UNITY UNIVERSITY

FACULITY OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH

FINAL RESEARCH
PAPER

June/2023
i|Page
Addis Ababa/Ethiopia
 HEALTH SCIENCE FACULITY

DEPARTMENT OF PUBLIC HEALTH

Assessing the factors that are negatively affect recovery from substance use disorders
among patients who are receiving treatment at St. Paul's Hospital Millennium Medical
College addiction treatment center, Addis Ababa, Ethiopia 2023.

A research paper submitted to the department of Public Health, faculty of Health Science, Unity
University, in partial fulfillment of the requirement for the bachelor‘s degree in Public Health.

June/2023

Addis Ababa/Ethiopia

ii | P a g e
 UNITY UNIVERSITY

HEALTH SCIENCE FACULITY

DEPARTMENT OF PUBLIC HEALTH

Assessing the factors that are negatively affect recovery from substance use disorders
among patients who are receiving treatment at St. Paul's Hospital Millennium Medical
College addiction treatment center, Addis Ababa, Ethiopia 2023.

A research paper submitted to the department of Public Health, faculty of Health Science, Unity
University, in partial fulfillment of the requirement for the bachelor‘s degree in Public Health.

Advisor: ZELALEM KEBEDE. (PHD CANDIDATE)

June/2023

Addis Ababa/Ethiopia

iii | P a g e
 Member’s Name & Id No

Name Id-Number Phone No Email

Abel Tekle Dejene UUSCHS/112/12R +251-900-05-87-74 Abeltekle90@gmail.com
Dawit Samuel Mekonnen UUSCHS/202/12T +251-940-46-69-77 Dawitsamuelmekonnen@gmail.com
Ephrem sisay Beyene UUSCHS/125/12R +251-939-50-80-51 ephremsisay08@gmail.com
Eskindir Solomon Tesfaye UUSCHS/126/12R +251-960-15-87-92 eskindirsolomon42@gmail.com
Ruth Tedla Tesfaye UUSCHS/150/11T +251-980-63-26-43 ruthtedlatesfaye@gmail.com
Tsegaye Orebo Olbamo UUSCHS/190/12R +251-910-30-31-83 tsegayeorebo615@gmil.com

Advisor

Zelalem Kebede (PHD CANDIDATE)

+251-911-80-64-65

Zelalemkebede65@gmail.com

iv | P a g e
 Unity University

Faculty of Health Science

Department of Public Health

This is to certify that this research paper is prepared by, Abel Tekle, Dawit Samuel, Ephrem
Sisay, Eskindir Solomon, Ruth Tedla, and Tsegaye Orebo: Assessing the factors that are
negatively affect recovery from substance use disorders among patients who are receiving
treatment at St. Paul's Hospital Millennium Medical College addiction treatment center, Addis
Ababa, Ethiopia 2023. Submitted in partial fulfillment of the requirement for the bachelor‘s
degree in Public Health Officer complies with the regulations of the university and meets the
accepted standards with respect to originality and quality.

Approval of the board examiners:

_________________ _________________ _________________

Name, Advisor Signature Date

_________________ _________________ _________________

Name, Internal Examiner Signature Date

_________________ _________________ _________________

Name, External Examiner Signature Date

v|Page
Dedication
We dedicate this paper for those who lost their life with the complication of addiction.

vi | P a g e
Acknowledgement
First of all we would like to thank the school of Public Health of Unity University for supporting
and allowing us to develop this final research paper. We would like to thank all instructors of
unity university faculty of health science.

Dear Zelalem K.,

Strangely enough, we would like to commence by extending our gratitude and appreciation to
you. Apart from the efforts of us, the success of this paper depends largely on your existence.
Existence? Yes, in your existence, we enjoy the fruits of your encouragement and guidance‘s.

The group members hardly knows where to start expressing the gratitude but for sure the
gratitude goes to all those who have assisted them in the process of completing this paper. We
also want to pass our super-sensational gratitude to Unity University.

All the school community, teachers, advisers, respondents, families and friends, will take our
eternal gratitude.

The Group Members

June/2023

Addis Ababa/Ethiopia

vii | P a g e
Abstract
Background

Addiction is a complex condition, manifested by uncontrollable substance use that affects

psychological and physical wellbeing. People with addiction mainly focused on consuming the
substance further than their life. There are three steps in relapse emotional relapse, mental
relapse, and physical relapse.

The aim of the study was to identify the causes and the factors of relapse, and to identify the
most common substances that are mostly used among substance users after substance use
disorder treatment.

Methodology

A quantitative, exploratory case study research design was used for the study. A total of 213
patients with relapse case under treatment were selected using purposive sampling technique. In
using this technique, it was supplemented by inclusive criteria to make the selection free of the
researcher‘s bias. The data were analyzed using SPSS analysis. The site of the study was St. Paul
Millennium medical college rehabilitation center.

Result

The findings show that psychosocial effects like negative emotional states, lack of support, and
peer pressures are recounted in factors causing relapse. Environmental factor and Economic
problems are the other relevant causes of relapse revealed by the study. The finding also revealed
that, health, psychology, social relationship, religion/spirituality and economy were also the
factors that make relapse.

Recommendation

It is recommended that structured, holistic aftercare should be implemented. Effective relapse

prevention should be made by understanding causes of relapse. Based on the findings of the
study, future research areas and effective interventions were forwarded. There are only few
researches done on the causes of relapse in Ethiopian context, so this research will contribute
essential information for future researchers.

Key words: Drug, Substance Use, Substance abuse, Substance user and Relapse.

viii | P a g e
Acronyms
AAU: Addis Ababa University

AOR: Adjusted Odds Ratio

CAGE-AID: Cut down, Annoyed, Guilty, Eye-opener- Adapted to Include Drug Use

CAS: College Alcohol and Smoker

CBE: College of Business and Economics

CDANR: College of Dryland Agriculture and Natural Resources

CI: Confidence Interval

CLG: College of Law and Governance

CNCS: College of Natural and Computational Sciences

DACA: Drug Administration and Control Authority of Ethiopia

EiT-M: Ethiopian Institute of Technology-Mekelle

LSD: Lysergic Acid Diethyl amine

MU: Mekelle University

OR: Odds Ratio

SPSS: Statistical Package for Social Sciences

SRS: Simple Random Sampling

UNODC: United Nations Office on Drugs and Crime

WHO: World Health Organization

ix | P a g e
Contents
Dedication .................................................................................................................................................... vi
Acknowledgement ...................................................................................................................................... vii
Abstract ...................................................................................................................................................... viii
Acronyms ..................................................................................................................................................... ix
Chapter one .................................................................................................................................................. 1
Introduction .................................................................................................................................................. 1
1.1 Background ............................................................................................................................................. 1
1.2. Statement of the problem ..................................................................................................................... 3
1.3. Research questions ................................................................................................................................ 4
1.4. Scope of the study ................................................................................................................................. 4
1.5. Significance of the study ........................................................................................................................ 4
1.6. Organization of the paper ...................................................................................................................... 5
1.7. Conceptual frame-work ......................................................................................................................... 6
Chapter Two .................................................................................................................................................. 7
Literature review........................................................................................................................................... 7
2. Substance use ........................................................................................................................................... 7
2.1. Substance use as an international problem........................................................................................... 7
2.2. Substance use in Africa .......................................................................................................................... 8
2.3. Substance use in Ethiopia ...................................................................................................................... 8
2.4. Factors of Substance use ....................................................................................................................... 9
2.4.1. Common and Unique Features of Substance Use .............................................................................. 9
2.5. Substance use in Low Income Countries ............................................................................................... 9
2.5.1. A case from Ethiopia ......................................................................................................................... 10
2.6. Factors associated with drug use ......................................................................................................... 10
2.6.1. Risk and protective factors ............................................................................................................... 10
2.6.1.1. Personal risk factors ....................................................................................................................... 11
2.6.1.2. The Environmental Risk Factors ..................................................................................................... 11
2.7. Substance use and culture ................................................................................................................... 11
2.8. Family and substance use .................................................................................................................... 12
2.9. Substance use and crime ..................................................................................................................... 12

v|Page
2.10. Substances most commonly used...................................................................................................... 12
2.11. Substance use and health .................................................................................................................. 12
2.12. Prevention and control ...................................................................................................................... 13
2.13. Studies on Relapse ............................................................................................................................. 13
2.13.1. Factors Contributing to Addiction Relapse among Drug Addicts ................................................... 13
2.13.1.1. Psychological Factors of Relapse ................................................................................................. 13
2.13.1.2. Social Factor of Relapse ............................................................................................................... 14
2.13.1.3. Environmental Factors of Relapse ............................................................................................... 14
2.14. Summary of Literature Review .......................................................................................................... 14
Chapter Three ............................................................................................................................................. 15
3. Objective of the Study............................................................................................................................. 15
3.1. General Objective ................................................................................................................................ 15
3.2. Specific Objective ................................................................................................................................. 15
Chapter Four ............................................................................................................................................... 16
Methodology............................................................................................................................................... 16
4. Methods and material ............................................................................................................................ 16
4.1. Study area and study period ................................................................................................................ 16
4.2. Study design ......................................................................................................................................... 16
4.3. Population ............................................................................................................................................ 17
4.3.1. Source population ............................................................................................................................. 17
4.3.2. Study population ............................................................................................................................... 17
4.4. Inclusion and exclusion criteria............................................................................................................ 17
4.4.1. Inclusion criteria................................................................................................................................ 17
4.4.2. Exclusion criteria ............................................................................................................................... 17
4.5. Study unit (N) ....................................................................................................................................... 17
4.6. Study variable....................................................................................................................................... 18
4.6.1 Independent variables ....................................................................................................................... 18
4.6.2. Dependent variables ......................................................................................................................... 18
4.7. Sample size determination .................................................................................................................. 18
4.8. Sampling techniques ............................................................................................................................ 19
4.9. Data collection methods ...................................................................................................................... 19
4.10. Data collection tools .......................................................................................................................... 20

vi | P a g e
4.11. Sources of data .................................................................................................................................. 20
4.11.1. Primary data.................................................................................................................................... 20
4.11.1.1. Interview ...................................................................................................................................... 20
4.11.2. Secondary data ............................................................................................................................... 20
4.12. Data collectors ................................................................................................................................... 20
4.13. Data quality control ........................................................................................................................... 21
4.14. Data processing and analysis ............................................................................................................. 21
4.15. Strength of the study ......................................................................................................................... 21
4.16. Materials used in the study................................................................................................................ 21
4.17. Operational definition........................................................................................................................ 21
4.18. Ethical consideration.......................................................................................................................... 22
4.19. Dissemination of the result ................................................................................................................ 23
Chapter Five ................................................................................................................................................ 24
5. Result ...................................................................................................................................................... 24
5.1 Background of the respondents............................................................................................................ 24
5.2. Themes ................................................................................................................................................. 28
Chapter Six .................................................................................................................................................. 43
6. Discussion................................................................................................................................................ 43
Chapter Seven ............................................................................................................................................. 46
Conclusion and Recommendation .............................................................................................................. 46
Reference .................................................................................................................................................... 47

vii | P a g e
List of Tables

Table 1: socio-demographic result of the respondents ................................................................................ 26

Table 2: Parents r/ship status ...................................................................................................................... 26
Table 3: Educational status of respondent‘s father ..................................................................................... 27
Table 4: Educational status of respondent‘s mother ................................................................................... 27
Table 5: How often did you chew khat ....................................................................................................... 29
Table 6: How often do you smoke? ............................................................................................................ 30
Table 7: what alcohol do you consume? ..................................................................................................... 32
Table 8: What illegal or non-medical addictive drugs did you use? ........................................................... 33
Table 9: How long did you use these drugs? .............................................................................................. 33
Table 10: Table 10: have you ever use or tried injecting drugs using syringes? ........................................ 33
Table 11: How many times did you treat for substance use disorder? ........................................................ 36
Table 12: Most commonly used substances or drugs.................................................................................. 39
Table 13: What alcohol is commonly used? ............................................................................................... 39
Table 14: What illegal or non-medical addictive drugs are most commonly used? ................................... 40
Table 15: Factors for relapse ....................................................................................................................... 40
T able 16: Causes for relapse ...................................................................................................................... 40
Table 17: Correlation of demographic result and factors............................................................................ 42

viii | P a g e
List of figures

Figure 1: Use of substance or drugs in the family ...................................................................................... 28

Figure 2: In what age did the respondents starts using substance or drugs ................................................. 28
Figure 3: Did you smoke cigarette or tobacco ............................................................................................ 29
Figure 4: How many cigarettes do you smoke per day? ............................................................................. 30
Figure 5: Have you ever consumed alcohol? .............................................................................................. 31
Figure 6: How often do you consume alcohol? .......................................................................................... 31
Figure 7: what is the usual amount you consume alcohol? ......................................................................... 32
Figure 8: What are the risk factors? ............................................................................................................ 34
Figure 9: How long did you use substance or drugs? ................................................................................. 35
Figure 10: Did you know that using substance or drugs have consequences ............................................. 35
Figure 11: Do you think the treatment was effective? ................................................................................ 36
Figure 12: How difficult was to stop consuming after the treatment? ........................................................ 37
Figure 13: What are the causes for relapse? ............................................................................................... 38
Figure 14: What is the time gap between taking substance or drugs after the treatment? .......................... 38

ix | P a g e
Chapter one

Introduction

1.1 Background
Addiction is a complex condition, manifested by uncontrollable substance use that affects
psychological and physical wellbeing. People with addiction mainly focused on consuming the
substance further than their life (Parekh, 2017).

Substance abuse is a patterned, harmful and hazardous use of psychoactive substance (drug)
including alcohol and illicit drugs in which the user consumes the substance in amounts or with
methods which are harmful to them or others (WHO, 2021 and Chan et al., 2016).

Illegal drug abuse is an international problem, which affects almost every country in the world,
both developed and developing countries. Drug abuse must be considered as a total community
problem and thus it is the responsibility of everyone to tackle it. Alcoholism, cigarette smoking,
khat chewing and using other drugs are the day-to-day phenomena seen in our communities (A
module on Substance Abuse for the Ethiopian Health Center Team, 2005).

The history of the human race has also been the history of drug abuse. The use of psychoactive
drug has spread to the young population in every part of the world starting from 1980‘s (WHO,
2004).

Recent estimates are that in 2008, 155 to 250 million people, or 3.5% to 5.7% of the world‘s
population aged 15-64, used other psychoactive substances, such as cannabis, amphetamines,
cocaine, opioids, and non-prescribed psychoactive prescription medication. The use of
psychoactive substances causes significant health and social problems for the people who use
them, and also for others in their families and communities (WHO, 2021).

