





































Clinical Medicine Insights
Received 15 Apr 2021 | Revised 25 May 2021 | Accepted 30 June 2021 | Published Online 19 July 2021

DOI: https://doi.org/xx.xxx/xxx.xx 
CMI 2 (3), 144−149 (2021) ISSN (O) 2694-4626 

RESEARCH ARTICLE

Clinical Perception, Demographic Profile With PC Among Adolescents With
Substance Use Disorder

Niaz Mohammad Khan 1∗ , MSI Mullick 2 Sharmin Hussain 3

1Associate Professor of Psychiatry,
National Institute of Mental
Health, Dhaka, Bangladesh
2Professor of Child and Adolescent 
Psychiatry, Bangabandhu Sheikh 
Mujib Medical University, Dhaka

3Junior Consultant, Pediatrics,
and FCPS Trainee of Pediatric
Neurology, National Institute of
Neurosciences (NINS), Shere
Bangla Nagar, Dhaka, Bangladesh

Abstract
Background: Substance Use Disorder (SUD) in adolescents, is a condition in 
which the use of one or more substances leads to clinically significant impairment 
or distress. It is a significant public health problem globally with a higher 
burden in low and middle-income countries. Objective: To find out the 
clinical perception, demo-graphic profile with pc among adolescents with substance 
use disorder. Methods and Materials: This descriptive and observational study 
was conducted in the Department of Psychiatry, Bangabandhu Sheikh Mujib 
Medical University (BSMMU), Dhaka, Bangladesh from March 2016 to September 
2018. Participants 75 (seventy five) Psychiatric Comorbidity among Adolescents 
with Substance Use Disorder patients included in the study. Data collection of 
Central Drug Addiction Treat-ment Centre (CDC), Tejgaon, Dhaka and 
AshoktiPunorbashonNibash (APON), Singair, Manikganj, Bangladesh. Adolescents 
with Substance Use Disorder aged between 11 to 17 years. Only male patients 
were taken as the sample because the above-mentioned treatment facilities do not 
provide service for the female adolescents. There are two groups of substance-related 
disorders: substance use disorders and substance-induced disorders. Results: The 
present study aimed at assessing the presence of comorbid psychiatric disorders 
among adolescents with Substance Use Disorder (SUD) included a total of 70 
adolescents. Over half (60%) of the respondents were <15 years old, and 40% 
of the respondents were >15 years age. The mean age of the respondents was 13.2 ± 
2.1years, and the range was 11-17 years. More than three-quarters (81.4%) of the 
respondents were Muslim and 14.2% Hindus. Most of the patients (45.7%) had more 
than one psychiatric disorder diagnosed. Regarding the specific disorder diagnosed 
Conduct Disorder was 31.4% and different socio-demographic features were 
collected like age, education level, family income, religion, family type, and family 
members and their relationships with the presence of psychiatric disorders was 
calculated. None showed a significant relationship. Conclusion: Based on the 
findings of the study, it can be concluded that clinical Perception, demographic 
profile of adolescents with SUD have a high rate of other comorbid psychiatric 
disorders. Understanding the relationship in etiological perspective and variables 
which influences the problem will help to provide intervention services for 
adolescents affected by SUD. Further epidemiological studies are needed to get a 
more representative result. 
Keywords: Adolescence, Substance Use Disorder, Psychiatric Disor-der, clinical 
Aspect.

Copyright : © 2021 The Authors. Published by Medical Editor and 
Educational Research Publishers Ltd.. This is an open access article 
under the CC BY-NC-ND license 
(https://creativecommons.org/licenses/by-nc-nd/4.0/).

CMI 2 (3), 144−149 MEERP LTD 144

https://creativecommons.org/licenses/by-nc-nd/4.0/


1 INTRODUCTION

Substance-related disorders are psychiatric dis-
turbances developing during or following sub-
stance use, and attributable to it. The drugs

