Profile of Substance Addicts in North Cyprus: Analyzing Addiction Characteristics, Mental Problems and Personal Features
Abstract
This paper reports a study that investigated the characteristics of addicts based on their status as prisoners and non-prisoners in Northern Cyprus. This study aimed to present a profile of the characteristics of addicts according to their preference for substances, personal characteristics and mental problems, and their mental trauma status. Using a quantitative research design, a researcher-designed questionnaire was used to obtain the necessary data. The sample was extracted using convenience sampling from among who received training and consultancy services in 2020-21 under the Support Program of the Northern Cyprus Prime Ministry Anti-Drug Commission. Data analysis was done in SPSS, frequency-percentile and chi-square tests were used. When the personality traits of substance addicts are evaluated, it is seen that individuals in prison have a lack of safe behavior and excitement-seeking behaviour. The findings revealed that compared to the non-prisoner cohort, the prisoner cohort of the sample exhibited a higher frequency of lack of safe and excitement-seeking behaviours accompanied by a high level of psychological and mental traumatic experiences.
Keywords: Substance addiction, profile of addicts, personal development, Northern Cyprus, education
Introduction
The introduction is presented in line with the main research foci of the study which are to investigate addicts’ personal and mental problems, and if their status as prisoners or non-prisoners is a variable in their substance abuse characteristics.
The perspective of mental illness in relation to substance addiction
"Dual diagnosis" refers to the phenomenon in which a person is diagnosed with both a primary mental illness and another condition (such as an addiction to alcohol or another substance) at the same time. Research from all over the world has shown that this phenomenon is extremely common in people who suffer from severe (Drake et al., 1989; Drake & Wallach, 1989). Substance abuse is the comorbid condition that occurs with severe mental illness at the highest rate (Drake et al., 2001). Dual diagnosis is a cause for concern due to its large increase in prevalence and association with poorer clinical and psychosocial outcomes. Both of these factors contribute to the problem (Hunt et al., 2002). This comorbidity is a significant risk factor for medication noncompliance, clinical relapse (Swofford et al., 1996), psychiatric hospitalization (Prince et al., 2009), early readmission after discharge, and risk of overdose (Bartoli et al., 2014). Additionally, it has been shown to be associated with the human immunodeficiency (Fazel et al., 2009; Lamb & Weinberger, 1998). Despite this, dual diagnosis is frequently misunderstood, improperly diagnosed, and inadequately treated, leading to frequent and disorganized visits to emergency departments (Curran et al., 2003).
In different mental health settings, studies report rates of alcohol and/or substance use disorder among people with psychotic illness ranging from 20% to 37%. However, figures in addiction settings seem to be lower, ranging from 6% to 15%. It would appear that the rates are particularly high in forensic settings (62%), as well as in inpatient and crisis team settings (38–50%). In terms of geography, it seems that the highest rates are found in the more central parts of cities. Some racial and ethnic groups have a significantly higher proportion of patients in clinical populations who have a dual diagnosis (Carra & Johnson, 2009). The prevalence of substance use disorders among those who suffer from severe mental illness is, on average, higher in the United States than it is in Europe. The Epidemiological Catchment Area (ECA) study found that 47 percent of individuals diagnosed with schizophrenia also had a comorbid substance use disorder at some point in their lifetime (Regier et al., 1990). According to the National Comorbidity Survey (NCS), approximately half of respondents who answered questions for the survey and met the criteria for a substance use disorder at some point in their lives also answered questions for the survey and met the criteria for one or more mental disorders in their lifetime (Kessler et al., 1996). However, in the United States of America, pioneering studies conducted in a variety of mental health settings reported large variations in dual-diagnosis rates, ranging between 20% and 65% among people who suffered from severe mental illness (Cuffel et al., 1994). In addition, rates may differ depending on whether a region is rural or urban (Mueser et al., 2001) as well as the individual's ethnic background.
However, it is possible that differences in comorbidity rates can be attributed to methodological flaws. For example, samples have frequently been selected based on clinical convenience rather than on epidemiological principles (Carra & Johnson, 2009), and assessments of substance use have frequently been less than ideal, with relatively few studies conducting comprehensive diagnostic evaluations (Drake et al., 1993). Additionally, frequency has been described in relation to various factors, including point prevalence, period prevalence, and lifetime prevalence (Goldfinger et al., 1996), and dependence on alcohol and other drugs is frequently not reported separately, despite the fact that the consequences of each may be different for people who have schizophrenia (Potvin et al., 2006).