Globally, drugs and substance abuse continue to be a challenge, especially among the youth in
school and out of school. It impacts negatively on the academic, social, psychological, and
physical development among the abusers (Quinter et al., 2019).

Psychoactive substance use, such as drinking alcohol, cigarette smoking, khat chewing, cannabis
use, and use of illicit drugs, is a public health concern worldwide.

In 2018, it is estimated that, 269 million people used drugs worldwide, which shows a 30 %
increment compared to drug users in 2009. More than 35 million people suffer from drug use
disorders reported by world drug report (UNODC, 2020). Drug problem grow into a global
problem when in view of that more than 1 out of 10 suffers from drug use disorders. Globally, it
is estimated that 192 million people used cannabis in 2018.
1|Page
The drug contains different substances which are responsible for altering the chemistry of the
brain and thereby change the physical, psychological, and behavior of the users (Gorski &
Merlene, 1986).

The social and environmental setting can‘t accept changes caused by addiction so that it may
place the individual at risk of harm. People with addiction got into difficult situations to use the
substance because they were only concerned about consuming it. They stop caring for their
hygiene, appearance. They lose confidence and start distancing themselves from society
(Saripalli, 2018).

In the Ethiopian context, substance use is increasing from time to time (Fekadu, Desta, Alem &
Martin 2007). Another study indicates that there is an increasing occurrence of substance use in
Ethiopia mostly among high school and University students (Tesfaye et al., 2014). Most recent
research shows that environmental factors as well as psychosocial factors such as negative
emotional states are described as one of the triggering factors causing relapse (Jufar, 2019).

People with addiction get different treatments. The most effective treatment is a treatment that
cooperates with medical and different therapies. Treatment that considers the individual
situation, co-occurring medical, psychiatric, and social problems can lead to sustained recovery.
However, there are short-term health problems that occur after withdrawal, like body shaking,
appetite loss, weakness, and headache (Saripalli, 2018).

There are three steps in the process of relapse. Emotional relapse is the main stage on the relapse
process. In this phase, it occurs very early and the patient in recovery might not think to lapse.
Even In this stage, different emotional breakdowns will be revealed such as anger, moodiness,
and anxious feelings, and others (Ackermann, 2019).

Mental relapse is another phase on relapse process. In this stage, the patient in recovery is
struggling not to lapse. There will be two different things that confuse the patient, one is return
using the drug and the other is not to use. In this stage, the patient thought using it and it is very
difficult to stop the process (Ackermann, 2019).

Physical relapse is the last stage happened when the patient starts consuming again. Taking the
drug once can lead to recurrent substance abuse behavior. (Ackermann, 2019).

2|Page
1.2. Statement of the problem
Addiction has many effects which will be revealed in a short period of time or in the long run,
directly or indirectly. These multi-dimensions effects are determined by the type of drug,
severity of drug use, intensity of drug use.

Global prevalence rates of alcohol use disorders were estimated to range from 0–16% among
adults in 2004.Global prevalence rates of illegal drug use disorders were also estimated to range
from 0–3% among adults in 2004 (WHO, 2004). A later WHO report shows the global burden of
disease attributable to alcohol and illicit drug accounts 5.4% of the total burden of disease.
Another 3.7% of the global burden of disease is attributable to tobacco use (WHO, 2004).

Due to the rapid pace of change in the economic and social sphere and prevailing political
instability in many African countries, alcohol and other psychoactive substance use and related
problems are becoming major public health concerns (WHO/UNDCP, 2003).

Recent studies in Africa indicate a high prevalence of substance use among young people when
compared to the general population, with associated physical and psychosocial problems such as
fighting, vandalism, theft, engaging in unprotected sex, personal injury, medical problems and
impaired relationships with family and friends. A recently published systematic review found
that the overall prevalence of ‗any substance use‘ among adolescents in sub-Saharan African is
41.6%, with alcohol and tobacco being the highest prevailing substances across the continent
compared to any other substance use (Olawole-Isaac et al., 2018).

In Ethiopia, substance use is one of the problems like many other developing countries In
Ethiopia, more than 50% of the population is young and over 15% is illegal drug users. (Federal
Democratic Republic of Ethiopia population census commission, 2008).

A study in Haramaya University revealed that, 62.4% of the overall populations use at least one
substance. 50.2% uses alcohols, 41% use Khat, 22% uses Cigarettes and 17% uses other illicit
drugs (Tesfaye et al., 2014).

Mostly in developing countries like Ethiopia, it is hard to attain education and job opportunities
easily so that many young people are vulnerable to practicing harmful things including using
drugs which lead them to addiction. After realizing the negative effects of the drugs on their
health, social life, and economic aspects, they want to stop using the drugs. The drug users starts
treatment after understanding the difficulty to stop by their effort however, most of them fail and
start reusing it.

If a person then doesn‘t use the substance for some time, their drug tolerance may drop; so even
if they take their usual amount after a break from abstaining, the body could not cope with it so it
leads to overdose. Overdose due to changed tolerance is one of the problems for the people who
stop using the drug for a while. The individual who is relapsed felt being comprised of
hopelessness, shame, and a profound sense of failure (N. Cummings & J. Cummings, 2000).

3|Page
There are only few researches done on the causes of relapse and the factors affecting addiction
treatment processes in Ethiopian context, so this research will contribute essential information
for future researchers.

1.3. Research questions

 What are the factors that affected substance use disorders treatments negatively?
 What are the reasons for relapse on individual who are treated for substance use disorder?
 What are the major consequences of addiction relapse?
 What are the practices of substance abuse among drug addicts?

1.4. Scope of the study

The research concentrated on patients with relapse who were treated for substance use disorder
in St. Paul Millennium medical college rehabilitation center in Addis Ababa. Other similar cases
under treatment at different centers were not included in this study which limits the scope of the
study.

1.5. Significance of the study

Study in this area is essential since there is a growing problem of misuse of substance with the
risk of high number of substance use disorder patients and the far reaching consequences. This
study will help identify the factors that are affecting the substance use disorders treatments.

This study would be used as a source of information to better understand the triggering factors of
relapse among substance abusers. Moreover, the study might have a considerable contribution to
researchers or other stake holders showing the gap both in terms of research and practice to
necessitate further action and as well in developing appropriate interventions by identifying
psychosocial factors that contribute to relapse among substance abusers. In addition the study
may provide some insight and helps as a supplementary source of information for further studyin
this area.

Recently, substance use is an increasing burden in the world, and most of the people with
addiction face relapse after treatment for different reasons which have many consequences in
their life. Therefore, learning the reasons for relapse is very important. It is important for health
workers to integrate the medicine and different therapies for best result.

The study has been believed to provide a set of empirical information on the mechanisms laid out
for the prevention and control of substance use which is becoming a very great problem of
almost all people in the town and further in the country. The study can be used as a basis for
further studies on illegal drug use issues. The findings of this study may also provide good

4|Page
insight to parents, social work practitioners, and teachers, researchers, policy makers and other
GOs and NGOs working with youths.

The study will also likely to add the general body of knowledge in the area of substance misuse
among high school students and generate important hypotheses for further studies.

This study is important as baseline information to examine strategies for intervention towards
preventions of substances abuse and for designing a treatment and rehabilitation program on
substance abuse. It will also be an input for awareness of policy-makers.

1.6. Organization of the paper

This study consists of seven distinct chapters. Chapter one presents an introduction which focus
on the overview of the substance, substance use disorders and substance use treatments.
Moreover, Statement of problems, methodology and significance of the study also addressed in
this chapter. Chapter two discussed on the review of related literatures specifically focusing on
the Ethiopian context towards substance use and its treatment processes. Chapter three focuses
objectives of the study. And chapter four focus on the research methodology, there for a detailed
discussion on sampling techniques, data collection and data analysis approaches were
considered. Chapter five is the main body of the research which presents the findings and results.
Chapter six presents the discussion part. And finally the last chapter will be chapter seven, it is
the research summary; conclusion and recommendation are drawn from the whole chapters are
discussed here.

5|Page
1.7. Conceptual frame-work
Risk factors:
Demographic variables:
 Personal
 Age
 Mental problems
 Gender
 Undeveloped
 Religion
personal skills
 Marital status
 Transition of age
 Educational background group
 Environmental
 Family
Commonly abused drugs  School
 Khat  Peer pressure
 Work area
 Cigarette
 Alcohol
 Drugs

Identification of all these leads to the way for prevention and control of
substance abuse

Substance use and addition

relapse on some patients

Control
Prevention
 Closing or reducing of houses
 Education for behavior working on substance abuse
change activity
 Rehabilitation for reduction  Identifying bodies working on
substance abuse as business

6|Page
Chapter Two

Literature review

2. Substance use
The concept of substance use a psychoactive substance is any substance people take to change
either the way they feel, think or behave. This description covers alcohol and tobacco as well as
other natural and manufactured drugs (UNODCCP, 2002).

A drug is any natural or artificial chemical that cause changes in the body or mind or both when
taken into the body. Drug use is old as man. History tells that the Chinese used opium as a cure
for dysentery before the 18th c (Selpher, 2013).

The history of the human race has also been the history of illegal drug use. Before 1980‘s the use
of psychoactive substances was limited to the elders when they performed special community
functions like rituals, and other ceremonies. However, after 1980‘s the use of psychoactive drug
has spread to the young population in every part of the world (WHO, 2004).

2.1. Substance use as an international problem

Around the Globe, there are an estimated 3.1 % the world population or 4.3% of the population
aged 15 and above abuse substances. While the majority of illegal drugs are consumed in
industrialized nations, drug addiction is no longer the rich nation‘s problem or the poor nation‘s
affliction; it crosses nation, ethnic, religious class and gender lines. Addicts range from the
homeless to white-collar professionals, college students, sex workers, rural farmers and street
children (DACA, 2005).

A reviewed study conducted in 2008 in large mid-Atlantic university showed that there is a
relationship between consumption of one substance and use of other illicit drugs. Compared to
non-binge drinkers, frequent binge drinkers were almost three times more likely to smoke
cigarettes; four times more likely to use marijuana; five times more likely to use amphetamines,
LSD, and chewing tobacco and six times more likely to use hallucinogens— all within 12
months. More than half of frequent binge drinkers used marijuana and cigarettes in the past year,
compared to 13% and 22% of non- binge drinkers (Kevin E. O‘Grady, 2008).

Increase in drug taking among young people incorporates all levels of social relations. What
began as the use of drugs in African traditional society for social relations changed over time into
a problem of dependence and abuse and is of a great concern (Kerachio, 1994).

7|Page
2.2. Substance use in Africa
The study conducted on Kenyan secondary school revealed that majority of the respondents
(80%) agreed that alcohol was the most frequently abused drug. The study posited that alcohol
was the most used drugs by students because alcohol, unlike other drugs, does not have a drastic
effect on personal health when consumed moderately; it is sold legally and has attained a
commodity status (Lemis M. Negsu, 2008). It is readily available and it is consumed mainly in
pubs and other entertainment centers, which have features students crave. Besides, it is more
acceptable in the society compared to other types of drugs. Moreover, it can easily be sneaked
into school without detection. Also, most beer commercials have very attractive scenes (Lemis
M. Negsu, 2008). The study found out that the main reason for drug abuse was peer pressure and
the common symptoms indicated that students who use illegal drugs had aggressive behavior,
depression and anxiety, sudden changes of appetite, cold clammy skin, irritable behavior,
frequent complaints of headache, memory loss, over excitement, over suspicious, secretive and
less self-confidence symptoms (Lemis M. Negsu, 2008).

A report based on review of both qualitative and quantitative studies revealed that students and
staff of institution of higher education of Ethiopia are at high risk of substance use (Kevin E.
O‘Grady, 2008). Thirty– one percent of students of college of medical sciences in northwestern
Ethiopia were current alcohol users followed by 26.3 and 23.3% current cigarette smokers and
khat chewers respectively (Fekadu A, 2007). Smokers usually become dependent on nicotine and
suffer physical and emotional (mental or psychological) withdrawal symptoms when they stop
smoking. These symptoms include irritability, nervousness, headaches, and trouble sleeping. The
true marker for addiction is that people still smoke even though they know smoking is bad for
them, affecting their lives, health, and families in unhealthy ways. Most people want to quit
psychoactive substance abuse, which refers to any substance that when taken by a person can
modify perception, mood, cognition, behavior or motor functions (Fekadu A, 2007).

2.3. Substance use in Ethiopia

In Ethiopia, levels of drug use continue to rise alarmingly from time to time. The rapid
globalization of the drug trade over the past decades has meant that no country is immune from
the threat. The drug trade transcends national borders, and Ethiopia continues to serve as a transit
route for the drug trade (National Drug Control Master Plan of FMHCACA, 20 I 0-20 15).

FMI-ICACA (2005) stated that cannabis use is becoming a serious problem 111 Ethiopia. It
grows in most regions of the country mainly in Oromia, Amhara, Benishangul Gumuz, SNNP
Regional States and Addis Ababa City Administration. FMHCACA (2005) also confirmed that
the number of cannabis abusers is also increasing from time to time mainly in the urban areas of
the country and inhalants abuse like benzene has also been a common observation among street
children.

8|Page
2.4. Factors of Substance use
Different studies have revealed that there are various factors for students to use substances. The
factors of drug taking generally have been regarded as determined by a combination of the
peculiar properties of the drug, characteristics of the user and the nature of the person's
environment. Some of these reasons include easy availability of drugs, peer group pressure, age
factors, parental influence and availability of cash.

2.4.1. Common and Unique Features of Substance Use

The common feature of almost all used substances are that they produce addiction, that they are
open to be abused potentially, that they led to multifaceted consequences, and that they produce
tolerance and withdrawal syndrome, and physical and psychological dependence. They also act
on the brain and produce impairment of judgment. Over the past two decades, the uses of illegal
drugs and therapeutic drugs have spread at an unprecedented rate and have penetrated every part
of the globe. No nation has been spared from the devastating problem caused by drug use. At the
same time, broad spectrum of the world community has demonstrated intense concern over the
problem (Lemis M. Negsu, 2008, U. H. Ihezue, 1988).

Ethiopia signed in three international drug conventions (United Nations, 1961, 1971, 1988).
Accordingly, Federal Police Commission, Anti-Narcotics Service of Ethiopia reported that,
cannabis 107.9 kg, heroin 21.27 kg and cocaine 11.42 kg were seizured in the past five years
(DACA, 2011). In article 38 of 1961 convention on narcotic drugs, the suggested measures
against the abused drugs are given special attention to prevention of abuse of drugs and early
identification, treatment, education, after-care, rehabilitation and social reintegration of the
persons involved. It also indicates that the measure taken is to co-ordinate their efforts to these
ends; promote the training of personnel and practicable measure on understanding of the problem
of abuse of substances and of its prevention for the general public (Lemis M. Negsu, 2008).

