Exploring the Prevalence and Determinants of Substance Use Among Drug Addicts in Pakistan

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Methods This cross-sectional study involved 598 adult males and 2 females. Participants were recruited from different psychiatric rehabilitation centres using the standard scoring scale of substance use according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. An additional questionnaire was used to assess the socio-demographic details. Results The mean age of participants was 29.54 ± 6.76 years. The mean score of DSM-5 level 2 was 16.55. The logistic regression analysis shows a significant association between peer pressure (OR = 24.98, 95% CI: 14.208–43.945; p < 0.0005) and curiosity (OR = 0.027, 95% CI: 0.11 − 0.068; p < 0.0005) with the severity of substance use. Sex (6.7%), relationship problems (6.7%), stress (5.3%), and strict family (6.7%) were also significantly associated with the severity of substance use. All polydrug users in this study were significantly associated with the severity of the drug. Marijuana (69%) was the most commonly used by the participants followed by heroin (56.9%) and methamphetamine (52.5%). It was found that substance use was significantly associated with memory impairment and violence. The majority of the participants (95%) have tried to stop using drugs. Age, marital status, and education are not associated with the severity of drug use. Conclusion The findings emphasize the urgency of tailored interventions and support strategies to combat substance addiction effectively. substance use disorder behavior marijuana abuse Peer pressure and Pakistan 1. INTRODUCTION Substance abuse refers to a repetitive and relapsing pattern of compulsive drug or alcohol use that leads to negative consequences in various aspects of an individual's life, including work, relationships, legal issues, and mental and physical health. This disorder is characterized by a lack of control over substance use (legal and illegal drugs or medications) despite the knowledge of the harmful effects and consequences [ 1 ]. Examples of adverse consequences include absences from work or school, legal troubles, marital and family problems, financial instability, and social isolation [ 2 ]. According to the World Health Organization (WHO), approximately 35 million people worldwide suffer from drug use disorders, with an estimated 11 million people injecting drugs and 1.3 million dying from drug use-related causes annually [ 3 ]. As per the last published drug report by the United Nations in 2013, an estimated 5.8 percent or 6.7 million adults in Pakistan used drugs in the last 12 months aged 15–64 years. Cannabis remained the most widely used drug estimated at 4.03 million or 3.6% of the population [ 4 ]. The diagnostic criteria are based on The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A trained healthcare professional, such as a psychiatrist conducts an assessment to determine whether an individual meets the diagnostic criteria for substance use disorder. Increasing use of illicit drugs or misuse of legal drugs has led substance use disorders (SUDs) to become a leading mental sickness in the young adult population [ 5 ]. One of the major reasons for the availability of illicit substances in Pakistan is illegal drug trafficking from Afghanistan with whom Pakistan shares its longest border. Till 2022, Afghanistan was the largest opium cultivator in the world and approximately 45% of cultivated opioids were illegally trafficked to Pakistan from here the drugs were distributed all over the region as well as to Europe highlighting Pakistan as a major distributor. Since the Taliban takeover in Afghanistan and their new strict policies from April 2022 regarding the cultivation of opium, 95% of the opium production has been reduced as of 2023. Despite the decline in heroin and cannabis productivity, there has been a surge in methamphetamine production in Afghanistan. Along with these, synthetic opioids like fentanyl are also being supplied in markets which have more adverse effects than natural opioids. Nonetheless, the supply chain and trafficking route of methamphetamine is the same as heroin and cannabis [ 6 , 7 ]. A survey conducted among male prisoners in Karachi showed a high prevalence of substance abuse, of which most were uneducated, unemployed, unmarried, and living in rural areas [ 8 ]. Studies show that individuals with SUDs employ various strategies to avoid social stigma and embarrassment in workplaces, schools, etc. This leads to the isolation of drug users from the rest of society [ 9 ]. A 2022 study was conducted in different rehabilitation centers all over Pakistan and findings indicated that the extent of the stigma associated with substance use disorder differed depending on the severity of substance use [ 10 ]. Among medical students in Pakistan, the most prevalent factors that prevented or discouraged students from drugs were found to be morality, religion, and awareness of the harmful effects of drugs. It was observed that female and day scholars demonstrated a higher willingness to discourage a friend who got engaged in drug use [ 11 ]. Although studies have been done earlier to assess the impact of SUDs on populations, the cause for the initiation of using drugs as well as recent literature regarding substance use disorder is lacking in the Pakistani population. To the best of our knowledge this is the first study conducted to determine the prevalence, severity and reasons that lead to substance abuse in Karachi, Pakistan. Due to the lack of female participants no conclusion concerning the impact of gender can be made. 2. MATERIALS AND METHODS This Cross-sectional study was conducted in various psychiatric hospitals and rehabilitation centers in Karachi. The study was approved by the ethical review board No: IRB 3323/DUHS/Approval/2023/25 of Dow University of Health Sciences, Karachi. Pakistan. A total of 600 adult males and females were included in this study. Consent was taken from each individual before filling out the forms along with an attendant. Participants who did not give consent were excluded from the study. Due to social stigma, the majority of the female patients refused to be a part of the study. A trained healthcare professional, such as a psychiatrist conducted a clinical, and physical assessment. At the same time, a psychologist analyzed the mental and emotional state of the patient to determine if the individual met the diagnostic criteria for substance use disorder. Patients using Crystal, Heroin, Powder, Tar yak, Token, and Tanzania. Drug Panel analysis for barbiturates and Opiates in the Urine of the participants were analyzed for the presence of (ng/ml): benzodiazepines, barbiturates, Amphetamines, Cannabinoids, cocaine, methadone, Opiates, Phencyclidine, Tricyclic Antidepressants, and Methamphetamines. Alcohol levels were also determined. The participants were diagnosed based on DSM-5. The criteria include a pattern of use that results in significant impairment or distress, a strong desire or craving to use the substance, difficulty in controlling use, continued use despite adverse consequences, and the development of tolerance and withdrawal symptoms. The DSM-5 also includes criteria related to the severity of the disorder, ranging from