that most often produce substance-related disorders
include tobacco, alcohol, cannabis, stimulants and
other hallucinogens. Numerous other substances, in-
cluding nitrous oxide, amyl-or butyl-nitrite, or an-
abolic steroids also may produce these disorders (1)
. There are substantial geographic variations in drug
use prevalence among the adolescents, with higher
rates in higher-income countries (although data from
lower-income countries often are lacking). A study
was done in West Bengal, India, out of 416 stu-
dents, 52 (12.5%) used or abused any one of the
substances irrespective of time and frequency in
the lifetime; 26 (15.1%) were among the urban
students and 26 (10.7%) were among their rural
counterparts. More than two-thirds (73.07%) of the
respondents expressed a desire to quit substance use
and 57.69% had tried to stop. ‘Easy availability’
and ‘relief from tension’ were the most frequent
reasons for the continuation of substance use (2) .
Comorbid mental disorder among adolescents with
substance abuse include depression, anxiety, conduct
disorder, and attention-deficit/hyperactivity disorder
(ADHD) (3) . A study conducted by Shantna. K.
et al., (4) show that the most prevalent comorbid
disorders in substance dependence patients and sub-
stance abusers were depressive disorders. They also
conclude that the majority of substance dependence
patients suffered from comorbid mental disorders.
The community-based prevalence study of psychi-
atric disorder among children of Bangladesh has not
yet been studied. According to the analytical predic-
tions, prevalence would be roughly 10-20% among
children and adolescents as like as the prevalence
findings of the reports of the developing countries.
A study of psychiatric outpatient attendance at the
Institute of Mental Health and Research in Dhaka,
revealed that 8.6% of cases were children or ado-
lescents (5) . In a different analysis of psychiatric
morbidity among the Institute outpatients, emotional
disorder was found to be the largest group with
32.5%, followed by conduct disorder 18.8%; mental
retardation comprised 16.2%, psychoses and allied

conditions 11.2%, epilepsy with behavioral prob-
lems 12.5% and the rest 8.5% comprised of other
groups of disorders, according to ICD-9 criteria (6)
. In a survey among the children in a child guidance
clinic at the Bangladesh Institute of Child Health and
Dhaka Childrens’ Hospital, Rabbani and Quamaruz-
zaman et al., (7) assessed psychiatric morbidity by
using the Rutter Multiaxial diagnostic system. Their
findings revealed that conduct disorder was 8.9%,
somatoform disorders 7.1%, attention deficit hyper-
activity disorder 68%, autism 6%, and other emo-
tional disorder 15.28% of the cases. Specific delays
in development were found to be 10%, andmental re-
tardation was 17.8% of the cases. Substance-induced
depression occurs during periods of substance use
but exceeding the expected effects of intoxication
or withdrawal from the substance used. Primary or
independent major depression is defined as either
predicting substance use entirely or occurring during
periods of sustained abstinence (8) . Another investi-
gatedadolescent admissions to residential substance
abuse programme and reported theprevalence of psy-
chiatric disorders comorbidity in 64% of the 91 ado-
lescents; depression (24%), conduct disorder (CD)
(24%) and attention deficit hyperactivity disorder
(ADHD–11%)were themost common conditions (9)
. In one study, alcoholics with independent major de-
pression were found to be more likely to attempt sui-
cide than those with substance-induced depression
[8]. In a systematic review made in Bangladesh re-
ports the prevalence of mental disorders in children.
Earliest report among urban primary school children
revealed 13.4% had some behavioral disorder, with
boys being twice more affected than girls (20.4 vs.
9.9%). However, a study among socially disadvan-
taged (urban slum) children, reported 22.9% had
some form of psychiatric disorder with a slightly
lower prevalence in boys than girls (20.0% in boys
and 25.5% in girls). Another study found 14.6% of
children with behavioral problems as reported by the
parents in rural Bangladesh (6) . Another more recent
community-based study reported the prevalence of
mental disorder among 18.4% of the children (10) .
The study was intended to find out the different type
of SUD our adolescents are suffering from in two
different treatment centers and their magnitude and
pattern of comorbid SUD. The expected outcome of

CMI 2 (3), 144−149 MEERP LTD 145



CLINICAL PERCEPTION, DEMOGRAPHIC PROFILE WITH PC AMONG ADOLESCENTS WITH
SUBSTANCE USE DISORDER
the study is to help in the field of the adolescent SUD
and its comorbidity’s proper assessment, diagnosis,
and formulation of an effective management plan.