In summary, substance abuse is an emerging public health problem and it is steadily increasing
globally including Ethiopia. The identified gaps from the reviewed literature are that there is
little data concerning commonly abused psychoactive substances other than khat, alcohol and
cigarette in Ethiopia and that the interventions are underemphasized although Ethiopia signed in
the three conventions since 1961.

2.5. Substance use in Low Income Countries

Addiction among adolescents is a major public health issue in developing countries. Use of
cigarettes, alcohol and illicit drug by adolescents is a matter of concern world-wide. Drug use in
this age group is associated with increased risk of accidents, violence and high risk of sexual
behavior, HIV, interpersonal problems, decrease in academic performance and failure to
complete education. Researches done in the Sub-Saharan countries showed there is a high use of
psychoactive substances and drugs among adolescents. The overall prevalence of ‗any substance

9|Page
use‘ is 41.6%. The use of caffeine containing products being the most predominant at 41.2%
followed by alcohol at 32.8%, tobacco products 23.5%, khat 22.0% and cannabis 15.9%
(Olawole-Isaac et al., 2018).

2.5.1. A case from Ethiopia

A School-based cross-sectional survey done in Ethiopia Rural and Urban area to determine the
magnitude of drug use among high school students and identify factors associated with drug use
among high school showed Alcohol and khat were the most commonly used drugs in all schools.
On the other hand, cigarette and cannabis were consumed more in the private school than in
government schools (Kassaye et al., 2017). The lifetime prevalence of substance use in Ethiopian
high school students is 41.4 percent for alcohol, 22.5 percent for khat, and 12.9 percent for
cigarette. Analysis showed that significant percent of high school students have exposed to
substance (Hirbo et al., 2019). Another study done on magnitude of substance use among young
people in Ethiopia showed lifetime prevalence of any psychoactive substance use among the
youth in Ethiopia ranges from 2.7% to 65.4% and up to 45.7% in the past 12 months (Amanuel
& Getacheew, 2019).

In Ethiopia one-third of the high school and higher education students used different
psychoactive substances. The overall prevalence of psychoactive substance abuse among high
School students is approximately 30%. Pear pressure is accountable for substance use among
students in more than 27.95% of the time. The lifetime prevalence of more than two substance
use was approximately 40% (Abate et al., 2021). Over a quarter of school adolescents and youths
consume alcohol in Ethiopia (Ali & Worku, 2020).

A review of the literature done among high school and college students in Ethiopia
recommended immediate actions need to be taken to mitigate/prevent existing substance use
problem like educating students about the health problems of harmful substance use, offering
community education on the use harmful substances (involving parents, relatives and teachers
and community leaders), providing coping mechanisms to help victims of substance use,
minimizing the factors that contribute to or encourage such substance use, and establishing novel
and more relevant drug/substance use policies at institutional and/or governmental levels (Abebe,
2013).

2.6. Factors associated with drug use

2.6.1. Risk and protective factors

NIDA (20 I 0) stated that no single factor determines whether a person will become addicted to
drugs. The overall risk for addiction is impacted by the bio logical make-up of the individual that
can even be influenced by gender or ethnicity, his or her developmental stage and the

10 | P a g e
surrounding social environment like conditions at home. At school and in the neighborhood. And
also as with any other disease, vulnerability to addiction differs from person to person. The more
risk factors an individual has, the greater the chance that taking drugs will lead to abuse and
addiction.

2.6.1.1. Personal risk factors

 Being young is in itself a risk factor. Young people are in a constant struggle to establish
their identities, and answer questions like, "Who am I? What is my role in society? What
do I want to be?" Finding answers to these questions is not an easy thing and it takes s
some time. Often, during this period, you can start doubting yourself, your ability to
achieve and to do things. It is then that you m ay try to "forget about the world" or
"drown your sorrows by abusing different substances.
 If a person has mental problems s/ he is more likely to start using drugs.
 Undeveloped personal skills like the inability to take decisions, to express what s/he
feels, to assert themselves, to solve problems, etc. also put an individual at greater risk of
succumbing to substance abuse.

2.6.1.2. The Environmental Risk Factors

 The young person's parents may not know how to look after him/her emotionally,
physically or in terms of providing the right kind of support and guidance.
 If the person may not have a family
 If the person's parents, brothers or sisters ma y abuse drugs of any kind
 If the society that the person is part of has cultural and/or religious values that encourage
substance abuse or the media, advertising and attitudes in the society condone abuse
 If the person is homeless and is living with or without his/ her family on the streets
 If there are few/ no opportunities for education
 If there is a lot of free un structured time in which there are no constructive, imaginative
and challenging activities to take part in
 If there are no job opportunities or even the hope of gelling a fulfilling job
 If health services are not provided.

2.7. Substance use and culture

Drug users may be part of a powerful "culture" where drug use is considered as 'normal'·. They
may come from a tradition of social drug use, such as a community of adults who drink home
brew, smoke cannabis or chew khat as a social activity, despite the negative effects that this habit
has on their health and the well-being of their families. Drug use, particularly drinking, may be
part of their family culture. Drunkenness, good natured or violent, may be tolerated with in their
family. Parental drug use is an especially powerful influence on children's behavior.

11 | P a g e
2.8. Family and substance use
Drug use can strain family relationships and ultimately make the family dysfunctional,
transforming families from an asset of society into a burden. Effects on the family can include
psychological and financial burdens, resulting too often in family breakdown (homelessness),
negative impacts on children and involvement in criminal activities. Drug use also affects an
individual's employability (Drug Administration and Control Authority of Ethiopia, 2005).

2.9. Substance use and crime

The link between drug and crime is another growing concern. Drug related crime can range from
acts committed under the pharmacological effect of the drug. Actions carried out to support drug
abusing habits, actual possession of illicit substances, and the criminal activities associated with
drug supply, such as murder, drug gang warfare and other crimes (Drug Administration and
Control Authority of Ethiopia, 2005).

2.10. Substances most commonly used

In Ethiopia, Khat has multi-dimensional values. Its social value is deep rooted in many parts of
the country and nowadays its contribution has become very significant to the national economic
growth. Khat is one of the leading hard currency earning export commodities of the country.
Locally it is a big employer of the working force and main stay of income for mill ions of
farmers and traders. It is grown almost everywhere in the country, especially in the eastern,
western and southern regions and sold to consumers in pub li c and in abundant quantities
(National Drug Control Master Plan of FMHCACA, 20 10-20 15). There are many illegal
substances abused today. There are other substances, such as over-the-counter medications,
household products and legitimate pharmaceuticals (medicines) that are also abused.

Some of the substances that are commonly used includes: depressants like; Alcohol, barbiturates
and sedative-hypnotics which have effects like: drowsiness and pleasant relaxation. Opiates like:
Morphine, and methadone which have effects that includes, relief of pain, pleasant, detached and
dreamy euphoria. Stimulants like: Cocaine, khat, amphetamines that results in Exhilaration or
excitement, reduced fatigue & hunger. Hallucinogens like: LSD (Lysergic Ac id Diethylamide),
mescaline, peyote that results in other-worldliness and perceptual distortions. Cannabis is the
other one like marijuana and hashish that results in relaxation & hallucinogenic effects. The
other is Nicotine for example, tobacco that results in sedation & stimulation (A module on
Substance Abuse for the Ethiopian Health Center Team, 2005).

2.11. Substance use and health

Drug abuse affects a number of organ systems. Central nervous system (CNS) symptoms can
range from headaches and altered mental status to life-threatening situations like coma and
seizures. Cardiovascular manifestations of drug use include alterations in blood pressure and
12 | P a g e
heart rate, as well as arrhythmias an organ ischemia. Respiratory arrest and pulmonary edema
may occur. Metabolic effects such as alterations in body temperature, electrolytes, and acid-base
disturbances are commonly seen. Reproductive consequences, ranging from impaired fertility to
intrauterine growth retardation, premature births and neonatal syndromes may also OCC UI'.
Infectious complications from intravenous drug use include viral infections such as HI V and
hepatitis, as well as bacterial infections.

2.12. Prevention and control

Whoever said that prevention is better than cure definitely got it right. It is much better to
prevent young people from starting to use drugs than entering at a later stage and helping them
give up drugs. This is important to keep in mind because that 'even though some of your
programs will aim at trying to give healthy and creative alternatives to young people who are
already using drugs, you must not forget that there is a whole section of your community who
might start using drugs' (UNODCCP, 2002).

2.13. Studies on Relapse

In Ethiopia, many studies are focused on the prevalence of drugs and causes of substance misuse;
however, there is one relevant research on psychosocial triggering factors of relapse among
substance users, the findings showed that psychosocial factors are such as negative emotional
states, peer pressure, lacking support after treatment, and personal loss. The other psychosocial
triggering factor for the relapse in this study is accessibility and availability of drugs and alcohol
as an environmental factor (Jufar, 2019).

Addiction Relapse is a complex problem which is challenging for treatment. There are different
factors contribute for addiction relapse.

2.13.1. Factors Contributing to Addiction Relapse among Drug Addicts

2.13.1.1. Psychological Factors of Relapse

Psychological factors are highly related to mental state. According to the study by Appiah
(2014), adverse emotional conditions related to the mind such as feeling miserable, upset,
isolated, worthless, blamed are the main initiating factors.

Many studies revealed psychosocial factors is the cause of relapse. Anxiety is one of the
psychological factors that increase the risks of relapse after substance use disorder treatment
among marijuana addicts (Arendt et al., 2007; White et al., 2004).

13 | P a g e
Self-efficiency is one of the main triggering factors for relapse after treatment. Self-efficacy is
about feeling confident as well as the ability to perform or deal with different circumstances
effectively (Bandura, 1977).

2.13.1.2. Social Factor of Relapse

Social factors affect one thought and behavior in social situations within the social structure and
social processes that impose on the individual are social beings, therefore, they can be affected
by society and it has a direct relation with relapse. Individuals with addiction live in a different
society that is supportive or reverses.

Significant research on explanations of relapse after treatment proved that social factors such as
old friend impact and untrusted by the family as well as community.

2.13.1.3. Environmental Factors of Relapse

Environmental factors are the main factors for relapse according to different researches.
Accessing the drug in a certain place after treatment has a crucial role in the relapse process.
Environmental factors like the availability or accessibility of drugs easily in a certain place
tempts the former addict to relapse. The study stated that availability and accessibility of
substances in their surroundings is the main reason for relapse. Returning to the place can
challenge them to return back to their old habit even after months of abstinence‖ (Schubart,
2001).

2.14. Summary of Literature Review

Substance abuse is a worldwide concern because it has negative effects toward the uses and the
community. The main psychoactive substances used in the country are alcohol, tobacco, khat and
cannabis. The literature confirmed that both intrapersonal and interpersonal factors are
contributing for relapse after treatment.

Intrapersonal factors such as negative emotional states, such as anger, anxiety, depression,
frustration and boredom associated with the highest rate of relapse. In addition to the
intrapersonal influences, social support plays a critical role as an interpersonal determinant of
relapse. Environmental factors have also played a crucial role to increase relapse rate among
substance abusers.

14 | P a g e
Chapter Three

3. Objective of the Study

3.1. General Objective

 Assessing the factors that are negatively affect recovery from substance use disorders
among patients who are receiving treatment at St. Paul's Hospital Millennium Medical
College addiction treatment center, Addis Ababa, Ethiopia 2023.

3.2. Specific Objective

 To identify the factors that negatively affect addiction treatment process
 To identify the causes of addiction relapse for effective intervention.
 To explore the most commonly used drugs.

15 | P a g e
Chapter Four

Methodology

4. Methods and material

4.1. Study area and study period

This study was focused on assessing the factors that negatively affect addiction treatment
process, and the cause of relapse of an addiction among substance use disorders during having
treatment in the rehabilitation centers. The study area was in rehabilitation centers which provide
different treatments for substance use disorder patients. St. Paul millennium medical college
rehabilitation centers were the study area. The rehabilitation center is located in Addis Ababa,
Ethiopia.

St. Paul millennium medical college rehabilitation center is one of the drug addiction treatment
centers as one of the faculty. It is a governmental organization. St. Paul millennium medical
college as it is known today was established through a decree of council of ministers in 2010,
although the medical school opened in 2007 and the hospital was established in 1968 by the late
emperor Haile Selassie. It is governed by a board under the federal ministry of health. The
college initiated Ethiopia‘s first integrated modular and hybrid problem based curriculum for its
undergraduate medical education, and is currently expanding to post graduate programs and
diversifying its undergraduate program offerings. sSt. Paul‘s is in the process of building its
capacity quickly in a short period of time, growing from 3-250 faculties members in the last six
years, and expanding teaching facilities. The college has more than 2800 clinical, academic and
administrative and support staffs that provide medical specialty services to patients who are
referred from all over the country, teaching medicine and nursing students and doing basic and
applied researches. While the inpatient capacity is more than 700 beds, the college sees an
average of 1200 emergency and outpatient clients daily.

The center provides in-patient and out-patient counseling therapies for alcohol and other
substance use. The rehabilitation center aims to help patients to maintain a lifestyle without the
substance through education, individual/group counseling and vocational rehabilitation.

The study period was from April to May 2023.

4.2. Study design

The study was employ quantitative approach. Quantitative research method was employed for
the patients. So, this research will be conducted by quantitative research approach.

16 | P a g e
An exploratory case study design was used in this study which allows the researcher to get detail
information from substance use disorder patients that have experienced relapse after the
treatment. As Yin (2003) point out that, case study allows investigator to retain the holistic and
meaningful characteristics of contemporary phenomena and real-life event desire to understand
complex social phenomenon.

4.3. Population
The population for this study was individuals who are receiving treatment at St. Paul millennium
medical college rehabilitation center.

The source population is substance use disorder patients with relapse after taking treatment on
St. Paul millennium medical college rehab center. The total number of patients in this
rehabilitation center is 500 in range.

4.3.1. Source population

All patients who have follow-up at St. Paul millennium medical college addiction rehabilitation
center.

4.3.2. Study population

Patients who are following-up for relapse addiction treatment.

4.4. Inclusion and exclusion criteria

4.4.1. Inclusion criteria

Participants have to fulfill the inclusion criteria to be part of the study.

 Willingness to participate on the study.

 They must be patients with relapse case after substance use disorder treatment.

4.4.2. Exclusion criteria

 Participants were acutely psychotic due to intoxication or withdrawal
 Any disturbed state.

4.5. Study unit (N)

The study units were patients diagnosed with substance use relapse disorders.