mild to severe based on the number of symptoms present. The current study was conducted in 2 phases. In the 1st phase, the population was scrutinized by using DSM-5 Level 1 (Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult), which is a 23 questions-based questionnaire that classifies participants into drug addicts and other mental disorder patients. A participant was classified as a drug addict if their score was 1 (slight) or above in the specified drug addiction questions present in the DSM-5 level 1 form. The non-addicts were excluded from this study, and a total of 598 Pakistani males and 2 females who were active drug users admitted to healthcare centers were given Level 2 (Substance Use—Adult) of DSM-5, which is specific for substance users to analyze their level of addiction. Additionally, a 15-item assessment tool was designed to measure the extent of prescription and illegal substance use in adults aged 18 and above. The individual is asked to complete the form before meeting with the healthcare provider. The questionnaire consists of questions that ask about the severity of substance use in the past 2 weeks. Another dichotomous questionnaire was developed which focused on socio-demographic and accumulating factors including awareness and consequences of substance use was also given to patients. The data were analyzed by using SPSS version 21, where frequencies, percentages, and other relevant data were summarized by categorical variables. Pearson's Chi-square test with odd’s ratio along with logistic regression and Fischer Exact test was used to analyze the association among different groups. A value of p < 0.05 was considered significant. 3. RESULTS The data shows there were 598 male and 2 female participants in the current study. The mean age of the participants was 29.54 ± 6.76 years. The mean value for the DSM-5 level II was 16.55 ± 11.7 which shows that all of the participants were categorized as severe and complex substance users. The most vulnerable substance use age group was 26–30 years, (37.3%). Followed by 31–35 (23.5%) and 18–25 (20.5%) years. The current study showed that a significantly greater number of married people (77.7%) were addicted while 22.33% were unmarried. Similarly, the data shows that 36.3% of participants were illiterate while 22.3% were educated up to the intermediate level. 21.3% had completed their primary or secondary schooling and 20.0% had completed their bachelor's degree. The data also highlighted the accumulating factors behind illicit drug use. The strongest factor was peer pressure (40.8%) followed by curiosity (14.2%), strict family (6.7%), relationship (6.7%), and sex (6.7%). Besides these, many other factors are shown to be involved in substance use such as stress (5.3%), seeking joy (4%), family dispute (2%), boring routine life (2.5%), and illness (3%). A few participants also started to use substance use because they had relatives who were drug addicts (3.3%). This study shows that education (0.8%) can also be a reason for substance use. Most of the participants were polysubstance users. Cumulative analysis showed marijuana/cannabis or hashish (69%) was mostly used followed by heroin (56.9%) and methamphetamine (52.5%) in the Pakistani population. The majority of the participants had awareness (74.3%) of the consequences of substance use but still, acquired it. Nevertheless, all the participants whether single or polysubstance users were significantly (p < 0.05) associated with the awareness of the drug (Tables 1 & 2 ). The majority of the (60.8%) participants had memory lapses while they were using substances. Whereas, 76.8% of the participants faced serious trouble (went to jail, beaten up by the father, brother, or police). The difficulty in overcoming addiction was evident as 95% of participants attempted to quit and stop. The mean value of the DSM-5 level II score was 16.55 clearly shows the severity and the complexity of substance use. The association between the severity/complexity of the participants with substance use was analysed by using the chi-square test and Fischer analysis. The result shows that marital status and education are not significantly associated with the severity of substance use. However, the severity of the substance use is associated with the type of illicit drugs used (p < 0.0005). The severity of the substance use was also highly significantly associated with all the reasons presented in the current study such as peer pressure, curiosity, joy seeking, sex, relation problems, addict relatives, mental stress, strict family, lack of enjoyment, and routine stress (Tables 1 & 2 ). A strong significant association between substance use and peer pressure (OR = 24.98, 95% CI: 14.208–43.945; p < 0.0005) and curiosity (OR = 0.027, 95% CI: 0.11 − 0.068; p < 0.0005) was identified as the most influencing factors in the onset of the addiction (Table 2 ). Nonetheless, a statistically significant association exists between gender and facing trouble while using substances (p-value = 0.010, Fischer’s exact test). This suggests that the likelihood of facing trouble while using substances may differ between males and females. These results underscore the complex challenges associated with drug addiction and its consequences on individuals and their social environment (Table 2 ). Table 01 Association of substance use with the severity and complexity of the drug users Do you ever forget things you did while using these drugs? Have you ever gotten into trouble while using these drugs? N = 600 P-value Marital Status Married Unmarried 0.61 χ2 0.80 χ2 Education level 0.992 χ2 0.661 χ2 Substance Use < 0.00* χ2 < 0.00* χ2 Type of substance Pain Killer < 0.00* χ2 < 0.00* χ2 Stimulant Sedative Marijuana Cocaine Club drugs Hallucinogens Heroin Inhalants Methamphetamine Reasons Peer Pressure < 0.00* χ2 < 0.00* χ2 Curiosity < 0.00* χ2 < 0.00* χ2 Try Something New < 0.00* χ2 < 0.000* Ŧ Joy seeking < 0.00* χ2 < 0.00* χ2 Illnesses < 0.00* χ2 < 0.000* Ŧ Mental Distress 0.003* Ŧ < 0.000* Ŧ Family Dispute < 0.000* Ŧ < 0.000* Ŧ Routine Stressors < 0.000* χ2 < 0.00* χ2 Addicted < 0.000* χ2 < 0.000* Ŧ No Amusement 0.002* χ2 0.028* Ŧ Strict Family < 0.000* χ2 < 0.00* χ2 Sex < 0.000* χ2 < 0.00* χ2 Relationship < 0.000* χ2 < 0.00* χ2 Education 0.005* Ŧ 0.595 Ŧ χ2 = Chi-square test, Ŧ= Fischer Exact test, * p-value < 0.05 was considered significant Table 02 Association between reasons and memory relapses Reasons Odds Ratio 95% CI P-Value Peer Pressure Yes 1 14.208–43.945 < 0.00* No 24.988 Curiosity Yes 1 0.11 − 0.068 < 0.00* No 0.027 Table 2 Logistic Regression Analyses revealed a significant association between peer pressure and curiosity in people who show memory impairment after using the drugs. *P-value ≤ 0.05 is considered significant. 