The perspective of substance addiction from a sociological point of view
Psychiatrists often view the use of opiates as an escape from life, and they view addicts as flawed individuals who are trying to compensate for, or avoid, their inferiorities and mental conflict. Those who are addicted to opiates are often viewed as defective (Lindesmith, 1938). In light of the well-known fact that an addict will invariably assert that the only thing the drug does for him is make him feel "normal," the idea that opiates provide an escape from life does not appear to be satisfactory or accurate either. While it is true that during the first few weeks of use the drug may cause pleasure in some cases and may function as a means of escape, once addiction has been established, this no longer holds true, as it is generally agreed upon that the euphoria that is associated with the use of opiates is highly transient in nature. The drug addict, who is supposed to derive some mysterious and uncanny pleasure from the drug, not only fails to do so as a rule, but is also keenly aware of the curse of addiction and struggles to escape it. In other words, the drug addict does not experience the pleasure that is supposed to be derived from the drug. In reality, he is one of the most obviously anxious and miserable beings in our society, despite the fact that he is a long way from being released from his obligations.
Addiction in prison
A significant number of incarcerated individuals have a previous record of substance abuse as well as a substance use disorder (SUD) (Fazel et al., 2017; UNODC, 2019). The pooled prevalence estimates for substance use disorders was found to be 51% among women and 30% among men, according to a recent systematic review and meta-analysis (Fazel et al., 2017). People with substance use disorders who are incarcerated are more likely than other inmates to have a wider variety of mental and social issues, including lower educational qualifications, lower rates of employment, more difficulties finding housing, poorer physical health, and a greater number of behavioral, psychological, and psychiatric issues (Dolan et al., 2018; Kinner & Rich, 2018).
It is estimated that approximately one in every three people who are currently being held in prisons around the world have tried drugs at least once while they were behind bars (UNODC, 2019). According to estimates provided by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), between 2 and 31 % of people incarcerated in European countries inject drugs (EMCDDA, 2012). People who inject drugs are at a greater risk of contracting communicable diseases such as HIV and hepatitis (Kinner et al., 2012) due to the fact that sharing needles is more common in correctional facilities than in community settings (van der Meulen, 2017). Previous research has also established that injecting drug use (IDU) while incarcerated is a significant risk factor for continuing IDU after release (Winter et al., 2019), and that IDU is an independent risk factor for reincarceration after release from prison. Both of these findings were published in the journal Addiction (Winter et al., 2019). Although a significant number of people end up in prison due to issues that are connected to their drug use (Csete et al., 2016), for some, drug use may begin while they are incarcerated. According to the findings of some studies, the use of drugs in prison is a natural progression from drug use and SUD prior to imprisonment, and that patterns of drug use in prison are a reflection of patterns of drug use prior to incarceration (Cope, 2000; Strang et al., 2006). However, there is a lack of consistency in the research that has been done on this topic, and it has been suggested that the high-risk environment of prisons is particularly conducive to the beginning stages of drug use (Boys et al., 2002).
Substance preferences
A lifetime experience rate for cannabis in European countries ranges from 0.7% to 35.6%, with an average rate of 2.8% for cocaine, 2.3% for amphetamines, and 2.5% for ecstasy among people aged approximately 15–64. In addition, the EMCDDA collects data on the prevalence of problem drug use, which is defined as injecting opioids or long-term or regular use of cocaine and/or amphetamines. These rates range from 8.2 to 0.3 and 0.22 to 5.68 per 1000 adults, respectively (Carra et al., 2015).
Purpose of the Study
The aim of this study is to describe the characteristics of addicts according to their status as prisoners or non-prisoners, by comparing their preference for substances, personal characteristics and mental problems, and their mental trauma status. It is aimed to evaluate the effects of being involved in crime on addicts. By emphasizing personality development, the study aims to reveal the possibility of developing the addicts’ personal strengths to overcome their addiction through education.
Research Questions
The study is driven by the following questions:
- What characteristics do substance use addicts in Northern Cyprus exhibit?
- Which substances do addicts in Northern Cyprus prefer to use?