17 | P a g e
4.6. Study variable

4.6.1 Independent variables

Socio-demographic factors

 Age
 Sex
 Religion
 Occupation
 Monthly income

Socio-cultural factors

 Peer pressure
 Availability of abused substances
 Parental influence

Clinical symptom factors

 Withdrawal symptoms
 Tolerance
 Dependence

4.6.2. Dependent variables

 Intention to stop the substance abuse

4.7. Sample size determination

The sample 213 was selected from among patients who were diagnosed and have followed
treatment in The St. Paul's Hospital Millennium Medical College. The sampling technique that
was used was purposive sampling method.

The initial inclusion criteria for the study was patients with minimum length of sobriety of three
months, however because of the difficulty of finding enough number of participants available for
interview who fulfill the criteria; the study also included those who are sober for less than three
months and those who were abstinent after treatment but now who are using alcohol but are
cutting down the amount at the time of the interview.

18 | P a g e
 Given

n= estimated sample w= margin of error =5% = 0.55

q= (1-p) = (1-0.5) = 0.5 p= prevalence =0.45

z= standard deviation at 95% confidence interval 5% =0.05

( )
( )

Since our population is <10,000, which is

500, we use correction formula.

+𝑛
n=369 𝑁
+
7
Sample size= 213
2 2 2
7
4.8. Sampling techniques
Purposive sampling technique was used as method of the research. In purposive sampling,
researchers handpick the cases to be included in the sample on the basis of their judgment of
their typicality. In this way, they build up a sample that is satisfactory to their specific needs
(Cohen et al., 2005).

Relapsed patients in St. Paul Millennium Medical college rehabilitation center were the target
population of the study.

4.9. Data collection methods

All interviews were conducted at The St. Paul's Hospital Millennium Medical College addiction
center. And the data collection procedure was done by graduating class students of Unity
university research group members through face to face interview. The data collector is
responsible for describing the purpose of the study, giving orientation, telling clients the
importance of honest and sincere reply, on responding to question.

The data was collected by a well-structured questionnaire developed by the research group
members by English language. Kobo tool box was used to minimize the cost of hard copy. The
data collection procedure was done by the graduating students of Unity University research
group members through face to face interview.

19 | P a g e
4.10. Data collection tools
Primary data was collected to carry out the research. As Denscombe (2010) puts, when the
researcher needs to understand people‘s emotions, opinions, experiences, and, feelings, then
interviews will be more appropriate method. Generally, an interview questionnaire was
employed to the patients.

Interview guide tools were developed in English originally and the translated into Amharic and
then back to English to check the validity of the contents.

Interview guide tools were developed in English originally and the translated into Amharic and
then back to English to check the validity of the contents. Tools or devices that we were go to
use in the study to gather data will be:

 Questionnaire papers
 Smart phones
 Occasionally observation

And the data was also collected by using kobo toolbox as a material.

4.11. Sources of data

4.11.1. Primary data

4.11.1.1. Interview
The other source of primary data was conducted by interview methods with the patients who are
following treatment.

4.11.2. Secondary data

Secondary sources of information for this study was from The St. Paul's Hospital Millennium
Medical College, available materials related to the research topic such as books, related
researches and articles, journals, electronic materials and other relevant documents. These were
reviewed to show the views of different authors on the study problem and to connect the research
with related literatures.

4.12. Data collectors

The quantitative data was conducted by the trained public health graduating students. The
interview was in separate room individually for providing confidence and confidentiality for the
respondents.

20 | P a g e
4.13. Data quality control
First all students was oriented by assigned group leaders about producers and process on data
gathering. We all group members have done Checking for completeness, consistency and editing
was done by group members. And also to assure the quality of data, pilot test was done in the 5%
of the other population.

4.14. Data processing and analysis

The quantitative data was processed by categorizing and IBM SPSS Statistics 25 version digital
software and using digital calculator. Data was analyzed by calculating frequency and
percentage, description and correlation. Findings presented in the form of sentence, figures,
tables and charts like bar graphs pie charts and also histograms.

4.15. Strength of the study

There were an advisors assigned to us in order to share their experience and guide us toward
right direction to have a very good background towards courses related to this research like
Epidemiology, Biostatics, Research Methodology and Health Education.

4.16. Materials used in the study

 Pen
 Pencil
 Paper
 Ruler
 Sharpener
 Rubber
 Laptop
 Smart phone
 Questionnaire

4.17. Operational definition

 Abuse: Using an illegal substance, even with the knowledge that it causes serious
problems.
 Addiction: subjective reports or experience of discomfort when the drug is stopped.
Addiction is the fact or condition of being addicted to a particular substance or activity.
 Binge drink: Five or more drinks for men or four and above drinks for women.
 CAGE-AID: is derived from the four questions of the tool: Cut down, Annoyed, Guilty,
and Eye-opener; it helps to determine if substance abuse exists.

21 | P a g e
  Community: A group of people sharing ideas and having common problems, concerns,
hopes and modes of behavior; which give them a sense of belonging to each other,
although they may not necessarily be bound by geographical boundaries.
 Current use: having consumed any abused substance at least once in the past 30 days.
 Dependence: Increasing tolerance and the onset of withdrawal symptom
 Drug: refers to an item that alters or affects the mental, physical and emotional
functioning of a person. In this study drug includes alcohol, khat, cigarettes, and
cannabis that can be taken through chewing, inhaling, smoking, drinking, or injection.
 Drug Dependence: Is the in ability to act norm al without having or taking the previous
things or drugs.
 Illicit drug: A psychoactive substance, the production, sale or use of which is prohibited.
 Licit drug: A drug that is legally available by medical prescription in the jurisdiction in
question or, sometimes, a drug legally available without medical prescription.
 Poly-drug use: Any use of more than one mood altering drug by an individual at any
time in the past.
 Psychoactive substance: any substance that, when taken by a person, can modify
perception, mood, cognition, behavior or motor functions.
 Relapse: refers to a return back to the old habit.
 Substance abuse: The term refers to the misuse and abuse of legal substances such as
nicotine, alcohol, over-the-counter drugs, prescribed drugs, alcohol concoctions,
indigenous plants, solvents and inhalants, as well as the use of illicit drugs.
 Substance Abuser: people who uses different substance in the cost of their life.
 Substance dependence is an addiction pattern of drug use with the development of drug
tolerance, withdrawal effects, and having a persistent longing but inability to stop or
reduce drug use.
 Substance Use: refers to consuming different substance to change mood or performance.
 Tolerance: needing more of the drug as time passes to achieve desire results.
 Withdrawal symptom: - A tremendous force for continuing use often at any cost.

4.18. Ethical consideration

The department of Public Health of Unity University was approved the research proposal and a
cooperation letter was sent to the rehabilitation center to get permission to obtain data.

This study aims to gather information from the participants on causes for relapse of addiction
among addicted People after having treatment in the rehabilitation center.

To conduct this research, ethical approval later was secured from Unity University, faculty
health science, department of public health official letter was delivered to all that may concern.

22 | P a g e
The participants were asked to discuss their thoughts, experiences and feelings related to the
causes and consequences of relapse. The participants were told about the study. The participants
was told that their responses would be confidential and only used for educational purpose. They
were also told to give the right information for the research purpose. All participants included in
the study were provided both written and verbal consent. Participating in the study is voluntary
and they were told to refuse to take part in the study if they don't want to participate. So, each
question was answered voluntarily.

4.19. Dissemination of the result

The finding and results of this study will be presented and disseminated to Unity University
faculty of health science, department of Public Health.

23 | P a g e
Chapter Five

5. Result
In this section, most important findings of the study were presented in three parts. Socio-
demographic profiles were presented in the first section and themes were presented in the second
section.

5.1 Background of the respondents

The participants in this study were 213 individuals, who were diagnosed for substance use
relapse disorder in St. Paul Hospital Millennium Medical College Rehabilitation Center.

In this study from 213 133 (62.44%) are male and 80 (37.56%) are female.

From this 213 respondents 13 (6.10%) are age of 15-20, 53 (24.88%) are age of 21-25, 44
(20.66%) are from 26-30, 27 (12.68%) are 31-35, 19 (8.92%) are 36-40, 36 (16.90%) are 41-50.
13 (6.10%) are 51-60, and the rest 8 (3.76%) are 61 and above 61.

In this study, the educational level of the respondents were also assessed, from this 213
respondents who have bachelor‘s degree is 79 (37.09%), diploma 31 (14.55), master‘s degree
40(18.78%) TVET 36(16.90%), 11-12 grade 15(7.04%), 9-10 grade 6(2.82%), 8 grade and less
3(1.41%), illiterate 3(1.41%).

From this 213 respondents 49(23.00%) are students, 63(29.58%) are government employee,
39(18.31%) private employee, 26(12.21%) housewife, 32(15.02%) have no job, and 4(1.88%)
are retirement. This data is represented in bar graph below.

The demographic data also shows us that, 102(47.89%) were married, 85(39.91%) are single,
16(7.51%) divorced, and 10(4.69%) are separated.

From this 213 respondents 103(48.4%) are a resident in Addis Ababa, 51(23.9%) Oromia,
20(9.4%) Amahara region, 9(4.2%) from southern region, 30(14.1%) are from other regions.

In this study 124(58.22%) are orthodox in religion, 32(15.02%) are Muslim, 33(15.49%) are
protestant, 10(4.69%) catholic, and the rest 14(6.57%) are have other religions.

The monthly income of these respondents is 490 and less than 490ETB 23(10.8%), 500-1499
ETB 26(12.2%), 1500-2499 ETB 46(21.6%), 2500-3499 ETB 26(12.2%), 3500-4999 ETB
10(4.7%), 5000-6999 ETB 23(10.8%), 7000-9999 ETB 38(17.8%), 10,000-14,999 ETB
18(8.5%), AND 15,000 ETB and above 3(1.4%). This is represented with table below. The table
below will represent the upper results graphically.

24 | P a g e
 Frequency Percent
Sex male 133 62.4
female 80 37.6
Total 213 100.0
Age 15-20 13 6.1
21-25 53 24.9
26-30 44 20.7
31-35 27 12.7
36-40 19 8.9
41-50 36 16.9
51-60 13 6.1
61 and above 61 8 3.8
Total 213 100.0
Occupation student 49 23.0
government employee 63 29.6
private employee 39 18.3
housewife 26 12.2
no job 32 15.0
retirement 4 1.9
Total 213 100.0
Educational bachelor's degree 79 37.1
status diploma 31 14.6
master's degree 40 18.8
TVET 36 16.9
11-12 grade 15 7.0
9-10 grade 6 2.8
8 grade and less than 3 1.4
illiterate 3 1.4
Total 213 100.0

Marital status married 102 47.9

single 85 39.9
divorced 16 7.5
separated 10 4.7
Total 213 100.0
Residence Addis Ababa 103 48.4
Oromia 51 23.9
Amahara region 20 9.4
Southern region 9 4.2

25 | P a g e
 other 30 14.1
Total 213 100.0
Religion Orthodox 124 58.2
Protestant 33 15.5
Muslim 32 15.0
Catholic 10 4.7
other 14 6.6
Total 213 100.0
Monthly income 490 and less than 490 23 10.8
birr
500-1499 birr 26 12.2
1500-2499 birr 46 21.6
2500-3499 birr 26 12.2
3500-4999 birr 10 4.7
5000-6999 birr 23 10.8
7000-9999 birr 38 17.8
10,000-14,999 birr 18 8.5
15,000 birr and above 3 1.4
Total 213 100.0
Table 1: socio-demographic result of the respondents

Family history of the respondents

The study also covers the respondents‘ family history or socio-demographic history of their
families. From these 213 respondents 105(49.3%) families (father and mother) are married (or
live together currently), 13(6.1%) are divorced, 20(9.4%) separated, 12(5.6%) have only father
alive, 12(5.6%) only mother alive, 51(23.9%) are both of them are not alive.

Are your father and mother living together? Frequency Percent

yes 105 49.3

divorced 13 6.1
separated 20 9.4
only father alive 12 5.6
only mother alive 12 5.6
both of them are not alive 51 23.9
Total 213 100.0
Table 2: Parents r/ship status

26 | P a g e
And from the respondent‘s educational status of fathers, 67(31.5%) have bachelor‘s degree,
60(28.2%) have diploma, 31(14.6%) master‘s degree, 6(2.8%) TVET, 10(4.7%) 11-12 grade,
4(1.9%) 9-10 grade, 6(2.8%) 8 grade and less than, and the rest 29(13.6%) are illiterate.

Educational status of your father Frequency Percent

9-10 grade 4 1.9
bachelor's degree 67 31.5
diploma 60 28.2
master's degree 31 14.6
TVET 6 2.8
11-12 grade 10 4.7
8 grade and less than 6 2.8
illiterate 29 13.6
Total 213 100.0
Table 3: Educational status of respondent‘s father

The educational status of their mothers is 38(17.8%) have bachelor‘s degree, 47(22.1%) diploma,
29(13.6%) TVET, 8(3.8%) 11-12 grade, 4(1.9%) 9-10 grade, 34(16.0%) 8 grade and less than,
45(21.1%) are illiterate and the rest 8(3.8%) have master‘s degree. This is indicated the table
below.

Educational status of your mother Frequency Percent

9-10 grade 8 3.8
bachelor's degree 38 17.8
diploma 47 22.1
TVET 29 13.6
11-12 grade 8 3.8
9-10 grade 4 1.9
8 grade and less than 34 16.0
illiterate 45 21.1
Total 213 100.0
Table 4: Educational status of respondent‘s mother

From this 213 respondents 98(46.01%) of their families use substance or drugs, and the rest
115(53.99%) do not use any substance or drugs. The pie chart below shows this in graphical
method.

27 | P a g e
 Figure 1: Use of substance or drugs in the family

5.2. Themes
Identifying most commonly used drugs

From this 213 respondents 13(6.57%) respondents start using substance or drug from age less
than 15, 116(58.59%) at age 16-20, 60(30.30%) at age 21-25, 6(3.03%) 26-30, and the rest
3(1.52%) start using substance or drug from age 31 and above.

Figure 2: In what age did the respondents starts using substance or drugs

In this study from 213 respondents, 160(75.1%) chew khat, while the other 38(17.8%) don‘t. and
from these 160(75.1%) respondents 90(24.9%) chew khat every day, 32(15.0%) chew every two
days, 8(3.8%) every other day, 30(14.1%) chew khat rarely.

28 | P a g e
How often do you chew khat Frequency Percent

everyday 90 42.3
every two days 32 15.0
every other day 8 3.8
rarely 30 14.1
Total 160 100.0
Table 5: How often did you chew khat

This 160(75.1%) respondents 154(72.3%) chew khat in the last 12 months, while the rest
6(2.8%) don‘t.