4. DISCUSSION According to our results, peer pressure is the primary catalyst for drug addiction in the Karachi population similar to studies done in other parts of the world [ 12 , 13 ]. Curiosity, the second highest motive behind drug abuse as per current results, remains consistent with similar studies done in other populations [ 14 ]. This study uncovers that most addicts are poly-drug users meaning they consume multiple or different types of drugs consecutively or all together and use illicit substances as well as legally accessible substances such as painkillers, stimulants, and sedatives. The illicit drug most commonly abused currently was found to be marijuana by 69% of participants. A decade ago, a survey done in Karachi revealed crack cocaine to be the most prevalent drug of abuse. [ 15 ]. The shift from crack cocaine being the most abused drug in 2011 to marijuana in 2024 illustrates a significant change in drug prevalence over the decade. In a US-based study, researchers found that individuals who used a specific drug almost always had friends who had also used the same drug within the past 30 days [ 16 ]. Another cross-sectional study showed that negative peer pressure demonstrates a higher likelihood of engaging in binge drinking and lifetime marijuana use compared to no peer group [ 17 ]. Higher perceived drug use and increased drug-related knowledge from peers correlated with more frequent substance use among students [ 18 ]. Additionally, active parental monitoring and parental disapproval are linked to a reduced likelihood of polysubstance use [ 19 ]. Among drug users, the desire to try new things out of curiosity is frequently cited as one of the primary reasons for their substance use [ 20 ]. Curiosity triggers the activation of specific brain areas, including the substantia nigra, ventral tegmental area, and hippocampus. The connectivity among these regions is closely linked to the process of learning [ 21 ]. The results suggest that 14.2% of participants exhibit high levels of curiosity about using drugs. A 2019 study reported that heroin was the most abused among addicts while cannabis (marijuana) held second place among the Pakistani population [ 5 ]. On the contrary, the current study shows that marijuana is the most widely abused illicit drug among addicts in Pakistan numbering up to 69% of the total participants. Moreover, the previous study was conducted on a smaller number of male participants (102) located in Islamabad, the capital of Pakistan, while the current study gives a bigger and more thorough analysis of drug addicts in the Karachi region, a metropolitan hub. In a study done in the USA, it was found that young people are increasingly using marijuana recreationally because they believe it to be a harmless drug. Over time, there has been a gradual increase in the concentration of active chemicals in recreational formulations that lead to cognitive impairment [ 22 ]. Cannabis is being used more often around the world for both recreational and medical purposes, although the efficacy and adverse effects of its use are comparatively poorly supported by research [ 23 ]. On the other hand, heroin is a highly addictive illegal drug. Its addiction is characterized by compulsive heroin use and a strong propensity to relapse following periods of abstinence. Chronic heroin use can also lead to serious health problems such as respiratory, hepatic, and renal diseases [ 24 ]. According to a study, early adulthood, low social class, primary level of literacy, and stress, are important risk factors for heroin addiction in the Pakistani population [ 25 ]. There are numerous reasons why cannabis use, particularly hashish consumption, is so high. First, networks connected to the drug trade in Afghanistan make it easily accessible. Second, many people hold the incorrect “belief” that hashish is not religiously prohibited and does not belong in the same category as alcohol or liquor. Thirdly, it is well-liked by people of all genders and classes and transcends class boundaries. Fourthly, it is reasonably priced as a recreational drug of choice because it is less expensive than alcohol. Fifthly, people mistakenly think that it does not have any addictive properties [ 26 ]. Most strikingly it is relatively cheap and can be purchased easily online through a credit card transaction. Cognitive deficits that result from continued drug use make it more challenging to achieve sustained abstinence [ 27 ]. The current study shows that 60.8% of patients reported being inattentive and having memory lapses after taking drugs. A study done in 2021, showed that 59.9% of patients relapsed after completing successful rehabilitation treatments [ 28 ]. Our research centered on individuals who made earnest attempts to discontinue their drug usage but faced persistent difficulties in doing so. Alarmingly, approximately 95% of our participants experienced relapses, highlighting a significant and worrisome pattern. Toxic addiction is linked to genetic disturbances in dopamine affecting the reward system, leading to substance abuse and withdrawal symptoms [29]. The addiction cycle consists of three stages: intoxication, withdrawal, and anticipation. Neurobiological changes in brain circuits support drug addiction's rewarding nature, primarily through dopamine manipulation in the nucleus accumbens [30]. Gabapentin, a neuropathic painkiller, was misused by 1% of the global population. Among them, 40–65% had a prescription while 15–22% were opioid abusers [31]..Misuse of prescription opioid pain relievers is associated with subsequent initiation of heroin use [32]. The current study shows that 41.7% of subjects were addicted to painkillers. Doctors must counsel patients about the addictive potential of prescribed painkillers. Methamphetamine is a potent and compulsive drug produced cheaply from basic chemicals like pseudoephedrine [33]. It has now been evaluated in this study that Methamphetamine is one of the leading abused drugs (52.5%) in the Pakistani addicted population. Cocaine use is increasing, especially among youth. It leads to frequent emergency room visits [34]. Cocaine was identified as the leading abused drug in the Pakistani population in the year 2011 [ 15 ]. Cocaine prevents neurotransmitter reuptake at neuronal synapses causing CNS depression [35]. Marijuana, commonly known as 'weed' or 'pot,' is a widely abused and trafficked illegal substance worldwide. It is predominantly used by young people (15 to 34 years old), with men using it more frequently than women [36]. Marijuana has psychoactive properties that affect the release of glutamate and GABA neurotransmitters which alter the reward perception, memory, learning, and pain. In healthy people, cannabis use is associated with a 2–4 times higher risk of psychosis [37]. In the current study, we determined that 69% of participants abused marijuana of which 26.7% used it nearly every day. "Club drugs" encompass a diverse range of constantly evolving chemical substances used recreationally [38]. These include ecstasy, gamma-hydroxybutyric acid, ketamine, fry, and lysergic acid diethylamide (LSD) which are becoming a more pervasive part of young adult culture [39]. Heroin, a potent CNS depressant also known as diacetylmorphine, can cause fatal respiratory depression, especially after intravenous injection, and has a mortality rate of 1–3% [40]. The current study reveals how SUDs are significantly linked with negative peers and curiosity, mostly affecting youngsters to consume drugs like marijuana, cocaine, methamphetamine, etc, which are very potent drugs with higher relapse rates. SUDs burden society as a whole. These disorders increase the risk of suicide ideation, medical or psychiatric conditions, disability, and substance-related deaths. SUDs also contribute to housing instability, homelessness, criminal behavior, transmission of HIV and hepatitis, unemployment, and welfare dependency. Treating addiction and its associated medical and psychiatric disorders further adds to the strain on society [41]. In the future, more studies should be conducted among the Pakistani population on substance abuse to gather relevant data and gain more attention to the subject. 