- What are the personal characteristics and mental problems of addicts in Northern Cyprus?
- What mental trauma situations have addicts in Northern Cyprus experienced?
Method
Research design
The research design is quantitative in nature enabling the research to be carried out in accordance with the descriptive model.
Participants
Using a convenience sampling technique, a total of 102 (67 prisoner, 35 non-prisoner) individuals who had received training and consultancy services in 2020-21 under the Support Program of the Northern Cyprus Prime Ministry Anti-Drug Commission volunteered to participate in the study. The participants’ identity was kept anonymous throughout the research process.
Instrument
A researcher-designed questionnaire was used to obtain the data for this study. The questionnaire was reviewed thoroughly and passed for implementation by a panel of academics and psychologists specializing in working with substance addiction. Before the questionnaire was used, a pilot study was conducted on 15 prisoners and 15 non-prisoners.
The study participants were primarily classified as prisoners and non-prisoners. The questionnaire comprised several sections of close-ended multiple-choice items which were used for both groups. The sections covered information on the demographic background of the addicts themselves and their families such as their education level, place of residence, how they spend their spare time, occupational status, and economic status. Family related questions included whether they had children, with whom they had lived with for the last six months, the status of their relationship with their spouse and their parents.
Separate sections contained items on their physical-mental health status, drug use, and personality traits. The items on their substance use included whether their friends used drugs, if they had access to drugs, whether they benefited from probation, whether they had been in prison, and their preference for drugs.
Procedure
The individuals participating in the study were first informed about the research and given the Information Form, and then the volunteers were included in the study by filling out the written consent forms.
Data Analysis
All the questionnaires were returned making it a 100% response rate. However, not all the items were answered by all the participants. The returned questionnaires were analyzed using SPSS. Simple frequencies and distribution are presented in tables below. Since all the variables in the study were categorical, chi-square tests were used to determine the presence of a significant difference between the categorical variables. The significance level was based on a value of 0.05.
Findings and Discussions
The data analysis are presented in tabular format based on the order of the research questions for both cohorts of prisoners and non-priosners.
Table 1 shows that 33 (51.6%) of the prisoner cohort exhibited a low-medium level of addiction, while 31 (48.4%) exhibited a high level of addiction. As for non-prisoner cohort, 18 (52.9%) exhibited a low-medium level of addiction and 16 (47.1%) exhibited a high level of addiction.
In terms of substance cravings, 52 of the prisoner cohort exhibited a low-medium level and 12 a high level of substance cravings while for the non-prisoner cohort, 20 (57.1%) exhibited low-medium levels and 15 (42.9%) exhibited high levels of substance cravings.
As for the effect of substance use for the prisoner cohort, 35 (54.7%) exhibited low-medium effects while 29 (45.3%) exhibited high-level effects. As for non-prisoners, 18 (51.4%) exhibited a low-medium level, and 17 (48.6%) exhibited a high level. The effect of substance use on life was evaluated by measuring several factors such as relationship with family and friends, work, education, physical health, economic and legal problems.
With regard to the intensity of substance use, 31 (48.4%) of prisoners exhibited a low-medium level of substance use and 33 (51.6%) exhibited a high level of substance use. As for the non-prisoners, 13 (38.2%) exhibited a low-medium level and 21 (61.8%) exhibited a high level of substance use.
A significant difference only emerged among the prisoners and non-prisoners with regard to the variable of substance craving while other variables did not make a significant difference.
Table 2 shows the addicts’ preferences for substances. For the prisoners, 18 (27.3%) opted for synthetic cannabinoids, 35 (53.0%) marijuana, 2 (3.0%) ecstasy, 1 (1.5%) heroin, 4 (6.1%) cocaine, and 2 (3.0%) alcohol. 4 (6.1%) did not respond to this item. For non- prisoners, preferences ranged from synthetic cannabinoid 11 (31.4%), marijuana 10 (28.6%), ecstasy 3 (8.6%), heroin 2 (5.7%), cocaine 1 (2.9%), pills 1 (2.9%), and alcohol 5 (14.3%). 2 (5.7%) did not respond to this item.
Substance preference did not make a significant difference among the two cohorts.