From 213 respondents 161(81.31%) respondents smoked tobacco or cigarette, while the rest
37(18.69%) don‘t.

Figure 3: Did you smoke cigarette or tobacco

From this 161(81.1%) respondents 158(74.2%) respondents have smoked in the last 12 months,
and rest 3(1.4%) respondents did not smoked it for the last 12 months. And from this 158(74.2%)
respondents 136(63.8%) smoked cigarette in the last 30 days, while the rest 25(11.7%) did not.
In this 161(81.1%) respondents 132(62.0%) smoke every time, while 29(13.6%) rarely.

29 | P a g e
How often do you smoke Frequency Percent

52 24.4

every time 132 62.0

rarely 29 13.6
Total 213 100.0
Table 6: How often do you smoke?

From this 161(81.1%) respondents 11(6.83%) smoke only 1 cigarette or tobacco per day, while
38(23.60%) smoke 2-5 cigarettes per day, 66(40.99%) 6-10, 4(2.48%) 11-15, 25(15.53%) 16-20
cigarettes and the rest 17(10.56%) smoked above 20 cigarettes.

Figure 4: How many cigarettes do you smoke per day?

In the result of this study, from 213 respondents 164(77.00%) respondents consumed alcohol, the
rest 49(23.00%) did not. This result is represented in pie chart below.

30 | P a g e
 Figure 5: Have you ever consumed alcohol?

From 164(77.00%) respondents 119(72.56%) consume every day, 16(9.76%) every two days,
7(4.27%) every other day, and the rest 22(13.41%) consume alcohol rarely.

Figure 6: How often do you consume alcohol?

31 | P a g e
From 164(77.00%) respondents 154(72.3%) respondents consumed alcohol in the last 12
months, while the rest 10(4.7%) di not. And also 106(49.8%) respondents consumed alcohol in
the last 30 days, while the rest 58(27.2%) did not consumed.

From 164(77.00%) respondents, 48(9.1%) respondents consumed whisky most frequently,

127(24.1%) beer, 123(23.4%) draft, 109(20.7%) tela, 49(9.3%) areke or jin, and the rest
respondents 18(3.4%) consume other alcohol. The table below will show this result.

Alcohol which is taken mostly Responses

N Percent
whisky 48 9.1%
beer 127 24.1%
draft 123 23.4%
tela 109 20.7%
tej 49 9.3%
Areke or jin 52 9.9%
Other alcohol 18 3.4%
Total 526 100.0%
Table 7: what alcohol do you consume?

From 164(77.00%) respondents, 63(38.41%) respondents consume alcohol with the usual
amount of 1-5 units, 75(45.73%) 6-10 units, and the rest, 26(15.85%) use above 10 units.

Figure 7: what is the usual amount you consume alcohol?

32 | P a g e
From 213 respondents 71(33.3%) respondents tried a ranges of illegal drugs or non-medical
addictive drugs, while the rest 127(59.6%) did not. This 71(33.3%) respondents 9(7.7%) tried
heroin, 32(27.4%) cannabis, 56(47.9%) marijuana, and the rest 20(17.1%) tried other drugs.

Illegal or non-medical addictive drugs Responses

N Percent
heroin 9 7.7%
cannabis 32 27.4%
marijuana 56 47.9%
Other drugs 20 17.1%
Total 117 100.0%
Table 8: What illegal or non-medical addictive drugs did you use?

From this 71(33.3%) respondents 30(14.1) respondents have used this drugs since early age,
37(17.4%) since adult age, and the rest 4(1.9%) lately.

How long did you use this drugs Frequency Percent

142 66.7
since early age 30 14.1
since adult age 37 17.4
lately 4 1.9
Total 213 100.0
Table 9: How long did you use these drugs?

In the last 12 months 71(33.3%) respondents have used these illegal or non-medical addictive
drugs. And also 48(22.5%) respondents use it in the last 30 days, while the rest 23(10.8%) did
not.

In this study, from 213 respondents 10(4.7%) have used or tried injecting drugs using syringe,
while the rest 203(95%) did not.

Have you ever use or tried injecting drugs using Frequency Percent
syringe
yes 10 4.7
no 203 95.3
Total 213 100.0
Table 10: Table 10: have you ever use or tried injecting drugs using syringes?

From this 10(4.7%) respondents 8(3.8%) have used it in the past 12 months, while from this
8(3.8%) respondents 4(1.9%) respondents use it in the past 30 days.

33 | P a g e
Identifying the factors for relapse

In this study, we also tried to assess the risk factor that leads the respondents to use substance or
drugs, from 213 respondents, 101(11.2%) the risk factor is family history, 160(17.8%) peer
pressure, 120(13.3%) environment, 92(10.2%) mental illness, 92(10.2%) stress, 98(10.9%),
depression, while lack of social support 72(8.0%), physical abuse 53(5.9%), substance or drug
availability 111(12.3%).

Figure 8: What are the risk factors?

From this 213 respondents 9(4.55%) use substance or drugs for 6 months, 10(5.05%) for 1 year,
57(28.79%) 1-2 years, 56(28.28%) for 3-5 years, 26(13.13%) for 6-10 years, and the rest
40(20.20%) use substance or drugs above 10 years. It is represented by bar graph below.

34 | P a g e
 Figure 9: How long did you use substance or drugs?

In this study, from 213 respondents 187(87.79%) know that using substance and drugs have
consequence, while the rest 26(12.21%) respondents didn‘t. this is represented graphically
below.

Figure 10: Did you know that using substance or drugs have consequences

35 | P a g e
From 213 respondents 79(36.9%) respondents have been treated only 1 time for substance use,
103(48.1%) 2-3 times, 27(12.6%) 4-5 times, 4(1.9%) above 5 times.

Frequency Percent
only 1 time 79 36.9
2-3 times 103 48.1
4-5 times 27 12.6
above 5 times 4 1.9
Total 213 100.0
Table 11: How many times did you treat for substance use disorder?

112(52.3%) respondents have been treated only 1 time in an outpatient setting, while 96(44.9%)
treated 2-3 times, 6(2.8%) 3-5 times. And from this 213 respondents 137(64.0%) have tried to
stop or cutting down by themselves, while the rest 77(36.0%) did not try. And from this
respondents 79(36.9%) respondents have treated only 1 time for substance use disorder,
103(48.1%) 2-3 times, 27(12.6%) 4-5 times, 4(1.9%) above 5 times. And 87(43.94%) know
think the treatment is effective, while the rest 111(56.06%) disagree with the effectiveness of the
treatment or service.

Figure 11: Do you think the treatment was effective?

From these 213 respondents, for 111(56.06%) respondents, it was very difficult to stop
consuming after the treatment, while for 73(36.87%) it was difficult, and for the rest 14(7.07%)
it is not difficult at all.

36 | P a g e
 Figure 12: How difficult was to stop consuming after the treatment?

Identifying the causes for relapse

From this 213 respondents, for 141(12.6%) the risk factor for relapse is personal, for 121(10.9%)
is psychological, 91(8.2%) is environmental factor, lack of support 95(8.5%), peer pressure
126(11.3%), physiological 63(5.7%), social 52(4.7%), economic 56(5.0%), mental illness
37(3.3), religion or spirituality 78(7.0%), unstable life style 97(87.%) , unstable
marriage50(4.5%) availability of drugs 91(8.2%), other factors 17(1.5%). It is represented
graphically below.

37 | P a g e
 Figure 13: What are the causes for relapse?

From 213 respondents for 51(25.76%) the time gap between taking drug after treatment is days,
for 65(32.83%) is weeks, for 29(14.65%) is 2 weeks, for 16 (8.08%) is months, for 10 (5.05%) is
couple of months, and the rest 27(13.64%) is after many months.

Figure 14: What is the time gap between taking substance or drugs after the treatment?

38 | P a g e
Identifying most commonly used drugs

The most common substances or drugs that are used is alcohol 164(29.0%), tobacco or cigarette
161(28.4%), khat 160(28.3%), illegal non-medical addictive drugs 71(12.5%), and lastly
injecting drugs using syringe 10(1.8%).

Most commonly used substances or drugs Responses Percent of Cases

N Percent
Khat 160 28.3% 80.0%
Tobacco or Cigarette 161 28.4% 80.5%
Alcohol 164 29.0% 82.0%
Illegal Non-Medical Addictive Drugs 71 12.5% 35.5%
Injecting Drugs Using Syringe 10 1.8% 5.0%
Total 566 100.0% 283.0%
Table 12: Most commonly used substances or drugs

From the highly consuming substance alcohol, whiskey is used by 48(9.1%), beer 127(24.1%),
draft 123(23.4%), tela 109(20.7%), tej 49(9.3%), areke or Jin 52(9.9%), and other alcohols
18(3.4%).

What alcohol Responses Percent of Cases

N Percent
beer 127 24.1% 77.4%
draft 123 23.4% 75.0%
tela 109 20.7% 66.5%
areke or jin 52 9.9% 31.7%
tej 49 9.3% 29.9%
whisky 48 9.1% 29.3%
other alcohol 18 3.4% 11.0%
Total 526 100.0% 320.7%
Table 13: What alcohol is commonly used?

From illegal drugs that is used by the respondents heroin is 9(7.7%), cannabis 32(27.4%),
marijuana 56(47%), and other drugs 20(17.1%).

What illegal drug Responses Percent of Cases

N Percent
marijuana 56 47.9% 78.9%
cannabis 32 27.4% 45.1%
heroin 9 7.7% 12.7%
Other drugs 20 17.1% 28.2%
Total 117 100.0% 164.8%

39 | P a g e
 Table 14: What illegal or non-medical addictive drugs are most commonly used?

Factor for relapse Responses Percent of Cases

N Percent
peer pressure 160 17.8% 80.8%
environment 120 13.3% 60.6%
substance or drug availability 111 12.3% 56.1%
family 101 11.2% 51.0%
depression 98 10.9% 49.5%
mental illness 92 10.2% 46.5%
stress 92 10.2% 46.5%
lack of social support 72 8.0% 36.4%
physical abuse 53 5.9% 26.8%
Total 899 100.0% 454.0%
Table 15: Factors for relapse

Cause for relapse Responses Percent of Cases

N Percent
personal 141 12.6% 71.2%
peer pressure factor 126 11.3% 63.6%
psychological 121 10.9% 61.1%
unstable lifestyle 97 8.7% 49.0%
lack of support 95 8.5% 48.0%
environmental actor 91 8.2% 46.0%
availability of the drugs 91 8.2% 46.0%
religion or spirituality 78 7.0% 39.4%
physiological 63 5.7% 31.8%
economic 56 5.0% 28.3%
social 52 4.7% 26.3%
unstable marriage 50 4.5% 25.3%
mental illness 37 3.3% 18.7%
other factors 17 1.5% 8.6%
Total 1115 100.0% 563.1%
T able 16: Causes for relapse

40 | P a g e
 Correlation
Correlation (demography and factors
for relapse family Peer environment Mental illness stress depression Lack of social support Physical abuse Substance or drug availability
pressure

Age Pearson .118 .062 .391** -.011 .223** .116 -.100 .198** .399**
Correlation

Sig. (2-tailed) .097 .384 .000 .878 .002 .104 .163 .005 .000

N 198 198 198 198 198 198 198 198 198

* **
Sex Pearson .080 .017 -.001 .169 .106 .081 -.105 .309 .195**
Correlation

Sig. (2-tailed) .264 .815 .993 .017 .138 .255 .139 .000 .006

N 198 198 198 198 198 198 198 198 198

Educational status Pearson -.102 -.024 .076 -.041 -.126 -.066 .113 .122 .081

Correlation

Sig. (2-tailed) .151 .739 .290 .567 .077 .358 .113 .086 .254

N 198 198 198 198 198 198 198 198 198

** * *
Occupation Pearson .255 -.028 -.042 -.010 .040 -.104 -.152 .169 .169*
Correlation

Sig. (2-tailed) .000 .691 .552 .892 .577 .144 .032 .017 .017

N 198 198 198 198 198 198 198 198 198

* ** **
Marital status Pearson .070 -.072 -.163 .036 .024 -.230 -.185 .001 -.017
Correlation

Sig. (2-tailed) .324 .313 .022 .612 .741 .001 .009 .990 .809

N 198 198 198 198 198 198 198 198 198

Residence Pearson .294** .302** .301** .067 .448** .227** .025 .528** .459**
Correlation

Sig. (2-tailed) .000 .000 .000 .351 .000 .001 .723 .000 .000

N 198 198 198 198 198 198 198 198 198

41 | P a g e
Religion Pearson .068 -.122 -.148* -.073 -.015 .007 -.054 .041 -.021
Correlation

Sig. (2-tailed) .340 .087 .038 .304 .830 .919 .450 .563 .767

N 198 198 198 198 198 198 198 198 198

Monthly income Pearson .072 .069 .384** -.108 .192** .234** -.063 .008 .373**
Correlation

Sig. (2-tailed) .313 .336 .000 .132 .007 .001 .379 .915 .000

N 198 198 198 198 198 198 198 198 198

Table 17: Correlation of demographic result and factors

42 | P a g e
Chapter Six

6. Discussion
The research question of this study was to identify the causes for relapse to addiction among
substance abusers after treatment and the factors of relapse which are successfully answered by
the findings of this study. From the result, three main factors contribute to the relapse
phenomenon psychosocial factor, environmental and economic factors. It has negative impact in
their health, social life, psychological wellbeing and finance. These section have two parts. The
first part will explain the factors and causes of relapse, and the second section will state about the
highly abused/used drugs.

In this section, the results of this study is going to be discussed in the light of studies and existing
evidence about substance use relapse. The discussion is going to be described under the
identified themes. These themes were psychological factors, peer pressure, environmental
factors, lack of social support, and religion and/or spirituality.

Psychological factors

Some of the respondents mentioned they felt guilty, hopeless, anger and frustration before
relapse. The findings also show that negative emotions put the drug addicts to return to drugs and
become relapsed because they think that the drug helps them deal with their problems.
According to the study by Appiah (2014), adverse emotional conditions related to the mind such
as feeling miserable, upset, isolated, worthless, blamed are the main initiating factors.

Peer pressure

Peer pressure has a crucial role in relapse. The finding shows that, old friends‘ influence also
plays a significant role with a persons‘ involvement in drug addiction.

In another study, Sampson et al. (2017), examined peer pressure as a major factor influencing
relapse among substance abuse patients in Nigeria. Those findings support the finding in this
study that old friends‘ influence factor also contributes to the relapse phenomenon among drug
addicts.

Environmental factors

Environmental factors like the availability or accessibility of drugs easily in a certain place
tempts the former addict to relapse. Some respondents stated that their environment is the main
reason for relapse. This also supported by other study, returning to the place can challenge them
to return back to their old habit even after months of abstinence‖ (Schubart, 2001).