5. CONCLUSION Peer pressure was and still is the number one reason for the onset of addiction. However, many new reasons are now identified in Pakistan that were not previously correlated with addiction such as curiosity, lack of amusement, and joy-seeking. Adolescents and young adults in particular should be made aware of this issue to stop this social catastrophe and eradicate it from our society. Declarations Credit authorship contribution statement Sonia Siddiqui : Conceptualization, Writing – original draft, Writing – review & editing, Validation, Formal analysis, Methodology, Supervision, Resources, Project administration and Software. Farooq Khalid : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Farhia Khalid : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Aetesam Towheed : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Shoaib Ahmed : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Talheen Naqvi : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Hafsa Paracha : Data curation, Writing – original draft, Investigation, Formal analysis, Methodology. Tania Hassan : Data curation, Writing – original draft, Investigation, Formal analysis. Ayesha Owais : Data curation, Writing – original draft, Investigation, Formal analysis. Source of Funding: This research was funded by the DUHS. Conflict of Interest: Authors declare no conflict of interest. Ethical Approval: The study was approved by the ethical review board No: IRB 3323/DUHS/Approval/2023/25 of Dow University of Health Sciences, Karachi. Pakistan. Acknowledgment: The authors are thankful to the Addicare Rehabilitation Center, Karachi Neuropsychiatric Hospital, Karachi, Sadaqat Hospital, Karachi, and Dr. Abdul Qader Khan Institute of Behavioural Health Sciences, DUHS, Karachi for their help during the study. References Swimmer KR, Sandelich S. Substance Use Disorder. 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Curr Pharm Des. 2014;20(25):4112–8. Urits I, Gress K, Charipova K, et al. Cannabis use and its association with psychological disorders. Psychopharmacol Bull. 2020;50(2):56–67. Abanades S, Peiró AM, Farré M. Club drugs: los viejos fármacos son las nuevas drogas de la fiesta [Club drugs: old medicines as new party drugs]. Med Clin (Barc). 2004;123(8):305–11. Klein M, Kramer F. Rave drugs: pharmacological considerations. AANA J. 2004;72(1):61–7. Demaret I, Lemaître A, Ansseau M. L'héroïne [Heroin]. Rev Med Liege. 2013 May-Jun;68(5–6):287–293. Daley DC. Family and social aspects of substance use disorders and treatment. J Food Drug Anal. 2013;21(4):S73–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4644279","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319615720,"identity":"08a849c7-ddda-4386-b4a9-019e56426676","order_by":0,"name":"Sonia Siddiqui","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYJCCA0DMw3AgsYGBwcCGsUECJMYGFiNKSxpxWqAaE0DkYcJa5Nt7Dx74wVAnw3c8ufE2T8F52Q232x8wfCg7zGDOcwCrFoMz5xIO9jAc5pE887DZmsfgtvGGO2cMGGecO8xg2duAXYtEjsEBoEd4DG4ktkkDtSRuuJHDwMzbdpjB4DwOh83IMTj4h6EOpuUcUEv6A+a/eLQw3MgxOMzDwAzTcgCoJcGAmRGk5SwOh505Y3BYxgDiF8s5BsnGM4GGHOw5l85j2YPd+/LtPcYf31TU2fMdT394480fO9m+G+kPH/wos5Yz50nA4TKwXRBKAsYHGc9jgEcDHEig8IjSMgpGwSgYBSMBAAApo2dFUnnrPgAAAABJRU5ErkJggg==","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Sonia","middleName":"","lastName":"Siddiqui","suffix":""},{"id":319615721,"identity":"0c881427-e0f2-48e4-8817-7954ccdb7e40","order_by":1,"name":"Farhia Khalid","email":"","orcid":"","institution":"National University of Medical Sciences (NUMS)","correspondingAuthor":false,"prefix":"","firstName":"Farhia","middleName":"","lastName":"Khalid","suffix":""},{"id":319615723,"identity":"43b57333-29a2-4870-96b5-1aabfdf6f15d","order_by":2,"name":"Muhammad Farooq Khalid","email":"","orcid":"","institution":"Baqai Medical University","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Farooq","lastName":"Khalid","suffix":""},{"id":319615725,"identity":"4bb23136-ea6b-4464-8a31-7b616b9f62d5","order_by":3,"name":"Aetesam Towheed","email":"","orcid":"","institution":"Baqai Medical University","correspondingAuthor":false,"prefix":"","firstName":"Aetesam","middleName":"","lastName":"Towheed","suffix":""},{"id":319615729,"identity":"bea1f444-a55d-4c14-b00f-2dd530365986","order_by":4,"name":"Shoaib Ahmed","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shoaib","middleName":"","lastName":"Ahmed","suffix":""},{"id":319615733,"identity":"ab5575c4-425c-4010-8a3d-8d22e814bf10","order_by":5,"name":"Hafsa Paracha","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hafsa","middleName":"","lastName":"Paracha","suffix":""},{"id":319615737,"identity":"096059c7-0442-4bd7-995e-c38f13ccef8e","order_by":6,"name":"Talheen Ali Naqvi","email":"","orcid":"","institution":"Dow University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Talheen","middleName":"Ali","lastName":"Naqvi","suffix":""},{"id":319615739,"identity":"f62cfb40-647c-4c3b-bb8e-85371a076d46","order_by":7,"name":"Tania Hassan","email":"","orcid":"","institution":"University of Karachi","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"","lastName":"Hassan","suffix":""},{"id":319615742,"identity":"f650656c-67d8-4179-abfc-e034ab37611c","order_by":8,"name":"Ayesha Owais","email":"","orcid":"","institution":"University of Karachi","correspondingAuthor":false,"prefix":"","firstName":"Ayesha","middleName":"","lastName":"Owais","suffix":""}],"badges":[],"createdAt":"2024-06-26 17:25:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4644279/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4644279/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89346640,"identity":"7a21582b-00bb-4380-93c4-a5b53196be6c","added_by":"auto","created_at":"2025-08-19 05:01:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":641956,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4644279/v1/46d7d741-3363-45a2-96f1-1f542e1826cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring the Prevalence and Determinants of Substance Use Among Drug Addicts in Pakistan","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eSubstance abuse refers to a repetitive and relapsing pattern of compulsive drug or alcohol use that leads to negative consequences in various aspects of an individual's life, including work, relationships, legal issues, and mental and physical health. This disorder is characterized by a lack of control over substance use (legal and illegal drugs or medications) despite the knowledge of the harmful effects and consequences [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Examples of adverse consequences include absences from work or school, legal troubles, marital and family problems, financial instability, and social isolation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the World Health Organization (WHO), approximately 35\u0026nbsp;million people worldwide suffer from drug use disorders, with an estimated 11\u0026nbsp;million people injecting drugs and 1.3\u0026nbsp;million dying from drug use-related causes annually [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As per the last published drug report by the United Nations in 2013, an estimated 5.8 percent or 6.7\u0026nbsp;million adults in Pakistan used drugs in the last 12 months aged 15\u0026ndash;64 years. Cannabis remained the most widely used drug estimated at 4.03\u0026nbsp;million or 3.6% of the population [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The diagnostic criteria are based on The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A trained healthcare professional, such as a psychiatrist conducts an assessment to determine whether an individual meets the diagnostic criteria for substance use disorder.