2 MATERIALS AND METHODS

This descriptive and observational study was
conducted in the Department of Psychiatry,
Bangabandhu Sheikh Mujib Medical University
(BSMMU), Dhaka, Bangladesh From March
2016 to September 2018. Participants 75 (seventy
five) Psychiatric Comorbidity among Adolescents
with Substance Use Disorder patients included
in the study. Data collection of Central Drug
Addiction Treatment Centre (CDC), Tejgaon,
Dhaka and AshoktiPunorbashonNibash (APON),
Singair, Manikganj, Bangladesh. Adolescents with
SubstanceUseDisorder aged between 11 to 17 years.
Only male patients were taken as the sample because
the above-mentioned treatment facilities do not
provide service for the female adolescents. There are
two groups of substance-related disorders: substance
use disorders and substance-induced disorders.
The diagnostic criteria are given in Appendix III.
Collected data was processed, cleaned and entered
into a windows PC. Data were analyzed using
statistical software SPSS version 22.0.

3 RESULTS

The present study aimed at assessing the presence
of comorbid psychiatric disorders among adoles-
cents with Substance Use Disorder (SUD) included
a total of 70 adolescents. Over half (60%) of the
respondents were <15 years old, and 40% of the
respondents were >15 years age. Themean age of the
respondents was 13.2± 2.1 years, and the range was

Supplementary information The online version of
this article (https://doi.org/xx.xxx/xxx.xx) contains
supplementary material, which is available to autho-
rized users.

Corresponding Author: Niaz Mohammad Khan
Associate Professor of Psychiatry, National Institute of
Mental Health, Dhaka, Bangladesh

11-17 years. More than three-quarters (81.4%) of the
respondents were Muslim and 14.2% Hindus. Most
of the patients (45.7%) hadmore than one psychiatric
disorder diagnosed. Regarding the specific disorder
diagnosed Conduct Disorder was 31.4% and differ-
ent socio-demographic features were collected like
age, education level, family income, religion, family
type, and family members and their relationships
with the presence of psychiatric disorders was calcu-
lated. None showed a significant relationship.Type
and frequency of psychiatric disorder diagnosed:
Most of the patients (45.7%) had more than one psy-
chiatric disorder diagnosed. Regarding the specific
disorder diagnosed Conduct Disorder was 31.4%,
ADHD in 21.4%, ODD in 18.5%, MDD in 17.1%,
both Specific and Social Phobia in 10%, GAD in
7.1%, OCD in 5.7% (Table: 1-3). The family history
of mental illness and Family history of substance
use shows no significant relationships. Significant
differences were found between the adolescents with
andwithout any history or trouble with law enforcing
agency.
Table-1: Demographic features and presence of psy-
chiatric disorders (n=70)

Table-2: Other pertinent information and presence of
psychiatric disorders (n=70)

CMI 2 (3), 144−149 (2021) MEERP LTD 146



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NIAZ MOHAMMAD KHAN, , MSI MULLICK AND SHARMIN HUSSAIN

4 DISCUSSION
The present study aimed to determine the pattern
of comorbid psychiatric disorders among the admit-
ted adolescents of two institutions namely Central
Drug Addiction Treatment Center (CDC), Tejgaon,
Dhaka, and the AshoktiPunorbashonNibash (APON)
in Singair, Manikganj, Bangladesh. The authority of
the two institutions was helpful regarding the data
collection. Over half (60%) of the respondents were
<15 years old, and 40% of the respondents were
>15 years age. The mean age of the respondents was
13.2 ± 2.1 years with a range of 11-17 years. Only
male patients were taken as the sample because the
above-mentioned treatment facilities do not provide
service for the female adolescents. More than three-
quarters (81.4%) of the respondents were Muslim,
and nearly 60% had a monthly family income of less
than taka 30000, Around 66% of the respondents had
in the primary level of education, and 15.7% had
secondary, and 12.8% were illiterate, and 5.7% had
non-formal education. Regarding the type of family,