43 | P a g e
Lack of social support

Above and beyond, lack of support after treatment was one of the factors to relapse revealed in
this research. This type of person is sensitive, emotional, and socially pressured. They think that
the substance use disorder treatment is enough to change their life but because of low self-
esteem, they will return back to their old habits and relapse. People with low self-esteem are
socially pressured, so when the community labels them as something bad, they feel uneasy to
associate with the community they felt left out so they will return back to their former friends
(Ibrahim & Kumar, 2009).

A scarce income was also the cause, of which insufficient funds led them to return to their old
job which they don‘t want to work and led them to stress. Recent studies by Brown University
have proven that ―exposure to stress is associated with drug addiction in humans and can induce
relapse and craving (Sinha et al., 2011).‖ Individuals dealing with stress are vulnerable to return
back to addiction or relapse.

Religion and/or spirituality

Religion and/or spirituality like ―tsibel‖, ―ement‖, ―kalkidan‖, church, visiting monarchs and etc.
are also the most common factors that affect the treatment process.

Highly abused/used drugs

The most common substances or drugs that are used is alcohol 164(29.0%), tobacco or cigarette
161(28.4%), khat 160(28.3%), illegal non-medical addictive drugs 71(12.5%), and lastly
injecting drugs using syringe 10(1.8%). This substances or/and drugs are most commonly used
and consumed substances or drugs. This is because the availability of drugs and substances,
family history and most commonly peer pressure.

Problem prioritization and actions to be taken

Problem prioritization is the key in health planning, enabling the identifications of priority
problems to intervene.

Problem/factors Frequency/magnitude Action to be taken

from 213 participants
personal 141  Information dissemination
 Prevention education
 Essential life skill teachings
 Individual psycho-therapies
peer pressure factor 126  Essential life skill teachings
 Information dissemination

psychological 121  Individual and group psycho-

44 | P a g e
 therapies
 Behavioral therapy models
unstable lifestyle 97  Essential life skill teachings
 Information dissemination
 Individual psycho-therapies
lack of support 95  Community based trainings
 Provide support
environmental actor 91  Establishing rules and regulations
 Community based trainings
 Information dissemination
availability of the drugs 91  Keep track of prescription drugs
 Community based trainings
 Information dissemination
religion or spirituality 78  Community based trainings
 Information dissemination
physiological 63  Diagnose and treat it
economic 56  5A‘s: ask, advise, assess, and
arrange

45 | P a g e
Chapter Seven

Conclusion and Recommendation

In the long run, this research works on the investigation of the causes for relapse to addiction
among addicted people after treatment. The findings of this study revealed that the relapse of
drug use could happen because of psychological, social, environmental, religion/spirituality and
economic factors such as, negative emotions, lack of support, former friend influences, being in
an environment that is highly exposed to illicit drugs, and activities, scare of resource or money.
The results of this study also confirmed what substances used mostly.

The aim of this research was to understand the causes and the factors of relapse and to change
from the grass root.

This study proved that the relapse rate is very high because of different reasons such as
psychological, social, environmental, and economic factors. Consequently, to reduce or prevent
relapse rate, the cause should be addressed. Addiction and relapse is multidimensional problem
so that different bodies should contribute.

Polices and strategies has to formulated by the government to prevent and control substance and
alcohol use in the country. Education or creating awareness about the negative effect of addiction
in all aspects of life can change people therefore; it has to be included in different lesson with
different levels.

Health professionals should address different therapies and strategies to address the problem of
relapse.

Implications

Awareness creation: - People with substance-related disorders have faced different psychosocial
problems. Therefore, the first implication of this study is exploring the perceptions of people
with relapse. So, educating the public on the concept of mental health and Psychotherapeutic
services is a very necessary thing.

Provision of psychotherapy :- Psychotherapy is important for people with substance related

disorder making to understand the nature of problems, to regain hope, feel empowered and made
them take the decision to get out of this problem, develop a sense of self, and positive living. It is
important for psychologists created a new way of understanding the patient's experience,
meaning, and interpretation. It helps to uncover hidden, contextual meanings that can be
deconstructed, giving voice to individual perspectives which suppressed due to stigma and
associated factors. It helps to the psychologist to choose the best way of the treatment.

Future research: -As research is the base for finding several interventions to the problem,
Therefore, the findings of this study helped as the baseline for the future researchers.
46 | P a g e
The following specific recommendations are also drawn:

 Mental Health professionals, create awareness about the nature of the substance, and
barriers to seeking psychotherapeutic services.
 Since the present study was limited to St. Paul Hospital psychiatric rehabilitation center,
Future study should be extended to other hospitals. This will help to provide a picture of
the perceptions of the people with substance use disorder towards psychotherapy.

47 | P a g e
Reference
Abate, S. M., Chekol, Y. A., & Minaye, S. Y. (2021). Prevalence and risk factors of

psychoactive substance abuse among students in Ethiopia: A systematic review and meta-

analysis. Annals of medicine and surgery, 70.

Abebe,W. (2013). Prevalence and consequences of substance use among high school and college

students in Ethiopia. African Journal of drug and alcohol studies, 12(2).

Ackermann K., (2019). Warning signs of relapse: depression, stress, and other triggers retrieved

from https://americanaddictioncenters.org/adult-addiction-treatment-programs/signs-of

relapse

Ali, T., & Worku, T. (2020). Current alcohol consumption and associated factors among school

adolescents and youths in Ethiopia: A systematic review and meta-analysis. SAGE open

medicine, 8.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological

Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Cohen, L., Manion, L. & Morrison, K. (2005). Research Methods in Education Sixth edition

DACA. Hand Book on Substances of Abuse for Trainers. Addis Ababa: Commercial printing

Enterprise, 2005. pp 7-36.

DACA. National Drug Control Master Plan of 2010-2014.Addis Ababa: commercial printing

Enterprise, 2011.p15.

47 | P a g e
Drug Ad ministration and Control Authority or Ethiopia, (2005). Hand Book on Substances of

Abuse for Trainers. Addis Ababa, Ethiopia

Federal Democratic Republic of Ethiopia population census commission. (2008). Summary and

statistical report of 2007, population and housing census results

Fekadu A, Atalay A, Charlotte H. Alcohol and Drug Abuse in Ethiopia: Past, Present and Future.

African Journal of Drug & Alcohol Studies, 2007; 6(1).

Fekadu, A., Desta M., Alem A. & Martin P. (2007). A descriptive analysis of admissions to

Amanuel Psychiatric Hospital in Ethiopia. Ethiopian Journal of Health Development

21(2) doi: 10.4314/ejhd.v21i2.10046

Gorski, T. T. & Merlene M. (1986), Staying sober: a guide for relapse prevention. Herald

house/independence press, Missouri 64056, USA

Jufar, E. (2019). Psychosocial triggering factors of relapse among substance abusers: the case of

amanuel mental specialized hospital rehabilitation center. Addis Ababa: Addis Ababa

University.

Kassaye, M., Sherief, H. T., Fissehaye, G., &Teklu, T. (2017). "Drug" use among high school

students in Addis Ababa and Butajira. The Ethiopian Journal of Health Development,

13(2).

Kerachio, B. Drug Abuse. Nairobi: Uzima Press, 1994

Kevin E. O‘Grady, Amelia M. Arria, Dawn M.B. Fitzelle, Eric D. Wish. Heavy Drinking and

Polydrug Use among College Students. Int J Drug Issues. 2008; 38(2): 445-466.

48 | P a g e
Lemis M. Negsu, Judah N, Alice M. Drug dependence and abuse in Kenyan secondary schools:

strategies for intervention. Academic Journals October 2008; 3(10): 304-308.

National Drug Control Master Pl an of FMHCACA . (20 I 0-20 15). Add is Ababa, Ethiopia.

National Drug Control Master Plan of FMHCACA . (2010-2015). Addis Ababa, Ethiopia.

NIDA . (20 I 0). Drugs, Brains and Behavior: The science of addiction. National Institutes of

Health. U.S. Department of Health and Human Services, NIH Pub No. 10-5605. USA.

Olawole-Isaac, A., Ogundipe, O., Amoo, E. O., & Adeloye, D. (2018). Substance use among

adolescents in sub-Saharan Africa: A systematic review and meta-analysis. South African

Journal of Child Health, 12,79-84.

Parekh R. (2017). What is addiction? Retrieved from https://www.psychiatry.org/patients

families/addiction/what-is-addiction

Saripalli, V. (2018). Addiction: Definition, symptoms, withdrawal, and treatment retrieved from

https://www.medicalnewstoday.com

Schubart, C. (2001). Probing the Riddle of Relapse. Science Now 2, p2.

Tesfaye, G., Derese, A., Hambisa, M. T. (2014). A cross-sectional study on substance use and

associated factors among university students in ethiopia. Journal of Addiction 2014

(969837) doi: 10.1155/2014/969837

U. H. Ihezue, MB, BS, MRCPsych Enugu. Alcohol and drug taking among Medical students at a

Nigerian University campus: part 2.Sociodemographic factors of Etiologic significance,

Nigeria. Journal of the National Medical Association, 1988; 80(2).

49 | P a g e
United Nations. Convention against Illicit Traffic in Narcotic Drugs and Psychotropic

Substances. Vienna, December 20, 1988.

United Nations. Convention on Psychotropic Substances: Final act of the United Nations

Conference for the Adoption of a Protocol on Psychotropic Substances, Vienna, February

21, 1971.

United Nations. Single convention on narcotic drugs, New York, March 30, 1961.

UNODC World Drug Report. (2020). retrieved from

http://www.unodc.org/unodc/press/releases/2020/June/media-advisory-global-launch-of

the-2020-world-drug-report.html

UNODCCP (2002). A participatory handbook for youth drug abuse prevention programs. A

guide for development and improvement. Global Youth Network, New York

WHO (2004). Psychoactive substances use and dependence. Retrieved April 2021, from

https://www.who.int/substance_abuse/publications/psychoactives/en

WHO (2021). Drug. Retrieved April 2021, from

https://www.who.int/substance_abuse/terminology/abuse/e

WHO/ UNDCP (2003). Substance use in southern Africa Knowledge, Attitudes, Practices and

Opportunities for Intervention. Retrieved April 2021, from

https://www.who.int/mental_health/media/en/707.pd

50 | P a g e
Annex I

Information Sheet (English version)

Unity University, Faculty of Health Science, Department of Public Health

Name of the Investigators:

 Abel Tekle  Eskindir Solomon

 Dawit Samuel  Ruth Tedla
 Ephrem Sisay  Tsegaye Orebo

Name of the organization: Unity University, Faculty of Health Science, Department of Public
Health

Name of the Sponsor: Investigators

Introduction

This information sheet and consent form is prepared by the investigators whose main aim is to
study the factors that are negatively affect recovery from substance use disorders among patients
who are receiving treatment at St. Paul's Hospital Millennium Medical College addiction
treatment center, Addis Ababa, Ethiopia 2023. The investigators are a Bachelor‘s degree student
from Unity University, Faculty of Health Science, and Department of Public Health.

Purpose: The purpose of this research is to assess the factors that are negatively affect recovery
from substance use disorders among patients who are receiving treatment at St. Paul's Hospital
Millennium Medical College addiction treatment center, Addis Ababa, Ethiopia.

Procedure: In order to assess, we invite you to take part in our project. If you are willing to
participate in our project, you need to understand and sign the consent form. Then, you will be
asked to give your response by the data collectors. For this questionnaire based study,
participants are patients who are receiving treatment in st. Paul‘s Hospital Millennium Medical
College Addiction Treatment Center. All the responses given by the participants and the results
obtained will be kept anonymous and confidential using coding system whereby no one will have
access to your responses.

Risks and/or Discomfort: By participating in this research project will not have any risk.

Benefits: If you participate in this research project, you may not get direct benefit but your
Participation is likely to help us in assessing the factors that are negatively affect recovery from
substance use disorders among patients who are receiving treatment at St. Paul's Hospital
Millennium Medical College addiction treatment center, Addis Ababa, Ethiopia. It will give an
insight for planning of effective interventions based on the findings of the study for improving

51 | P a g e
the health status of patients who are receiving treatment for substance use disorder relapse and
the community as well.

Incentives: You will not be provided any incentives to take part in this project. Confidentiality
and Anonymity: The information that we will collect from this research project will be kept
confidential. Information about you that will be collected from the study will be stored in a file,
which will not have your name on it, but a code number assigned to it.

Right to Refuse or Withdraw: You have the full right to refuse from participating in this
research (you can choose not to respond some or all of the questions) if you do not wish to
participate; and this will not affect the health service you get from any health facility. You have
also the full rights to withdraw from this study at any time you wish to, without losing any of
your rights as a client of this health facility.

CONSENT FORM (English version)

Based on the purpose and objectives of the study, therefore, you are rightfully eligible for the
interview. It is an interview I would like to ask you set of specific questions. I will be grateful if
you can spend some time talking with me. The interview is consent-based voluntary,
confidential, private and of approximately half an hour‘s duration. Other than a general serial
code, your name and other identification aspects are not going to be recorded on the interview
sheet.

Everything you are going to tell will get kept strictly confidential and private. You will not get
obliged to respond to one or more of the specific questions that you do not want to respond to.
But so long as you find it reasonably convincing, it undoubtedly is going to be more helpful
when all of the questions of the interview set will get completed. Now, we can only start asking
you the set of specific questions after I have confirmed your willingness. We kindly ask you to
take active part and contribute to the study.

Are you willing to participate in the study?

(A) Yes (B) No, Thank You

If the client subject agrees to participate in the study, start the interview.

1.) Interviewer signature certifying that the informed consent has been given verbally.