\u003c/p\u003e \u003cp\u003eIncreasing use of illicit drugs or misuse of legal drugs has led substance use disorders (SUDs) to become a leading mental sickness in the young adult population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. One of the major reasons for the availability of illicit substances in Pakistan is illegal drug trafficking from Afghanistan with whom Pakistan shares its longest border. Till 2022, Afghanistan was the largest opium cultivator in the world and approximately 45% of cultivated opioids were illegally trafficked to Pakistan from here the drugs were distributed all over the region as well as to Europe highlighting Pakistan as a major distributor. Since the Taliban takeover in Afghanistan and their new strict policies from April 2022 regarding the cultivation of opium, 95% of the opium production has been reduced as of 2023. Despite the decline in heroin and cannabis productivity, there has been a surge in methamphetamine production in Afghanistan. Along with these, synthetic opioids like fentanyl are also being supplied in markets which have more adverse effects than natural opioids. Nonetheless, the supply chain and trafficking route of methamphetamine is the same as heroin and cannabis [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A survey conducted among male prisoners in Karachi showed a high prevalence of substance abuse, of which most were uneducated, unemployed, unmarried, and living in rural areas [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies show that individuals with SUDs employ various strategies to avoid social stigma and embarrassment in workplaces, schools, etc. This leads to the isolation of drug users from the rest of society [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A 2022 study was conducted in different rehabilitation centers all over Pakistan and findings indicated that the extent of the stigma associated with substance use disorder differed depending on the severity of substance use [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among medical students in Pakistan, the most prevalent factors that prevented or discouraged students from drugs were found to be morality, religion, and awareness of the harmful effects of drugs. It was observed that female and day scholars demonstrated a higher willingness to discourage a friend who got engaged in drug use [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although studies have been done earlier to assess the impact of SUDs on populations, the cause for the initiation of using drugs as well as recent literature regarding substance use disorder is lacking in the Pakistani population. To the best of our knowledge this is the first study conducted to determine the prevalence, severity and reasons that lead to substance abuse in Karachi, Pakistan. Due to the lack of female participants no conclusion concerning the impact of gender can be made.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cp\u003eThis Cross-sectional study was conducted in various psychiatric hospitals and rehabilitation centers in Karachi. The study was approved by the ethical review board No: IRB 3323/DUHS/Approval/2023/25 of Dow University of Health Sciences, Karachi. Pakistan.\u003c/p\u003e \u003cp\u003eA total of 600 adult males and females were included in this study. Consent was taken from each individual before filling out the forms along with an attendant. Participants who did not give consent were excluded from the study. Due to social stigma, the majority of the female patients refused to be a part of the study. A trained healthcare professional, such as a psychiatrist conducted a clinical, and physical assessment. At the same time, a psychologist analyzed the mental and emotional state of the patient to determine if the individual met the diagnostic criteria for substance use disorder. Patients using Crystal, Heroin, Powder, Tar yak, Token, and Tanzania. Drug Panel analysis for barbiturates and Opiates in the Urine of the participants were analyzed for the presence of (ng/ml): benzodiazepines, barbiturates, Amphetamines, Cannabinoids, cocaine, methadone, Opiates, Phencyclidine, Tricyclic Antidepressants, and Methamphetamines. Alcohol levels were also determined. The participants were diagnosed based on DSM-5. The criteria include a pattern of use that results in significant impairment or distress, a strong desire or craving to use the substance, difficulty in controlling use, continued use despite adverse consequences, and the development of tolerance and withdrawal symptoms. The DSM-5 also includes criteria related to the severity of the disorder, ranging from mild to severe based on the number of symptoms present.\u003c/p\u003e \u003cp\u003eThe current study was conducted in 2 phases. In the 1st phase, the population was scrutinized by using DSM-5 Level 1 (Self-Rated Level 1 Cross-Cutting Symptom Measure\u0026mdash;Adult), which is a 23 questions-based questionnaire that classifies participants into drug addicts and other mental disorder patients. A participant was classified as a drug addict if their score was 1 (slight) or above in the specified drug addiction questions present in the DSM-5 level 1 form.\u003c/p\u003e \u003cp\u003eThe non-addicts were excluded from this study, and a total of 598 Pakistani males and 2 females who were active drug users admitted to healthcare centers were given Level 2 (Substance Use\u0026mdash;Adult) of DSM-5, which is specific for substance users to analyze their level of addiction.\u003c/p\u003e \u003cp\u003eAdditionally, a 15-item assessment tool was designed to measure the extent of prescription and illegal substance use in adults aged 18 and above. The individual is asked to complete the form before meeting with the healthcare provider. The questionnaire consists of questions that ask about the severity of substance use in the past 2 weeks. Another dichotomous questionnaire was developed which focused on socio-demographic and accumulating factors including awareness and consequences of substance use was also given to patients.\u003c/p\u003e \u003cp\u003eThe data were analyzed by using SPSS version 21, where frequencies, percentages, and other relevant data were summarized by categorical variables. Pearson's Chi-square test with odd\u0026rsquo;s ratio along with logistic regression and Fischer Exact test was used to analyze the association among different groups. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eThe data shows there were 598 male and 2 female participants in the current study. The mean age of the participants was 29.