Table 3 reveals the analysis of items related to mental problems and personality traits of substance addicted individuals. Of the prisoners’ cohort, 37 (56.9%) do not suffer from depression while 28 (43.1%) do. 32 (49.2%) do not suffer from anxiety, while 33 (50.8%) do. In terms of anger control, 34 (52.3%) can control their anger, while 31 (47.7%) have anger control problems. 35 (53.8%) exhibit a lack of safe behavior while 30 (46.2%) exhibit safe behavior. In terms of sensation seeking behavior, 22 (33.8%) do not seek excitement while 43 (66.2%) do. 37 (56.9%) do not exhibit impulsive behavior while 28 (43.1%) do. As for mental trauma status, 35 (64.8%) did not suffer psychological trauma while 19 (35.2%) do.
As for the non-prisoner cohort, in terms of their mental problems and personality traits, 11 (31.4%) do not suffer from depression while 24 (68.6%) do. 15 (42.9%) do not suffer anxiety while 20 (57.1%) do. 9 (25.7%) do not have anger control problems, while 26 (74.3%) do. 27 people (77.1%) exhibit a lack of safe behavior and 8 people (22.9%) exhibit safe behaviour. 9 (25.7%) are not excitement seekers while 26 (74.3%) are. 13 (37.1%) do not exhibit impulsive behavior while 22 (62.9%) do. As for mental trauma, no psychological trauma was indicated in 18 people (52.9%) compared to 16 (47.1%) who do.
The examination of the chi-square results revealed that three variables - depression, anger control problem, and lack of safe behavior - made a significant difference in the prisoner and non-prisoner cohorts.
Table 4 reveals the analysis of items related to mental trauma events. For the prisoner cohort, 32 (49.2%) have not experienced a fire, flood or other disaster or a serious traffic accident to date, while 33 (50.8%) have. In terms of experiencing physical assault or beating to date, 17 (26.6%) were not exposed to this situation while 47 (73.4%) were. In terms of being exposed to sexual assault or harassment, 60 (93.8%) said that they had not while 4 (6.3%) said they had. 23 (35.9%) had not experienced the sudden and unexpected loss of a loved one, while 41 (64.1%) had. 42 (65.6%) had not experience being in gunfights, while 22 (34.4%) had. 47 (73.4%) had not lost a relative due to murder or suicide, while 17 (26.6%) had. 23 (23.9%) had never seen an injured or dead person, while 41 (64.1%) had. 36 (60.0%) had not experienced very bad and unbearable events in their childhood, while 24 (40.0%) had.
For the non-prisoner cohort in terms of the items related to mental trauma events, 15 (42.9%) have not experienced a fire, flood or a serious traffic accident while 20 (57.1%) have. 12 (34.3%) have not exposed to a physical assault or beating while 23 (65.7%) have. 29 (87.9%) have never experienced sexual assault or harassment, while 4 (12.1%) have. 11 (31.4%) people have not experienced the sudden and unexpected loss of a loved one, while 24 (68.6%) have. 27 (77.1%) have never been in a gunfight, while 8 (22.9%) have. 21 (60.0%) have not lost a relative due to murder or suicide, while 14 (40.0%) have. 18 (51.4%) have never seen an injured or dead person while17 (48.6%) have. 15 (42.9%) have not experienced very bad and unbearable events in their childhood, while 20 (57.1%) have.
The mental trauma variable was not significant in terms of whether substance addicts were in prison or not.
Discussion and Conclusion
A summary of the results is presented accompanied by a discussion supported by previous literature.
The evaluation of the results in Table 1 reveals that the substance use characteristics of the participants in terms of their addiction intensity, substance cravings, the effect of substance use on life and the effect of substance use are higher for the prisoner cohort compared to the non-prisoner cohort. Interestingly, substance craving was found to be higher among the non-prisoners compared to the prisoners. This is perhaps because it is more convenient for addicts who are not in prison to access these substances. A study conducted by Çöpoğlu et al. (2014), which investigated the characteristics of prisoner addicts and non-prisoner addicts were examined found that the main determining variable was substance use so that the rate of involvement in crime was higher for addicts with high substance use. However, in addition to the substance use variable, gender and education level were also found to be important variables. Studies have (Çöpoğlu et al, 2014) revealed that addicts who commit crimes are mostly male and their education level is low.
Motivational sessions with addicts are required to help them quit the substance. In addition, psychological support, psychoeducation and coping mechanisms to deal with substance cravings should be taught to them. Hence, focused educational interventions are necessary to help addicts overcome their addiction.
