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Introduction. Patients under methadone maintenance treatment programs (MMTPs) are susceptible to numerous complications (e.g., mental and metabolic disorders). This study evaluated the effects of probiotics on clinical symptoms, biomarkers of oxidative stress, inflammation, insulin resistance, and serum lipid content in patients receiving MMTPs. Materials and Methods. A randomized, double-blind, placebo-controlled trial was conducted among 70 patients receiving MMTPs to receive either 1.8 × 109 CFU/day probiotics (n = 35) or placebo (n = 35) for 12 weeks. Clinical symptoms and metabolic profiles were measured before and after the intervention in patients receiving MMTPs. Results. Compared with the placebo group, probiotic supplementation resulted in a significant improvement in the severity of depression ( P < 0.05 ). In addition, probiotic administration significantly decreased fasting plasma glucose (FPG), total cholesterol, and low-density lipoprotein cholesterol (LDL cholesterol) ( P < 0.05 ). Furthermore, probiotics resulted in a significant reduction in high-sensitivity C-reactive protein (hs-CRP) and a significant elevation in total antioxidant capacity (TAC) and total glutathione (GSH) levels ( P < 0.05 ). Conclusion. Treatment with probiotics for 12 weeks to patients receiving MMTPs had beneficial effects on symptoms of depression, as well as several metabolic profiles. Clinical Trial Registration: this study was registered in the Iranian website (https://www.irct.ir) for clinical trials registration (https://fa.irct.ir/trial/46363/IRCT20170420033551N9). The registration date is March 22, 2020.

INTRODUCTION Sex addiction is a major psychiatric disorder in which a person is compelled to participate in sexual activities despite negative consequences. This study was conducted to localize a brief sex addiction screening instrument (PATHOS) for use in the Iranian population and to determine variables predictive of sex addiction in the general Iranian population. METHODS In this study, we evaluated the psychometric properties of PATHOS in a sample of 443 Iranians in 2018. Data were analyzed using exploratory factor analysis (Factor 10.8.04 software). Simple and multiple linear regression analyses were used to investigate construct validity and variables predictive of addiction. RESULTS Exploratory factor analysis identified two factors in this dichotomous questionnaire and reported the questionnaire's test-retest reliability in the target population. Prognostic variables for sexual addiction in the Iranian population were determined to be female gender, higher education, viewing pornographic videos, having multiple sex partners, having difficulty interacting in sex, and history of masturbation. CONCLUSION The Persian version of the brief sex addiction screening instrument (PATHOS) has sufficient reliability and validity in the Iranian population. The predictive variables of sex addiction are indicative of the presence of risk of this disorder in Iranian samples and more studies are needed in order to enable prevention and treatment.