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76 years. The mean value for the DSM-5 level II was 16.55\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7 which shows that all of the participants were categorized as severe and complex substance users. The most vulnerable substance use age group was 26\u0026ndash;30 years, (37.3%). Followed by 31\u0026ndash;35 (23.5%) and 18\u0026ndash;25 (20.5%) years. The current study showed that a significantly greater number of married people (77.7%) were addicted while 22.33% were unmarried. Similarly, the data shows that 36.3% of participants were illiterate while 22.3% were educated up to the intermediate level. 21.3% had completed their primary or secondary schooling and 20.0% had completed their bachelor's degree. The data also highlighted the accumulating factors behind illicit drug use. The strongest factor was peer pressure (40.8%) followed by curiosity (14.2%), strict family (6.7%), relationship (6.7%), and sex (6.7%). Besides these, many other factors are shown to be involved in substance use such as stress (5.3%), seeking joy (4%), family dispute (2%), boring routine life (2.5%), and illness (3%). A few participants also started to use substance use because they had relatives who were drug addicts (3.3%). This study shows that education (0.8%) can also be a reason for substance use. Most of the participants were polysubstance users. Cumulative analysis showed marijuana/cannabis or hashish (69%) was mostly used followed by heroin (56.9%) and methamphetamine (52.5%) in the Pakistani population.\u003c/p\u003e \u003cp\u003eThe majority of the participants had awareness (74.3%) of the consequences of substance use but still, acquired it. Nevertheless, all the participants whether single or polysubstance users were significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) associated with the awareness of the drug (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The majority of the (60.8%) participants had memory lapses while they were using substances. Whereas, 76.8% of the participants faced serious trouble (went to jail, beaten up by the father, brother, or police). The difficulty in overcoming addiction was evident as 95% of participants attempted to quit and stop. The mean value of the DSM-5 level II score was 16.55 clearly shows the severity and the complexity of substance use. The association between the severity/complexity of the participants with substance use was analysed by using the chi-square test and Fischer analysis.\u003c/p\u003e \u003cp\u003eThe result shows that marital status and education are not significantly associated with the severity of substance use. However, the severity of the substance use is associated with the type of illicit drugs used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0005). The severity of the substance use was also highly significantly associated with all the reasons presented in the current study such as peer pressure, curiosity, joy seeking, sex, relation problems, addict relatives, mental stress, strict family, lack of enjoyment, and routine stress (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A strong significant association between substance use and peer pressure (OR\u0026thinsp;=\u0026thinsp;24.98, 95% CI: 14.208\u0026ndash;43.945; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0005) and curiosity (OR\u0026thinsp;=\u0026thinsp;0.027, 95% CI: 0.11\u0026thinsp;\u0026minus;\u0026thinsp;0.068; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0005) was identified as the most influencing factors in the onset of the addiction (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Nonetheless, a statistically significant association exists between gender and facing trouble while using substances (p-value\u0026thinsp;=\u0026thinsp;0.010, Fischer\u0026rsquo;s exact test). This suggests that the likelihood of facing trouble while using substances may differ between males and females. These results underscore the complex challenges associated with drug addiction and its consequences on individuals and their social environment (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 01\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of substance use with the severity and complexity of the drug users\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDo you ever forget things you did while using these drugs?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHave you ever gotten into trouble while using these drugs?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61 \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80 \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.992 \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.661 \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubstance Use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003eType of substance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain Killer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStimulant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSedative\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarijuana\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCocaine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClub drugs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHallucinogens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeroin\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInhalants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMethamphetamine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e \u003cp\u003eReasons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeer Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCuriosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTry Something New\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJoy seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIllnesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMental Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily Dispute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoutine Stressors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddicted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Amusement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.028* \u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrict Family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.000* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00* \u003csup\u003eχ2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005*\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.595\u003csup\u003eŦ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eχ2\u0026thinsp;=\u0026thinsp;Chi-square test, Ŧ= Fischer Exact test, * p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 02\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between reasons and memory relapses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReasons\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePeer Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e14.208\u0026ndash;43.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.988\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCuriosity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026minus;\u0026thinsp;0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Logistic Regression Analyses revealed a significant association between peer pressure and curiosity in people who show memory impairment after using the drugs. *P-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 is considered significant.