the addiction outpatient clinics and the inpatient addiction ward of the Institute of Psychiatry, Ain-Shams University Hospitals and two other private hospitals in Cairo.
• Written informed consent was obtained from the patients, their parents, the healthy volunteers and their parents involved in the study in a private setting after full explanation of the study rational and including their right to withdraw from the study at any time without any consequences. The data collected were kept confidential with the researcher.
• The patients were assessed in the study using The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (patient version) performed by the researcher to confirm the diagnosis of substance dependence disorder and exclude any other Axis-I co-morbidities. The parents of the patients were assessed in the study using SCID-I to exclude axis I disorders and SCID-II to asses personality disorders.
• The healthy volunteers were assessed in the study using The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (non-patient version) to exclude any Axis-I disorders. The parents of the healthy volunteers were assessed in the study using SCID-I to exclude axis I disorders and SCID-II to asses personality disorders.
• By the end of the study data were analyzed using the Statistical Package for Social Sciences (SPSS) (17th version)
The study concluded that:
1- Prevalence of personality disorder in parents of patients with substance dependence disorder was 34% and prevalence in parents of controls 24%. This means that relative risk for developing SUD when parents have personality disorder compared to normal parents is 1.6 folds.
2- Relative risk for developing substance dependence disorder when father has personality disorder compared to father with no personality disorder is 1.9 folds
3- Relative risk for developing substance dependence disorder when mother has personality disorder compared to mother with no personality disorder is 1.4folds.
4- Obsessive compulsive personality disorder is more common in fathers of substance dependant patients.
5- Paranoid personality disorder and Borderline personality disorder are more common in mothers of substance dependant patients.