High alcohol consumption is an important public health problem, and understanding factors associated with such consumption is essential.This study aimed to assess individual and social factors associated with alcohol consumption during the coronavirus disease 2019 (COVID-19) pandemic in the Islamic Republic of Iran.In this qualitative study, purposive sampling was used to select study participants by sharing the survey link on the Telegram application channels with an Iranian audience during COVID-19. The study was conducted from March to June 2020 and reached all Iranian provinces. We used qualitative content analysis to investigate specific concepts in the responses.Of the 116 participants who responded to the survey, 34 (29.3%) were females, and 82 (70.7%) were male. The mean age of the participants was 34.8 years (standard deviation 9.9; range 17-71 years). Most of the participants (75.9%) reported having consumed alcohol, and 56.9% reported having self-medicated for an illness without a doctor's prescription before the COVID-19 pandemic. The most common reason given for alcohol consumption was to relieve stress during home quarantining (32.3%). Based on analysis of the responses, two themes emerged: coping motivations and coping skills, with five subthemes and 14 basic codes. Coping motivations were more powerful than coping skills in relation to high alcohol consumption.Poor coping skills and strong motivations, combined with misinformation on social media and the internet, appear to have led to new or higher alcohol consumption among survey respondents.الدوافع وراء تعاطي الكحول أثناء جائحة كوفيد 19-، جمهورية إيران الإسلامية.أبو الفضل فتاح، مليحة خلوتي، مهدي أبو نوري، نادر ملوي، فاطمة أزرطاش، مسعود باباخانيان.يعد ارتفاع تعاطي الكحول مشكلة صحية عامة مهمة، ومن الضروري فهم العوامل المرتبطة بهذا التعاطي.هدفت هذه الدراسة إلى تقييم العوامل الفردية والاجتماعية المرتبطة بتعاطي الكحول أثناء جائحة مرض فيروس كورونا 2019 (كوفيد-19) في جمهورية إيران الإسلامية.في هذه الدراسة الكيفية، استُخدمت عينات مقصودة لاختيار المشاركين في الدراسة من خلال مشاركة رابط المسح عبر قنوات تطبيق Telegram مع فئة من الجمهور الإيراني أثناء جائحة كوفيد 19-. وأُجريت الدراسة في الفترة من مارس/آذار إلى يونيو/حزيران 2020، ووصلت إلى جميع المحافظات الإيرانية. واستخدمنا تحليل المحتوى الكيفي لاستقصاء مفاهيم محددة في الإجابات.من بين 116 مشاركًا أجابوا عن المسح، كان 34 منهم (29.3٪) من الإناث. وكان متوسط عمر المشاركين 34.8 سنة (الانحراف المعياري 9.9؛ النطاق 17-71 سنة). وأفاد معظم المشاركين (75.9٪) بأنهم تعاطوا الكحول، وأفاد 56.9٪ بأنهم قاموا بمداواة أنفسهم من أحد الأمراض دون الحصول على وصفة طبية من الطبيب قبل جائحة كوفيد-19. وكان السبب الأكثر شيوعًا لتعاطي الكحول هو تخفيف التوتر أثناء الحجر الصحي المنزلي (32.3٪). واستنادًا إلى تحليل الإجابات، ظهر موضوعان هما: دوافع التأقلم، ومهارات التأقلم، إلى جانب خمسة موضوعات فرعية و14 رمزًا أساسيًا. وكانت دوافع التأقلم أقوى من مهارات التأقلم فيما يتعلق بارتفاع تعاطي الكحول.يبدو أن ضعف مهارات التأقلم والدوافع القوية، إلى جانب المعلومات المغلوطة في وسائل التواصل الاجتماعي والإنترنت، أدت إلى مستوى جديد أو أكثر ارتفاعًا من تعاطي الكحول بين المشاركين في المسح.Les motivations en matière de consommation d'alcool pendant la pandémie de COVID-19 en République islamique d'Iran.Une forte consommation d'alcool représente un problème de santé publique important ; il est donc essentiel de comprendre les facteurs qui lui sont associés.L’ étude visait à évaluer les facteurs individuels et sociaux associés à la consommation d'alcool pendant la pandémie de maladie à coronavirus 2019 (COVID-19) en République islamique d'Iran.Dans la présente étude qualitative, un échantillonnage ciblé a été utilisé pour sélectionner les participants. Pour ce faire, le lien de l'enquête a été partagé sur les canaux de l'application Telegram avec un public iranien pendant la pandémie de COVID-19. L'étude a été menée de mars à juin 2020 et a couvert toutes les provinces iraniennes. Nous avons utilisé une analyse qualitative du contenu pour étudier des concepts spécifiques figurant dans les réponses.Sur les 116 participants ayant répondu à l'enquête, 34 (29,3 %) étaient des femmes et 82 (70,7 %) étaient des hommes. L'âge moyen des participants était de 34,8 ans (écart type 9,9 ; fourchette comprise entre 17 et 71 ans). La plupart des participants (75,9 %) ont déclaré avoir consommé de l'alcool et 56,9 % ont déclaré s'être automédicamentés pour une maladie sans ordonnance médicale avant la pandémie de COVID-19. La raison la plus fréquemment invoquée pour justifier la consommation d'alcool était le soulagement du stress pendant la quarantaine à domicile (32,3 %). L'analyse des réponses a permis de dégager deux thèmes : les motivations à la consommation d'alcool et les capacités d'adaptation, avec cinq sous-thèmes et 14 codes de base. Les motivations prenaient le dessus sur les capacités d'adaptation dans le cas d'une forte consommation d'alcool.De faibles capacités d'adaptation et de fortes motivations, associées à des informations erronées diffusées sur les médias sociaux et l'Internet, semblent avoir conduit à un nouvel usage de l'alcool ou à une consommation plus élevée chez les personnes interrogées.

Background: Drug abuse is a social burden and a public health disorder. Previous evidence suggested numerous illicit substances (e.g., opioids, amphetamines, cocaine, & cannabis) affect immune system functions, oxidative stress mechanisms, inflammatory cytokines, and reactive oxygen species production. This study aimed to determine the extent of these metabolic parameters in opioid-dependent patients. We also compared these patients with a healthy control group. Methods: This study was conducted in Amirie Clinic, Kashan, Iran. Plasma and serum samples from 50 illicit opioid users (study group) and 50 non-opioid users (control group) were studied. Metabolic levels for MDA, NO, TAC, GSH, Insulin, HOMA-IR, and hs-CRP were assessed in both research groups (N=100). Results: There was a significant difference in the status of MDA (P=0.003), NO (P=0.01), TAC (P=0.003), GSH (P=0.001), insulin (P=0.04), HOMA-IR (P=0.02), and hs-CRP (P=0.001) between the study and control groups. Furthermore, there was a significant correlation among the duration of illicit opioid use and MDA concentrations (r=-0.424, P=0.002), as well as TAC levels (r=0.314, P=0.02). Conclusion: The study results suggested metabolic profiles were impaired in the study group, compared to the controls.