\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eAccording to our results, peer pressure is the primary catalyst for drug addiction in the Karachi population similar to studies done in other parts of the world [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Curiosity, the second highest motive behind drug abuse as per current results, remains consistent with similar studies done in other populations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study uncovers that most addicts are poly-drug users meaning they consume multiple or different types of drugs consecutively or all together and use illicit substances as well as legally accessible substances such as painkillers, stimulants, and sedatives. The illicit drug most commonly abused currently was found to be marijuana by 69% of participants. A decade ago, a survey done in Karachi revealed crack cocaine to be the most prevalent drug of abuse. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The shift from crack cocaine being the most abused drug in 2011 to marijuana in 2024 illustrates a significant change in drug prevalence over the decade.\u003c/p\u003e \u003cp\u003eIn a US-based study, researchers found that individuals who used a specific drug almost always had friends who had also used the same drug within the past 30 days [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Another cross-sectional study showed that negative peer pressure demonstrates a higher likelihood of engaging in binge drinking and lifetime marijuana use compared to no peer group [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Higher perceived drug use and increased drug-related knowledge from peers correlated with more frequent substance use among students [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, active parental monitoring and parental disapproval are linked to a reduced likelihood of polysubstance use [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Among drug users, the desire to try new things out of curiosity is frequently cited as one of the primary reasons for their substance use [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Curiosity triggers the activation of specific brain areas, including the substantia nigra, ventral tegmental area, and hippocampus. The connectivity among these regions is closely linked to the process of learning [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The results suggest that 14.2% of participants exhibit high levels of curiosity about using drugs. A 2019 study reported that heroin was the most abused among addicts while cannabis (marijuana) held second place among the Pakistani population [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. On the contrary, the current study shows that marijuana is the most widely abused illicit drug among addicts in Pakistan numbering up to 69% of the total participants. Moreover, the previous study was conducted on a smaller number of male participants (102) located in Islamabad, the capital of Pakistan, while the current study gives a bigger and more thorough analysis of drug addicts in the Karachi region, a metropolitan hub.\u003c/p\u003e \u003cp\u003eIn a study done in the USA, it was found that young people are increasingly using marijuana recreationally because they believe it to be a harmless drug. Over time, there has been a gradual increase in the concentration of active chemicals in recreational formulations that lead to cognitive impairment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Cannabis is being used more often around the world for both recreational and medical purposes, although the efficacy and adverse effects of its use are comparatively poorly supported by research [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. On the other hand, heroin is a highly addictive illegal drug. Its addiction is characterized by compulsive heroin use and a strong propensity to relapse following periods of abstinence. Chronic heroin use can also lead to serious health problems such as respiratory, hepatic, and renal diseases [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. According to a study, early adulthood, low social class, primary level of literacy, and stress, are important risk factors for heroin addiction in the Pakistani population [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are numerous reasons why cannabis use, particularly hashish consumption, is so high. First, networks connected to the drug trade in Afghanistan make it easily accessible. Second, many people hold the incorrect \u0026ldquo;belief\u0026rdquo; that hashish is not religiously prohibited and does not belong in the same category as alcohol or liquor. Thirdly, it is well-liked by people of all genders and classes and transcends class boundaries. Fourthly, it is reasonably priced as a recreational drug of choice because it is less expensive than alcohol. Fifthly, people mistakenly think that it does not have any addictive properties [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Most strikingly it is relatively cheap and can be purchased easily online through a credit card transaction.\u003c/p\u003e \u003cp\u003eCognitive deficits that result from continued drug use make it more challenging to achieve sustained abstinence [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The current study shows that 60.8% of patients reported being inattentive and having memory lapses after taking drugs. A study done in 2021, showed that 59.9% of patients relapsed after completing successful rehabilitation treatments [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our research centered on individuals who made earnest attempts to discontinue their drug usage but faced persistent difficulties in doing so. Alarmingly, approximately 95% of our participants experienced relapses, highlighting a significant and worrisome pattern. Toxic addiction is linked to genetic disturbances in dopamine affecting the reward system, leading to substance abuse and withdrawal symptoms [29]. The addiction cycle consists of three stages: intoxication, withdrawal, and anticipation. Neurobiological changes in brain circuits support drug addiction's rewarding nature, primarily through dopamine manipulation in the nucleus accumbens [30].\u003c/p\u003e \u003cp\u003eGabapentin, a neuropathic painkiller, was misused by 1% of the global population. Among them, 40\u0026ndash;65% had a prescription while 15\u0026ndash;22% were opioid abusers [31]..Misuse of prescription opioid pain relievers is associated with subsequent initiation of heroin use [32]. The current study shows that 41.7% of subjects were addicted to painkillers. Doctors must counsel patients about the addictive potential of prescribed painkillers. Methamphetamine is a potent and compulsive drug produced cheaply from basic chemicals like pseudoephedrine [33]. It has now been evaluated in this study that Methamphetamine is one of the leading abused drugs (52.5%) in the Pakistani addicted population. Cocaine use is increasing, especially among youth. It leads to frequent emergency room visits [34]. Cocaine was identified as the leading abused drug in the Pakistani population in the year 2011 [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Cocaine prevents neurotransmitter reuptake at neuronal synapses causing CNS depression [35].