الفهرس 
Substtance Use DiisorderOnly 14 pages are availabe for public view
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Abstract
Substance use disorder is a global health problem as it is associated with a lot of disabilities e.g. occupational, familial, financial and psychological. Because of the widespread of psychiatric disorder, substance use disorder and their associated disabilities, accurate comprehension of their co morbidity is very important for prevention and treatment, especially among young adult as this age group disabilities represent a burden on any society. An increasingly alarming phenomenon of tramadol use disorder has been heavily demonstrated in Egypt in the recent years. It has been suggested that tramadol could be effective for alleviating symptoms of depression, anxiety, and phobias. Co-occurrence of Tramadol and opioid use disorder is more frequent among subjects with generalized anxiety, social phobia or depression. Prevalence of depression was more significant among subjects with opioid use disorder. On the other hand, depression was less frequent among tramadol users as tramadol and venlafaxine shared monoaminergic action leading to the tramadol effects on mood. Not only anti-depressant effect of tramadol was observed among subjects included in the study but also appearance of social phobia after tramadol withdrwal was obviously observed nearly in all subjects included in the study. While opioid use disorder has initial anti-depressant effect, prolonged opioid use lead to significant depression that decreased gradually after withdrawal. It has been found that either depression, generalized anxiety disorder or social phobia may trigger substance use especially tramadol and opioid. Finally, Proper treatment of depression, anxiety and social phobia associated with tramadol and/or opioid use disorder either occur prior to or subsequent to substance use should be put in mind as these disorders mentioned above play an important role not only in substance use but also in recurrence. Aim of the work: The aim of this work is to identify the relationship between social phobia and tramadol and opioid use, and if it has a role in starting drug use. Patients and Methods Study setting: This study was carried out at Psychiatry, Neurology and Neuro-Surgery Center in Tanta University. Data collection: One hundered and three Patients admitted to our addiction unit with tramadol and/or opioid use during the period from the first of June to the end of December 2017 were subjected to the following: 1. Psychiatric history and examination through Structured Clinical Interview for DSM5 Disorders (SCID-5-CV). 2. Physical Examination. 3. Drug screen in urine. 4. Psychometric tests: a) Hamilton Depression Rating Scale (HAM-D). b) Hamilton Anxiety Rating Scale (HAM-A). c) Raulin and Wee scale for social phobia. d) Addiction Severity Index (ASI). Only patient with drug screen of urine positive to tramadol, opioid and/or both drugs were assessed by addiction severity index. All patients in this study will be followed up at the beginning of treatment, after 1 month, after 2 months and after 5 months of treatment. Inclusion criteria Tramadol and/or opioid use only. Age between 18 and 50 year. Both sexes Male and Female. All participants should continue at least 6 year of education. This is necessary to be able to complete psychological evaluation. Exclusion criteria Age below 18 or above 50 year. Patients who have serious systemic disorders. Significant neurological disorder (e.g. cerebrovascular stroke, epilepsy, Parkinsonism). Learning disabilities and language difficulties. Mental retardation and pervasive developmental disorders. The following results were obtained: Age: average age was mainly between 25-38 years old. Gender: 74.8% were male while the 25.2% were female. Occupation: 72% were employed and 27% were not employed. Marital status: 54.3% were married, 35% were single and 10.7% were divorced. Drug use disorder: The majority of the cases were tramadol users with 38.8%, followed by users of both drugs with 36.9% followed by opioid users with 24.3%. Among tramadol users depression increased after one month while among opioid users depression was severe at base line then decreased gradually. Users of both drug experience lower level of depression than those of opioid users only.Tramadol users had little variation of anxiety all over the study while users of opioid had higher level of anxiety that increased after one month of withdrawal. Tramadol users had obviously increased level of social phobia after one month of withdrawal. Although opioid users had a higher level of social phobia at base line, the level of social phobia didn’t increase by the same degree of tramadol.