80% were from a joint family with 20% having 5
– 6 family members. Regarding the pattern of SUD
among the adolescents most common was the To-
bacco Use Disorder (51.4%), followed by Cannabis
Use Disorder (47.1%), Sedative, Hypnotic, or Anx-
iolytic Use Disorder (22.8%), Amphetamine-type
substance (20.0%), Inhalant Use Disorder (17.1%),
Opioid Use Disorder (15.7%), Alcohol Use Disorder
(12.8%), >1 Substance Use Disorder (87.1%). There
were no cases of Hallucinogen Use Disorder. Data
from the Monitoring the Future (MTF) study in
the US, a national school-based survey, show that
adolescent substance use is relatively common by
the end of the high school years. Cannabis was the
most frequently used illegal drug, with 31.5% of 12th
graders reporting some lifetime use (11) . Alcohol
and tobacco are even more common, with 73% of
today ’ s students have consumed alcohol by the end
of high school and 45% of high school seniors re-
porting drinking in the past month (12) . Forty-seven
percent of high school seniors report some experi-
ence with cigarette smoking, and 22% were current
smokers in 2006 (13) . The use of different drugs is
highly interrelated in both epidemiological and clin-
ical samples of adolescents (14) . A study was done
among the street children in Mumbai, India shows
the prevalence of Substance Use Disorder is around
90%. Nicotine was the most frequent substance of
abuse, used by 104 (63.8%) adolescent street chil-
dren. Seventy-eight (48%) adolescents were using
inhalants. Sixty (37%) were using alcohol, and 42
(26%) were using sedatives and stimulants. Thirty-
one (19%) were found to be using cannabis and
opioids (14) . According to the analytical predic-
tions, prevalence would be roughly 10-20% among
children and adolescents as like as the prevalence
findings of the reports of the developing countries.
A study of psychiatric outpatient attendance at the
Institute of Mental Health and Research in Dhaka,
revealed that 8.6% of cases were children or ado-
lescents (10) . In a different analysis of psychiatric
morbidity among the Institute outpatients, emotional
disorder was found to be the largest group with
32.5%, followed by conduct disorder 18.8%; mental
retardation comprised 16.2%, psychoses and allied
conditions 11.2%, epilepsy with behavioral prob-
lems 12.5% and the rest 8.5% comprised of other

MEERP LTD CMI 2 (3), 144−149 (2021) 147

Table-3: Pattern of psychiatric disorder 
diagnosed (n=54)



CLINICAL PERCEPTION, DEMOGRAPHIC PROFILE WITH PC AMONG ADOLESCENTS WITH
SUBSTANCE USE DISORDER
groups of disorders, according to ICD-9 criteria (6) .
A multicentric exploratory study to assess the preva-
lence of psychiatric disorders among 5-10-year-olds
in rural, urban and slum areas in Bangladesh by
Mullick and Goodman found the overall prevalence
is 15.2% [6]. Rabbani et al., (7) shows the preva-
lence of mental disorders among children adoles-
cents aged 5-17 years is 18.4%. So it is evident
that the burden of the comorbid psychiatric disorder
is found very high among adolescents with SUD.
Most common disorder found was Conduct Dis-
order (CD) 31.4%, Attention-Deficit/Hyperactivity
Disorder (ADHD) 21.4%, Oppositional Defiant Dis-
order (ODD) 18.5%, Major Depressive Disorder
(MDD) 17.1%, Social Phobia 10%, Specific Pho-
bia 10%, Panic Disorder 7.1%, Generalized Anxi-
ety Disorder (GAD) 7.1%, Obsessive Compulsive
Disorder (OCD) 5.7%, Post Traumatic Stress Dis-
order (PTSD), and Separation Anxiety Disorder
2.8%. Methods for the Epidemiology of Child and
Adolescent Mental Disorders (MECA) Study found
29.8% for anxiety disorders, 7.9% for mood disor-
ders, 18.7% for disruptive behaviors. The study also
showed that among adolescents with current SUD,
76.0% (70.0% of females, 80.0 % of males) also
had anxiety, mood, or disruptive behavior disorder
compared with 24.5% of adolescents without current
SUD, (15) described several possible relationships
between adolescent substance abuse and affective
disorders, conduct disorder and antisocial personal-
ity, anxiety disorders, attention-deficit hyperactiv-
ity disorder, schizophrenia and psychotic symptoms,
and eating disorders. Another investigated adoles-
cent admissions to residential substance abuse pro-
gram and reported the prevalence of psychiatric dis-
orders comorbidity in 64% of the 91 adolescents;
depression (24%), conduct disorder (CD) (24%) and
attention deficit hyperactivity disorder (ADHD –
11%) were the most common conditions [9]. Fur-
ther, literature review estimate rates of psychiatric
comorbidity among adolescents receiving treatments
for substance abuse at 50–90% (16) . The high levels
of psychiatric comorbidity among adolescents with
SUD suggest dual diagnosis is ‘the rule rather than
the exception’ (17) . Adolescents with SUD have
higher rates of both mood disorders and CD (16)
], attention deficit hyperactivity disorder, CD and
substance use often co-exist and are associated with

poorer treatment outcomes, (9) those with CD are
more likely to have an earlier onset of substance
use (17) , timely intervention of co-occurring psychi-
atric and SUDs is associated with better engagement
with treatment (18) .