Context: Heavy metals, including thallium and lead, are introduced to illicit drug users’ body as a result of using drugs such as cocaine and heroin. Objective: This study aimed to determine urine, blood, and hair thallium (Tl) concentrations in illicit opioid users along with the relevant clinical signs and symptoms consistent with thallotoxicosis and to compare them with the corresponding variables in the control non-opioid user group. Materials and Methods: This case–control study was conducted on 50 illicit opioid users who had abused opioids continuously for more than a year, referred to Amirie Drug Abuse Treatment Clinic in Kashan, Iran. The control group included 50 non-opioid users. Thallium concentrations in urine, blood, and hair were assessed in both groups ( n = 100) using electrothermal (graphite furnace) atomic absorption spectrometry (ET AAS, GF AAS). Results: In the studied group, the median (interquartile range) concentrations of thallium in urine, blood, and hair were 54.8 ± 79.9 μg/L, 14.5 ± 11.1 μg/L, and 5.4 ± 3.7 µg/g, respectively; these values were 4.8 ± 5.2 μg/L, 2.5 ± 2.4 μg/L, and 1.4 ± 1.1 µg/g, respectively, in the control group. There were significant differences in urine, blood, and hair thallium concentrations between the study group and the control group ( p < 0.001). There were significant correlations between duration of illicit opioid use and urine thallium concentrations ( r = 0.394, p = 0.005) and hair thallium concentrations ( r = 0.293, p = 0.039), but not with blood thallium concentrations ( r = 0.246, p = 0.085). Urine and blood thallium concentrations of illicit opioid users with clinical signs and symptoms consistent with thallotoxicosis of weakness ( p = 0.01), depression ( p = 0.03), and headache ( p = 0.03) were higher than users without these problems. Discussion and conclusion: The results of the study showed that thallium concentrations in urine, blood, and hair in illicit opioid users were significantly higher than the comparable concentrations in the control group. This can be due to the use of illicit opioids adulterated with thallium. Also, this study showed long-term illicit opioid use may lead to thallium exposure. In addition, cigarette smoking was associated with increased thallium exposure.

Background and purpose: The aim of the current study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) on aggression and general health of patients with a diagnosis of ps...

Background: Homeless women are at high risk of sexually transmitted infections (STIs) due to their adverse early-life experiences. Objectives: This study aimed to examine the association between adverse early-life experiences and the risk of acquiring STIs among homeless women in Tehran. Patients and Methods: A descriptive-analytical cross-sectional study was carried out in 2014. The study recruited 241 homeless women through quota sampling from the drop in centers and shelters affiliated to a local welfare organization in Tehran, Iran. Data were obtained using questionnaires on demographics and adverse early-life experiences. Blood and urine samples were tested for human immunodeficiency virus (HIV), herpes simplex virus 2 (HSV-2), syphilis, Chlamydia trachomatis, and Neisseria gonorrhea. Descriptive statistics including frequency were calculated for all variables. To analyze the data at a significance level of 0.05, binary logistic regression was used. Results: The prevalence rates of HIV/AIDS, HSV-2, syphilis, Chlamydia trachomatis, and Neisseria gonorrhea were 8.29%, 23.65%, 14.93%, 11.61%, and 6.63%, respectively. The results of logistic regression showed that the risk of acquiring STIs increases by factors such as sexual abuse (OR = 4.06; 95% CI = 1.21 - 13.6, P = 0.02), running away from home (OR = 4.46; 95% CI = 1.67 - 12.89, P = 0.03), drug use (OR = 3.93; 95% CI = 1.13 - 13.58, P = 0.03), alcohol use (OR = 4.12; 95% CI = 1.38 - 12.24, P = 0.01), imprisonment and criminal records (OR = 2.72; 95% CI = 1.01 - 7.52, P = 0.04), premarital sexual activity (OR = 4.71; 95% CI = 1.06 - 13.84, P = 0.05), divorce (OR = 3.47; 95% CI = 1.06 - 11.32, P = 0.03), Nikah mut’ah (OR = 4.33; 95% CI = 1.39 - 13.49, P = 0.01), having multiple sex partners (OR = 5.2; 95% CI = 1.81 - 14.96, P = 0.02), and having unprotected sexual relationships (OR = 3.69; 95% CI = 1.00 - 13.62, P = 0.05). Conclusions: Homeless women had high rates of adverse early-life experiences and overall 41.49% of them were affected at least by one STI. Future interventions should focus on the reduction of adverse early-life experiences, especially during adolescence, including the promotion of adolescent empowerment, promotion of condom use, and improvement of awareness of STIs.