It is believed that certain problems faced by addicts can be solved with outpatient treatment (Yoldaş & Demircioğlu, 2020). In this case, special studies should be conducted by experts especially for addicts in prison and focused psychological support should be provided for them. Successful treatment programmes conducted by other countries could be studied and applied in the North Cyprus context.
In terms of the second research question of the study, the analysis in Table 2 reveals that the top drug choice of prisoners is cannabis, specifically synthetic cannabinoid type drugs. Synthetic cannabinoid is also the preferred substance among the non- prisoners, though it has almost the same rate of use as cannabis. The easy accessibility of cannabis can explain this finding. Ögel et al. (1999) established a relationship between substance use and crime. According to the results of this study, pill users were more likely to commit crime, while heroin users commit more substance-related crimes.
In terms of mental problems, the prisoner cohort suffered more from anxiety, exhibited a lack of safe behavior and mood disorder, while the non-prisoner cohort exhibited more depression, anxiety, anger, lack of safe behavior, mood disorder and impulsive behavior. This reveals that the addicts, be they prisoners or non-prisoners, suffer from a range and intensity of mental problems. Mir et al.’s study (2015) revealed that affective, personality and anxiety disorders were intense, especially in female prisoners with addiction.
One of the causes of addiction is psychological disorders and mood disorders. It is known that many people struggling with addiction actually resort to alcohol or drugs in order to relieve the symptoms of their psychological disorders. Although the visible problem is addiction, it has been revealed in many studies that the cause of addiction is mostly psychological (Nalbantoğlu, 2021). It is important here to determine whether the mental problems accompanying addiction are caused by the substance or occurred before the substance use. However, in both cases, the continuation of the treatment of mental problems together with the treatment of addiction gains importance in terms of the effectiveness of the treatment.
The analysis of the personality traits of addicts reveals that individuals in prison exhibit a lack of safe behavior as well as excitement-seeking behaviors. In some studies, features such as sensation seeking, impulsivity, and social maladjustment are associated with the quality of the relationship with parents in the first years of childhood. Cuomo et al.’s study (2008) investigated childhood traumas of substance addicted prisoners and found that the childhood traumas of substance addicted prisoners are much higher than non-substance-addicted prisoners. In addition to causing the initiation and continuation of alcohol-substance use, personality traits also have the power to direct behavior. The existence of a full-fledged rehabilitation center becomes important in the need to conduct special studies to determine focused interventions according to the personality characteristics of individuals who are in prison or not, to conduct studies with families, and to continue the rehabilitation process for an extended duration. Hiller, Knight, and Simpson's research (1999) revealed that psychoeducation applied to substance addicted prisoners continues to be effective and reduces crime rates after prisoners are released from prison. Hence, the importance of focused educational interventions cannot be underestimated in helping addicts, wherever they are, overcome their addiction and lead productive happy lives.
The analysis also reveals that individuals, be they prisoners or non-prisoners, have experienced a high level of psychological trauma establishing the premise that addicted individuals seem more likely to have been exposed to trauma. Several studies (Brady, Krebs & Laird, 2004) concur with this as they have shown that the presence of a history of trauma also creates a predisposition to alcohol and/or substance addiction. Hence, psychological and psychiatric support, psychoeducation, and psychoeducation for families should be provided in order to completely treat drug use and addiction, and to treat trauma and addiction together in order to keep the individual free from drug use. Fazel, Bains and Doll (2006) also emphasize that special addiction services for substance addict prisoners will have a significant impact.
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eBook ISBN
978-1-80296-959-7
Publisher
European Publisher
Volume
3
Print ISBN (optional)
-
Edition Number
1st Edition
Pages
1-245
Subjects
Education, educational psychology, pedagogy, positive pedagogy, special education, second language teaching
Cite this article as:
Tremeşeli, T. T., & Tekyaprak, N. (2022). Profile of Substance Addicts in North Cyprus: Analyzing Addiction Characteristics, Mental Problems and Personal Features. In A. Güneyli, & F. Silman (Eds.), ICEEPSY 2022: Education and Educational Psychology, vol 3. European Proceedings of International Conference on Education and Educational Psychology (pp. 126-138). European Publisher. https://doi.org/10.15405/epiceepsy.22123.11