 Name __________________
 Signature _________________
 Date __________________

2.) Interviewee signature _________________

52 | P a g e
 Questionnaire

S.No Coding categories Questions and filter Skip Code

Section One: Identification

Part One: Personal Information
101 Age Less 14-----------1
15-20-----------2
21-25-----------3
26-30-----------4
31-35-----------5
36-40 ----------6
41-50-----------7
51-60-----------8
61 And Above 61------------9
102 Sex Male---------1
Female -----------2
Prefer Not To Say--------3
103 Educational Status Bachelor‘s Degree-----------1
Diploma----------2
Master‘s Degree----------3
TVET------4
11-12 Grade---------5
9-10 Grade-----------6
8 Grade And Less Than---------7
Illiterate--------------8
104 Occupation Student-----------1
Government Employee----------2
Private Employee----------3
Housewife---------4
No Job-----------5
Retirement-------------6
105 Marital Status Married---------1
Single-----------2
Divorced------------3
Separated---------4
106 Residence Addis Ababa------1
Oromia---------2
Amhara-------3
Southern Ethiopia---------4
Other----------5
107 Religion Orthodox---------1
Protestant----------2
Muslim---------3
53 | P a g e Catholic-----------4
Other----------5
108 Monthly Income 490 and less than 499 birr-----------1
500-1499 birr------------2
1500-2499 birr------------3
500-3499 birr------------4
3500-4999 birr-----------5
5000-6999 birr------------6
7000-9999 birr------------7
10,000-14,999 birr---------8
15,000 birr and above----------9
Part two: Family History
109 Are Your Father and Mother Living Yes---------1
Together Currently? Divorced-----------2
Separated---------3
only father alive------------4
only mother alive---------5
both of them are not alive-----------6
110 What Is The Educational Status Of Your Bachelor‘s Degree----------1
Father? Diploma----------2
Master‘s Degree-----------3
TVET------4
11-12 Grade---------5
9-10 Grade---------6
8 Grade And Less Than---------7
Illiterate--------------8
111 What Is The Educational Status Of Your Bachelor‘s Degree----------1
Mother? Diploma----------2
Master‘s Degree----------3
TVET------4
11-12 Grade---------5
9-10 Grade-----------6
8 Grade And Less Than---------7
Illiterate----------8
112 Do Any Of Your Families Use Substance Yes---------1
Or Drugs? No----------2 (if no skip) 113,114
113 What Substance Do They Use? Khat---------1
Cigarette---------2
Alcohol-----------3
illegal drugs---------4
other----------5
114 Since When Did They Start Use? Teen age---------1
Adult age----------2
After 30th age---------3
Old age---------4
Section Two: Pre-Test
201 Did you diagnosed with substance use? Yes---------1
No----------2 (if no skip) 202,203

54 | P a g e
202 When did you diagnosed?
203 Where did you diagnosed?
204 Did you diagnosed with substance use Yes---------1
relapse? No----------2 (if no skip) 205,206
205 When did you diagnosed?
206 Where did you diagnosed?
207 Did the client pass to be included for the Yes---------1
study? No----------2
Section Three:
Part One: Identifying the Most Commonly Used Drugs
301 How old are you when you start taking Less than 15 years old------------1
substance or drug? 16-20 years old------------2
21-25 years old------------3
26-30 years old----------4
31 and above years old----------5
302 Have you ever chew khat? Yes---------1
No----------2 (if no skip) 303,304,305
303 How often do you chew khat? Everyday--------1
Every two days--------2
Every other day--------3
Rarely----------4
304 Have you chew khat in the last 12 Yes---------1
months? No----------2
305 Have you chew khat in the last 30 days? Yes---------1
No----------2
306 Have you ever smoked cigarette/tobacco? Yes---------1
No----------2 (of no skip) 307,308,309,310
307 Have you smoked cigarette in the past 12 Yes---------1
months? No----------2
308 Have smoked cigarette in the past 30 Yes---------1
days? No----------2
309 How often do you smoke? Every time-----------1
Rarely----------2
310 How many cigarette =s did you smoke Only one-----------1
per day? 2-5----------2
6-10-----------3
11-15-----------4
16-20-----------5
Above 20-----------6
311 Have you ever consumed alcohol? Yes---------1
No----------2 (if no skip) 312,313,314,315,316
312 How often do you drink alcohol? Everyday--------1
Ever two days---------2
Every other day--------3
Rarely----------4
313 Have you consumed alcohol in the past Yes---------1

55 | P a g e
 12 months? No----------2
314 Have you consumed alcohol in the past Yes---------1
30 days? No----------2
315 What was the type of drink you usually Whisky---------1
had? Beer-----------2
Draft---------3
Tela----------4
Tej----------5
Areke/jin----------6
Other----------7
316 What is the usual amount that you take 1-5 units-----------1
(use local measurements)? 6-10 units-----------2
Above 10 units----------3
317 Have you tried a ranges of illegal/non- Yes---------1
medical/addictive drugs? No----------2 (if no skip) 318,319,320,321
318 Which of the following drugs have you Cocaine-----------1
tried? Heroin-----------2
Cannabis--------3
Marijuana-------4
Other----------5
319 How long have you been using these Since early age----------1
illegal/non-medical/addictive drugs? Since adult age----------2
Lately----------3
320 Have you use it in the past 12 months? Yes---------1
No----------2
321 Have you use it in the past 30 days? Yes---------1
No----------2
322 Have you ever tried injecting drugs using Yes---------1
syringe? No----------2 (if no skip) 323,324
323 Have you ever tried injecting drugs using Yes---------1
syringe in the past 12 months? No----------2
324 Have you use it in the past 30 days? Yes---------1
No----------2
325 What other illegal drugs or substances do
you use?
326 What are the risk factors? Family----------1
Peer pressure----------2
Environmental----------3
Mental illness ----------4
Stress---------5
Depression----------6
Lack of social support----------7
Physical abuse---------8
Substance or drug availability-----------9
327 How long did you take substance or 6 months---------1

56 | P a g e
 drugs? 1 year---------2
1-2 years---------3
3-5 years---------4
6-10 years----------5
Above 10 years--------6
328 What are your reasons to use substance?
329 Do you think that substances and drugs Yes---------1
have consequences/risk on your health, No----------2
social economic and psychological
situation?
Part Two: Identifying the Factors for Relapse
330 Have you ever tried to stop or cutting Yes---------1
down the use of substance or drugs by No----------2
yourself?
331 How did you join the rehabilitation Self-initiation------------1
centers when you come first? Family bring me------------2
Friends bring me----------3
Other----------4
332 How many times in your life have you Only 1 time-----------1
been treated for substance use? 2-3 times-----------2
4-5 times-----------3
Above 5 times------------4
333 How many days have you been treated in Only 1 time-----------1
an outpatient setting for alcohol or drugs 2-3 times-----------2
in the past 30 days? 3-5 times-----------3
Above 5 times------------4
334 Where did you receive the first
treatment?
335 What types of services or treatments have CBT---------1
you got in that rehab center? Medication----------2
Other----------3
336 Do you think it was effective? Yes---------1
No----------2
337 How difficult was to stop consuming the Very difficult-----------1
substances or drugs after the treatment? Difficult-----------2
No difficult at all-----------3
Part Three: Identifying the Causes for Relapse
338 What are the reasons of relapse? Personal----------1
Psychological----------2
Environmental----------3
Lack of support---------4
Peer pressure----------5
Physiological-----------6
Social-----------7
Economic----------8

57 | P a g e
 Mental illness-----------9
Religion/spirituality------------10
Unstable lifestyle------------11
Unstable marriage---------12
Availability of the substances or drugs----13
Other----------14
339 The time gap between taking drugs after Days--------1
treatment? Weeks----------2
2 weeks---------3
Months--------4
Couple of months---------5
After many months----------6
340 Can you share the moment you fell at the
time of relapse?

58 | P a g e
Annex II

የመረጃ ገፅ (Amharic version)

ዩኒቲ ዩኒቨርሲቲ ፣ የጤና ሳይንስ ፋኩልቲ ፣ የህብረተሰብ ጤና ት/ት ክፍል

የድርጅቱ ስም- ዩኒቲ ዩኒቨርሲቲ ፣ የጤና ሳይንስ ፋኩልቲ ፣ የህብረተሰብ ጤና ት/ት ክፍል

የስፖንሰር አድራጊው ስም- መርማሪዎች

መግቢያ

ይህ የመረጃ ወረቀት እና የስምምነት ቅጽ በዋነኝነት ዓላማቸው ህክምና በሚቀበሉ በሽተኞች መካከል ካለው ንጥረ
ነገር አጠቃቀም ጋር ተያይዞ የሚመጣውን ጉዳት አሉታዊ ተፅእኖ እና ግርሻን የሚያመጡትን ምክንያቶች በቅዱስ
ጳውሎስ ሆስፒታል ሚሊኒየም የህክምና ኮሌጅ ሱስ ሕክምና ማዕከል ፣ አዲስ አበባ ፣ ኢትዮጵያ 2023. መርማሪዎቹ
ከዩኒቲ ዩኒቨርስቲ፣ ከጤና ሳይንስ ፋኩልቲ፤ የህብረተሰብ ጤና ት/ት ክፍል የመጀመሪያ ዲግሪ ተማሪ ናቸው.

ዓላማው የዚህ ምርምር ዓላማ በቅዱስ ጳውሎስ የሱስ ማገገሚያ ሕክምና በሚቀበሉ በሽተኞች መካከል ካለው
ንጥረ ነገር አጠቃቀም ችግሮች ማገገም ላይ አሉታዊ ተጽዕኖ የሚያሳድሩትን ምክንያቶች መገምገም ነው. የጳውሎስ
ሆስፒታል ሚሊኒየም የህክምና ኮሌጅ ሱስ ሕክምና ማዕከል ፣ አዲስ አበባ ፣ ኢትዮጵያ.

ሂደት- ለመገምገም በፕሮጄክቶቻችን ውስጥ እንዲሳተፉ እንጋብዝዎታለን. በፕሮጄክቶቻችን ውስጥ ለመሳተፍ

ፈቃደኛ ከሆኑ የስምምነት ቅጹን መረዳትና መፈረም ያስፈልግዎታል. ከዚያ ፣ በመረጃ ሰብሳቢዎች ምላሽዎን
እንዲሰጡ ይጠየቃሉ. ለዚህ መጠይቅ መሠረት ያደረገ ጥናት ተሳታፊዎች በቅዱስ ጳውሎስ ውስጥ ህክምና የሚያገኙ
ህመምተኞች ናቸው. የጳውሎስ ሆስፒታል ሚሊኒየም የህክምና ኮሌጅ ሱስ ሕክምና ማዕከል. በተሳታፊዎች የተሰጡ
ምላሾች እና የተገኙት ውጤቶች ማንም ሰው ምላሽዎን የማይደርስበት የኮድ ስርዓት በመጠቀም ማንነቱ ያልታወቀ
እና ምስጢራዊ ሆኖ እንዲቆይ ይደረጋል.

አደጋዎች እና / ወይም ምቾት- በዚህ የምርምር ፕሮጀክት ውስጥ በመሳተፍ ምንም አደጋ የለውም.

ጥቅሞች- በዚህ የምርምር ፕሮጀክት ውስጥ የሚሳተፉ ከሆነ, ቀጥተኛ ጥቅም ላይ ላይሰጡ ይችላሉ ነገር ግን
ተሳትፎዎ በቅዱስ ጳውሎስ ውስጥ ህክምና በሚቀበሉ በሽተኞች ላይ ካለው ንጥረ ነገር አጠቃቀም ችግር ጋር አሉታዊ
ተፅእኖ ያላቸውን ምክንያቶች ለመገምገም እኛን ሊረዳ ይችላል. የጳውሎስ ሆስፒታል ሚሊኒየም የህክምና ኮሌጅ ሱስ
ሕክምና ማዕከል ፣ አዲስ አበባ ፣ ኢትዮጵያ. ለሱስ አጠቃቀም ችግር እና ህክምና ለሚቀበሉ ህመምተኞች የጤና
ሁኔታን ለማሻሻል በጥናቱ ግኝት ላይ በመመርኮዝ ውጤታማ ጣልቃ-ገብነትን ለማቀድ የሚያስችል ግንዛቤ ይሰጣል፡፡

ማበረታቻዎች- በዚህ ፕሮጀክት ውስጥ ለመሳተፍ ምንም ማበረታቻዎች አይሰጡም. ምስጢራዊነት እና ስም-ከዚህ
የምርምር ፕሮጀክት የምንሰበስበው መረጃ በሚስጥር ይቀመጣል. ከጥናቱ የሚሰበሰቡት መረጃ በፋይል ውስጥ
ይቀመጣል ፣ ይህም ስምዎ ላይ የለውም ፣ ግን ለእሱ የተመደበው የኮድ ቁጥር.

የማደስ ወይም የመተው መብት: በዚህ ምርምር ውስጥ ላለመሳተፍ ሙሉ መብት አልዎት ለመሳተፍ የማይፈልጉ
ከሆነ ለአንዳንድ ወይም ለሁሉም ጥያቄዎች መልስ ለመስጠት መምረጥ ይችላሉ; እና ይህ ከማንኛውም የጤና ተቋም

59 | P a g e
የሚያገኙትን የጤና አገልግሎት አይጎዳውም. እንዲሁም የዚህ የጤና ተቋም ደንበኛ እንደመሆንዎ መጠን
ማንኛውንም መብቶችዎን ሳያጡ ከዚህ ጥናት ለመውጣት ሙሉ መብቶችም አልዎት.

የስምምነት ቅፅ

በጥናቱ ዓላማ እና ዓላማዎች ላይ በመመርኮዝ ለቃለ መጠይቁ በትክክል ብቁ ነዎት. የተወሰኑ ጥያቄዎችን
እንዲጠይቁዎት እፈልጋለሁ. ከእኔ ጋር ለመነጋገር የተወሰነ ጊዜ ማሳለፍ ከቻሉ አመስጋኝ ነኝ. ቃለመጠይቁ በስምምነት
ላይ የተመሠረተ በፈቃደኝነት ፣ ምስጢራዊ ፣ የግል እና በግምት ለግማሽ ሰዓት ያህል ነው. ከአጠቃላይ የመለያ ኮድ
ውጭ ፣ ስምዎ እና ሌሎች የመታወቂያ ገጽታዎች በቃለ መጠይቁ ላይ አይመዘገቡም.

የሚነግርዎት ነገር ሁሉ በጥብቅ ሚስጥራዊ እና ግላዊ ሆኖ ይቀመጣል. ምላሽ መስጠት የማይፈልጉትን የተወሰኑ
ጥያቄዎች ለአንድ ወይም ከዚያ በላይ የመመለስ ግዴታ የለብዎትም. ግን በምክንያታዊነት አሳማኝ ሆኖ እስካገኙት
ድረስ ፣ በቃለ መጠይቁ ላይ የተነሱት ጥያቄዎች ሁሉ ሲጠናቀቁ የበለጠ አጋዥ እንደሚሆን ጥርጥር የለውም. አሁን ፣
ፈቃደኛነትዎን ካረጋገጥኩ በኋላ የተወሰኑ ጥያቄዎችን ስብስብ መጠየቅ ብቻ መጀመር እንችላለን. ንቁ ተሳትፎ
እንዲያደርጉ እና ለጥናቱ አስተዋፅ እንዲያበረክቱ በትህትና እንጠይቃለን.

በጥናቱ ለመሳተፍ ፈቃደኛ ነዎት?