\u003c/p\u003e \u003cp\u003eMarijuana, commonly known as 'weed' or 'pot,' is a widely abused and trafficked illegal substance worldwide. It is predominantly used by young people (15 to 34 years old), with men using it more frequently than women [36]. Marijuana has psychoactive properties that affect the release of glutamate and GABA neurotransmitters which alter the reward perception, memory, learning, and pain. In healthy people, cannabis use is associated with a 2\u0026ndash;4 times higher risk of psychosis [37]. In the current study, we determined that 69% of participants abused marijuana of which 26.7% used it nearly every day. \"Club drugs\" encompass a diverse range of constantly evolving chemical substances used recreationally [38]. These include ecstasy, gamma-hydroxybutyric acid, ketamine, fry, and lysergic acid diethylamide (LSD) which are becoming a more pervasive part of young adult culture [39]. Heroin, a potent CNS depressant also known as diacetylmorphine, can cause fatal respiratory depression, especially after intravenous injection, and has a mortality rate of 1\u0026ndash;3% [40].\u003c/p\u003e \u003cp\u003eThe current study reveals how SUDs are significantly linked with negative peers and curiosity, mostly affecting youngsters to consume drugs like marijuana, cocaine, methamphetamine, etc, which are very potent drugs with higher relapse rates. SUDs burden society as a whole. These disorders increase the risk of suicide ideation, medical or psychiatric conditions, disability, and substance-related deaths. SUDs also contribute to housing instability, homelessness, criminal behavior, transmission of HIV and hepatitis, unemployment, and welfare dependency. Treating addiction and its associated medical and psychiatric disorders further adds to the strain on society [41]. In the future, more studies should be conducted among the Pakistani population on substance abuse to gather relevant data and gain more attention to the subject.\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003ePeer pressure was and still is the number one reason for the onset of addiction. However, many new reasons are now identified in Pakistan that were not previously correlated with addiction such as curiosity, lack of amusement, and joy-seeking. Adolescents and young adults in particular should be made aware of this issue to stop this social catastrophe and eradicate it from our society.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCredit authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSonia Siddiqui\u003c/strong\u003e: Conceptualization, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing, Validation, Formal analysis, Methodology, Supervision, Resources, Project administration and Software.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFarooq Khalid\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u0026nbsp;\u003cstrong\u003eFarhia Khalid\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u003cstrong\u003eAetesam Towheed\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u003cstrong\u003eShoaib Ahmed\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u003cstrong\u003eTalheen Naqvi\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u003cstrong\u003eHafsa Paracha\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis, Methodology. \u003cstrong\u003eTania Hassan\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis. \u003cstrong\u003eAyesha Owais\u003c/strong\u003e: Data curation, Writing \u0026ndash; original draft, Investigation, Formal analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Funding:\u0026nbsp;\u003c/strong\u003eThis research was funded by the DUHS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e Authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThe study was approved by the ethical review board No: IRB 3323/DUHS/Approval/2023/25 of Dow University of Health Sciences, Karachi.\u0026nbsp;Pakistan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eThe authors are thankful to the Addicare Rehabilitation Center, Karachi Neuropsychiatric Hospital, Karachi, Sadaqat Hospital, Karachi, and Dr. Abdul Qader Khan Institute of Behavioural Health Sciences, DUHS, Karachi for their help during the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSwimmer KR, Sandelich S. 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J Food Drug Anal. 2013;21(4):S73\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"substance use disorder, behavior, marijuana abuse, Peer pressure and Pakistan","lastPublishedDoi":"10.21203/rs.3.rs-4644279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4644279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo investigate the underlying causes that lead to the initiation of drug usage among drug addicts in Pakistan and to assess the prevalence of drug abuse and its association with influential factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study involved 598 adult males and 2 females. Participants were recruited from different psychiatric rehabilitation centres using the standard scoring scale of substance use according to The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. An additional questionnaire was used to assess the socio-demographic details.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of participants was 29.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76 years. The mean score of DSM-5 level 2 was 16.55. The logistic regression analysis shows a significant association between peer pressure (OR\u0026thinsp;=\u0026thinsp;24.98, 95% CI: 14.208\u0026ndash;43.945; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0005) and curiosity (OR\u0026thinsp;=\u0026thinsp;0.027, 95% CI: 0.11\u0026thinsp;\u0026minus;\u0026thinsp;0.068; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0005) with the severity of substance use. Sex (6.7%), relationship problems (6.7%), stress (5.3%), and strict family (6.7%) were also significantly associated with the severity of substance use. All polydrug users in this study were significantly associated with the severity of the drug. Marijuana (69%) was the most commonly used by the participants followed by heroin (56.9%) and methamphetamine (52.5%). It was found that substance use was significantly associated with memory impairment and violence. The majority of the participants (95%) have tried to stop using drugs. Age, marital status, and education are not associated with the severity of drug use.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings emphasize the urgency of tailored interventions and support strategies to combat substance addiction effectively.\u003c/p\u003e","manuscriptTitle":"Exploring the Prevalence and Determinants of Substance Use Among Drug Addicts in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 19:43:30","doi":"10.21203/rs.3.rs-4644279/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1448cb55-054c-4125-b0be-59bfc2bb8816","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T04:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-19 19:43:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4644279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4644279","identity":"rs-4644279","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}