One of the most effective strategies to prevent transmission of sexually transmitted infections (STIs) is use of condom, but obstacles to its use in high-risk groups have not yet been fully understood. The main objective of our study is to evaluate barriers to condom use among "Socially damaged women" (SDW). A qualitative method was utilized. Two focus group discussions (FGDs) and eighteen semi-structured in-depth interviews were conducted with SDW, 15-45 years old, at shelters and harm-reduction drop-in-centers in Tehran, Iran. Data was analyzed using the content analysis approach. All women in the study were sexually active and most of them were divorced. They all had primary school education at a minimum, and a limited knowledge of HIV and STIs, yet the rate of condom use in these high-risk groups are low. The most common obstacles to consistent condom use among "SDW" included misperception, low perceived sensitivity and self-efficacy partner objections. Hence, preventions strategies based on increasing knowledge about STIs and condom use, self-efficacy, perceived sensitivity must be designed and improvised to induce condom use. These data will be useful in designing and improving STIs prevention outreach programs in Iran.

Background and Objectives Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation method, which shows promising therapeutic effects in controlling drug cravings. Methods In this study, we present cumulative and booster effects of tDCS sessions on methamphetamine cravings, lapse, and cognitive impairment in a methamphetamine dependent subject. Results Our study shows cumulative effects of continuous anodal tDCS sessions on right dorsolateral prefrontal cortex (DLPFC) could reduce drug cravings and their consequences. Discussion and Conclusions Moreover, booster tDCS treatments might be helpful in controlling psychological stress and drug cravings. (Am J Addict 2016;XX:1–3)

Background: Alcohol use is a health concern in Iran, the most populated Persian Gulf country. However, alcohol use disorder treatment is a new issue in Iran, which needs consideration. Objectives: In this article, we present a study protocol that aims to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran. Methods: The study design is a prospective cohort and multi-center research, which will be conducted in major cities of Iran in 2016 - 2017. Overall, 750 participants with psychiatric diagnosis of hazardous alcohol drinking or dependence will be recruited. The settings will be 150 outpatient drug treatment centers. This project will be implemented in 3 phases. Phase I will be the preparation phase, Phase II will focus on training treatment providers and Phase III will be the main phase of the study and will evaluate the feasibility and effectiveness of integration of alcohol use disorder treatment services within outpatient network of drug treatment centers. Five questionnaires will be used to assess the study outcomes. Completing the study questionnaires at baseline, weeks 4, 12, 24, and 52 will assess participants. Data analyses, including descriptive statistics, regression models, and repeated measures of ANOVA will be performed using SPSS version 22. Conclusions: This is the first study to investigate the feasibility and effectiveness of integration of outpatient alcohol use disorder treatment in drug treatment centers in Iran. If found effective, the results of this study will be useful for applying in Iran and other countries in Western and Central Asia.

Background: A change in behavior is one of the most important components of readiness for drug use treatment in Iran. Objectives: The aim of this study was to determine ones willingness to change and continue treatment amongst patients receiving opium tincture (OT) maintenance treatment in Tehran, Iran. Methods: This longitudinal study was conducted in 2014. Overall, 140 participants were selected from clients who were referred by a non-governmental organization providing OT, Congress 60, to four drug use treatment centers. At the start of the study, the questionnaire; stages of change readiness and Treatment Eagerness Scale were completed. After three months, participants were divided into two groups of retention and relapse. Data was analyzed using SPSS version 21 and by performing an independent t-test. Results: There was no significant difference between the retention group and relapse group regarding demographic characteristics (P > 0.05). Motivation for change was higher in the retention group compared to the relapse group and their differences were significant (P < 0.001). Group differences between the two groups were statistically significant (P < 0.001) in rates of recognition, ambivalence and taking steps. Conclusions: In drug-dependent clients, motivation for behavior change is one of the most effective factors for treatment retention. Motivation for behavior change is composed of better recognition of the problem, higher rates of taking steps and less ambivalence in decision making. Further studies are suggested.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation method, which shows promising therapeutic effects in controlling drug cravings.In this study, we present cumulative and booster effects of tDCS sessions on methamphetamine cravings, lapse, and cognitive impairment in a methamphetamine dependent subject.Our study shows cumulative effects of continuous anodal tDCS sessions on right dorsolateral prefrontal cortex (DLPFC) could reduce drug cravings and their consequences.Moreover, booster tDCS treatments might be helpful in controlling psychological stress and drug cravings. (Am J Addict 2016;25:264-266).

Schwann Shariatirad , Omid Massah , Ali Farhoudian , Seyed Ramin Radfar , Nader Molavi , Seyed Sepehr Hashemian , Reza Daneshmand , Alireza Noroozi * a Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran b Students Research Center of International Campus, Tehran University of Medical Sciences, Tehran, Iran UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, USA d Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran e Substance Abuse Prevention and Treatment Office (SAPTO), Ministry of Health and Medical Education, Tehran, Iran f School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Iran