(ሀ) ( አዎ (ለ) አይ ፣ አመሰግናለሁ

የጥናቱ ርዕሰ ጉዳይ በጥናቱ ለመሳተፍ ከተስማሙ ቃለመጠይቁን ይጀምሩ.

1.) የተነገረው ስምምነት በቃላት እንደተሰጠ የሚያረጋግጥ ቃለ-መጠይቅ ፊርማ.

•ስም _________________

•ፊርማ ________________

•ቀን _________________

2.) የተጠያቂው ፊርማ _________________

60 | P a g e
መጠይቅ

ኮድ ምድቦች ጥያቄዎች እና ማጣሪያ ዝለል ኮድ ኮድ

ክፍል አንድ-መታወቂያ
ክፍል አንድ የግል መረጃ ዝለል

የ 101 ዕድሜ ከ 14 -------1

15-20 ------------2
21-25 -----------3
26-30 -----------4
31-35 ----------5
36-40 ---------6
41-50 --------7
51-60 ---------8
61 እና ከ 61 በላይ -------9

102 ፆታ ወንድ ----------1

ሴት -------------2
ላለመናገር ይምረጡ ----------3
103 የትምህርት ሁኔታ የመጀመሪያ ዲግሪ ------------1
ዲፕሎማ -----------2
ማስተር ዲግሪ -----------3
ቴሌቪዥን ---- 4
11-12 ክፍል ----------5
9-10 ክፍል -----------6
8 ኛ ክፍል እና ከ 8 በታች----------7
ያልተማረ -----------8
104 የሥራ ሁኔታ ተማሪ ----------1
የመንግስት ሰራተኛ -----------2
የግል ሰራተኛ -----------3
የቤት እመቤት ----------4
አይ ኢዮብ -------------
ጡረታ ------------6
105 የጋብቻ ሁኔታ አገባ ----------1
ነጠላ -----------
ተከፋፋይ --------
ተለያይቷል ----------4
106 የመኖሪያ አዲስ አበባ ----- 1
ኦሮሚያ ----------2
አሚራ ---- - 3
ደቡባዊ ኢትዮጵያ - -4
ሌላ -----------5

61 | P a g e
107 ሃይማኖት ኦርቶዶክስ - - -1
ፕሮቴስታንት - - 2
ሙስሊም - - 3
ካቶሊክ -----------4
ሌላ -----------5
108 ወርሃዊ ገቢ 490 እና ከ 499 ብር በታች -----1
500-1499 birr -----------2
1500-2499 birr -------------3
500-3499 birr -----------4
3500-4999 birr --------5
5000-6999 birr --------6
7000-9999 birr ---------7
10,000-14,999 birr ----------8
15,000 ብር እና ከዚያ በላይ -----9
ክፍል ሁለት የቤተሰብ ታሪክ
109 አባትህ እና እናትህ አዎ ----------1
በአሁኑ ጊዜ አብረው
ይኖራሉ?
ተከፋፋይ ----------
ተለያይቷል ----------3
አባት ብቻ -------------
በሕይወት ብቻ እናት - - -5
ሁለቱም በሕይወት አይደሉም -----------110
የአባትህ የትምህርት የባችለር ዲግሪ -----------1
ሁኔታ ምንድነው?
ዲፕሎማ -----------2
ማስተር ዲግሪ --------
ቴሌቪዥን ---- 4
11-12 ክፍል ----------5
9-10 ክፍል ----------6
8 ኛ ክፍል እና ከ8 በታች ----------7
ያልተማረ -----------8
111 የእናትህ የባችለር ዲግሪ -----------1
የትምህርት ሁኔታ
ምንድነው?
ዲፕሎማ -----------2
ማስተር ዲግሪ -----------3
ቴሌቪዥን ---- 4
11-12 ክፍል ----------5
9-10 ክፍል -------
8 ኛ ክፍል እና ከ 8 በታች ----------7
ያልተማረ -----------8

62 | P a g e
112 ከቤተሰቦችዎ አዎ -------1
ውስጥ ማንኛውም
ንጥረ ነገር ንጥረ
ነገሮችን ወይም
መድኃኒቶችን
ይጠቀማሉ?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 113,114
113 ምን ንጥረ ነገር ካት ----------1
ይጠቀማሉ?
ሲጋራ ----------2
አልኮሆል ---------
ህገ-ወጥ መድኃኒቶች ----------4
ሌላ -----------5
114 መጠቀም በአሥራዎቹ ዕድሜ - - -1
የጀመሩት መቼ ነው?
የጎልማሳ ዕድሜ -----------2
ከ 30 ኛው ዕድሜ በኋላ ----------3
የዕድሜ መግፋት ----------4

ክፍል ሁለት-ቅድመ-
ሙከራ
201 በቁሳዊ አጠቃቀም አዎ ----------1
ላይ ምርመራ አደረጉ?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 202,203
202 መቼ ነው
በምርመራዎ
203 የት ምርመራ
አደረጉ
204 ንጥረ ነገር እንደገና አዎ ----------1
ማገገም እንዳለብዎት
በምርመራዎ ላይ ነዎት?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 205,206
205 መቼ ነው
በምርመራዎ
206 የት ምርመራ
አደረጉ
207 ደንበኛው ለጥናቱ አዎ ----------1
እንዲካተት አስተላል
?ል?
አይ -----------2
ክፍል ሶስት:
ክፍል አንድ-በጣም

63 | P a g e
የተለመዱ ጥቅም ላይ
የዋሉ መድኃኒቶችን
መለየት
301 ንጥረ ነገር ወይም ከ 15 ዓመት በታች ------1
መድሃኒት መውሰድ
ሲጀምሩ ዕድሜዎ ስንት
ነው?
ከ16-20 ዓመት --------------2
ከ21-25 ዓመት ----------3
ከ 26 እስከ 30 ዓመት ---------4
31 እና ከዚያ በላይ ዓመት ------5
302 መቼም khat ን አዎ ----------1
አታልቅህ ታውቃለህ?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 303,304,305
303 ምን ያህል ጊዜ በየቀኑ ---------1
khat ን ታጭዳለህ?
በየሁለት ቀናት ------2
በየቀኑ - - 3
አልፎ አልፎ - - 4
304 ባለፉት 12 ወሮች አዎ ----------1
ውስጥ ካታን አሾፈህ?
አይ -----------2
305 ባለፉት 30 ቀናት አዎ ----------1
ውስጥ khat ን አሾፈህ?
አይ -----------2
306 ሲጋራ / ትምባሆ አዎ ----------1
መቼም አጨሱ?
አይ --------- 2 ‹ዝለል> 307,308,309,310
307 ላለፉት 12 ወሮች አዎ ----------1
ሲጋራ አጨሱ?
አይ -----------2
308 ላለፉት 30 ቀናት አዎ ----------1
ሲጋራ አጨሱ?
አይ -----------2
309 ምን ያህል ጊዜ በየጊዜ ---------1
ታጨሱ?
አልፎ አልፎ - - 2
310 በቀን ስንት ሲጋራ አንድ ብቻ --------1
‹TAG1> s ያጨሱ
ነበር?
2-5 -----------2
6-10 ---------3

64 | P a g e
 11-15 -----------4
16-20 -----------5
ከ 20 በላይ - - - 6

311 አልኮልን መቼም አዎ ----------1

አልጠጡም?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 312,313,314,315,316
312 የአልኮል መጠጥ በየቀኑ ----------1
ምን ያህል ጊዜ
ትጠጣለህ?
ለሁለት ቀናት ያህል - - -2
በየቀኑ - - 3
አልፎ አልፎ - - 4
313 ላለፉት 12 ወሮች አዎ ----------1
አልኮልን ጠጡ?
አይ -----------2
314 ላለፉት 30 ቀናት አዎ ----------1
አልኮልን ጠጡ?
አይ -----------2
315 ብዙውን ጊዜ ምን ዊስኪ ----------1
ዓይነት መጠጥ ነበር?
ቢራ -----------2
ረቂቅ ----------3
ቴላ -----------4
ቴጄ -----------5
አሬክ / ጂን ----------- - 6
ሌላ ----------7
316 ‹TAG1› ን 1-5 አሃዶች ---------1
የሚወስዱት
የተለመደው መጠን
‹TAG1› አካባቢያዊ
ልኬቶችን ይጠቀሙ ›?
6-10 አሃዶች --------------2
ከ 10 ክፍሎች በላይ -----------3
317 ሕገ-ወጥ / አዎ ----------1
መድሃኒት ያልሆኑ / ሱስ
የሚያስይዙ
መድኃኒቶችን ክልል
ሞክረዋል?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 318,319,320,321
318 ከሚከተሉት ኮኬይን ------------1
መድኃኒቶች ውስጥ

65 | P a g e
የትኛውን ሞክረዋል?
ሄሮይን -----------2
ካናቢስ -------------3
ማሪዋና ---- - - 4
ሌላ -----------5
319 እነዚህን ሕገ-ወጥ ከልጅነቱ ጀምሮ --------- 1
/ መድሃኒት-አልባ / ሱስ
የሚያስይዙ
መድኃኒቶችን ለምን
ያህል ጊዜ ሲጠቀሙ
ኖረዋል?
ከአዋቂነት ዕድሜ ጀምሮ --------2
ከቅርብ ጊዜ - - 3
320 ላለፉት 12 ወሮች አዎ ----------1
ይጠቀሙበታል?
አይ -----------2
321 ላለፉት 30 ቀናት አዎ ----------1
ይጠቀሙበታል?
አይ -----------2
322 መርፌን አዎ ----------1
በመጠቀም አደንዛዥ
ዕፅ ለመውሰድ
ሞክረዋል?
አይ --------- 2 ምንም መዝለል ከሌለ ‹ዝለል> 323,324
323 ላለፉት 12 ወሮች አዎ ----------1
መርፌ በመጠቀም
መርፌዎችን በመርፌ
ለመሞከር ሞክረዋል?
አይ -----------2
324 ላለፉት 30 ቀናት አዎ ----------1
ይጠቀሙበታል?
አይ -----------2
325 ምን ሌሎች ህገ-
ወጥ መድኃኒቶች
ወይም ንጥረ ነገሮች
ይጠቀማሉ
326 የአደጋ ምክንያቶች ቤተሰብ -----------1
ምንድ ናቸው?
የአኩሪ ግፊት -----------2
አካባቢያዊ --------- 3
የአእምሮ ህመም --------- 4
ውጥረት - - -5

66 | P a g e
 ጭንቀት -------------6
የማኅበራዊ ድጋፍ እጥረት --------7
አካላዊ ጥቃት ----------8
ንጥረ ነገር ወይም የመድኃኒት ተገኝነት ----------
----
327 ንጥረ ነገር ወይም 6 ወር ----------1
አደንዛዥ ዕፅ ለምን
ያህል ጊዜ ወስደዋል?
1 ዓመት ----------2
1-2 ዓመታት ----------3
3-5 ዓመታት ----------4
ከ6-10 ዓመታት -----------5
ከ 10 ዓመታት በላይ -------------6
328 ንጥረ ነገር
ለመጠቀም
ምክንያቶችዎ ምንድ
ናቸው
329 ንጥረ ነገሮች እና አዎ ----------1
መድኃኒቶች በጤናዎ ፣
በማህበራዊ
ኢኮኖሚያዊ እና በስነ-
ልቦና ሁኔታዎ ላይ
መዘዝ / አደጋ አላቸው
ብለው ያስባሉ?
አይ -----------2
ክፍል ሁለት-ለመልሶ
ማገገም ሁኔታዎችን
መለየት
330 ንጥረ ነገሮችን አዎ ----------1
ወይም መድኃኒቶችን
በራስዎ ለማቆም
ወይም ለመቁረጥ
ሞክረው ያውቃሉ?
አይ -----------2
331 መጀመሪያ ራስን ማስተዳደር -----1
ሲመጡ የመልሶ
ማቋቋም ማዕከሎችን
እንዴት ተቀላቀሉ?
ቤተሰብ ያመጣኛል ----------2
ጓደኞች እኔን ያመጣሉ --------- 3
ሌላ -----------4
332 በሕይወትዎ 1 ጊዜ ብቻ -----------1

67 | P a g e
ውስጥ ስንት ጊዜ
ለቁሳዊ አጠቃቀም
ተስተናግደዋል?
2-3 ጊዜ -------------2
4-5 ጊዜ -------------3
ከ 5 ጊዜ በላይ -----------4
333 ላለፉት 30 ቀናት 1 ጊዜ ብቻ ------------1
የአልኮል ወይም
የአደንዛዥ ዕፅ አከባበር
በሚታከምበት ጊዜ
ስንት ቀናት ያህል
ተከምረዋል?
2-3 ጊዜ --------2
3-5 ጊዜ -------------3
ከ 5 ጊዜ በላይ ---------4
334 የመጀመሪያውን
ሕክምና የት ተቀበሉ
335 በዚያ የመልሶ CBT - - -1
ማቋቋም ማእከል
ውስጥ ምን ዓይነት
አገልግሎቶች ወይም
ሕክምናዎች
አግኝተዋል?
መድሃኒት -----------2
ሌላ -----------3
336 ውጤታማ ነው አዎ ----------1
ብለው ያስባሉ?
አይ -----------2
337 ከህክምናው በኋላ በጣም ከባድ -------1
ንጥረ ነገሮችን ወይም
መድኃኒቶችን መጠጣት
ምን ያህል ከባድ ነበር?
አስቸጋሪ ---------2
በጭራሽ አስቸጋሪ የለም -------3
ክፍል ሶስት-ለመልሶ
ማገገም መንስኤዎችን
መለየት
338 የመልሶ ማቋቋም የግል ----------- 1
ምክንያቶች ምንድ
ናቸው?
ሥነ-ልቦና ----------2
አካባቢያዊ --------- 3

68 | P a g e
 የድጋፍ እጥረት ----------4
የአኩሪ ግፊት -----------5
ፊዚዮሎጂ -------------6
ማህበራዊ ------------7
ኢኮኖሚ -----------8
የአእምሮ ህመም-----9
ሃይማኖት / መንፈሳዊነት -------10
የማይቻል የአኗኗር ዘይቤ----11
የማይቻል ጋብቻ ----------12
ሌላ -----------13
339 ከህክምና በኋላ ቀናት---------1
አደንዛዥ ዕፅ መውሰድ
መካከል ያለው የጊዜ
ክፍተት?
ሳምንታት -----------2
2 ሳምንቶች ----------3
ወሮች -------4
የወራት ጥንዶች ----------5
ከብዙ ወሮች በኋላ -----------6

340 በሚመለሱበት ጊዜ
የተሰማዎትን ስሜት
ጊዜ ማጋራት ይችላሉ

69 | P a g e
Annex III

70 | P a g e