5 CONCLUSIONS

Based on the findings of the study, it can be con-
cluded that clinical Perception, demographic profile
of adolescents with SUD have a high rate of other
comorbid psychiatric disorders. Understanding the
relationship in etiological perspective and variables
which influences the problemwill help to provide in-
tervention services for adolescents affected by SUD.
Further epidemiological studies are needed to get a
more representative result.

REFERENCES

1. Thapar A, Taylor E, Snowling M, Scott S, Leck-
man J, Pine D. Rutter’s child and adolescent psy-
chiatry. Malden, MA: Wiley-Blackwell; 2015.

2. Pal R, Dasgupta A, Tsering D. Substance use
among adolescent high school students in India:
A survey of knowledge, attitude, and opinion.
Journal of Pharmacy And Bioallied Sciences.
2010;2(2):137–137. Available from: https://dx.
doi.org/10.4103/0975-7406.67005. doi:10.4103
/0975-7406.67005.

3. Griswold KS, Aronoff H, Kernan JB, Kahn
LS. Adolescent substance use and abuse: recog-
nition and management. Am Fam Physician.
2008;77(3):331–336.

4. Shantna K, Chaudhury S, Verma AN, Singh
AR. Comorbid psychiatric disorders in sub-
stance dependence patients: A control study.
Industrial Psychiatry Journal. 2009;18(2):84–
84. Available from: https://dx.doi.org/10.4103/
0972-6748.62265. doi:10.4103/0972-6748.622
65.

CMI 2 (3), 144−149 (2021) MEERP LTD 148

https://dx.doi.org/10.4103/0975-7406.67005
https://dx.doi.org/10.4103/0975-7406.67005
http://dx.doi.org/10.4103/0975-7406.67005
http://dx.doi.org/10.4103/0975-7406.67005
https://dx.doi.org/10.4103/0972-6748.62265
https://dx.doi.org/10.4103/0972-6748.62265
http://dx.doi.org/10.4103/0972-6748.62265
http://dx.doi.org/10.4103/0972-6748.62265


MEERP LTD
NIAZ MOHAMMAD KHAN, , MSI MULLICK AND SHARMIN HUSSAIN

5. Mullick MSI, Khanam M, Islam H. Psychiatric
morbidity of outpatient children in Institute of
Mental Health and Research. Bang J Psychiatry.
1995;7:4–8.

6. Mullick MSI, Khanam M, Islam H. Psychiatric
morbidity of outpatient children in Institute of
Mental Health and Research. Bang J Psychiatry.
1995;7:4–8.

7. Rabbani MG, Alam MF, Ahmed HU, Sarker
M, Chowdhury WA, Zaman MM. Prevalence
of mental disorders, mental retardation, epilepsy
and substance abuse in children. Bang J Psychi-
atr. 2009;23:13–54.

8. Davis L, Uezato A, Newell JM, Frazier E.
Major depression and comorbid substance
use disorders. Current Opinion in Psychiatry.
2008;21(1):14–18. Available from: https://dx.
doi.org/10.1097/yco.0b013e3282f32408. doi:1
0.1097/yco.0b013e3282f32408.

9. Wise BK, Cuffe SP, Fischer T. Dual diag-
nosis and successful participation of adoles-
cents in substance abuse treatment. Journal of
Substance Abuse Treatment. 2001;21(3):161–
165. Available from: https://dx.doi.org/10.1016/
s0740-5472(01)00193-3. doi:10.1016/s0740-54
72(01)00193-3.

10. Griswold KS, Aronoff H, Kernan JB, Kahn
LS. Adolescent substance use and abuse: recog-
nition and management. Am Fam Physician.
2008;77(3):331–336.

11. Johnston L, Malley P, Bachman J. Monitor-
ing the Future: National survey results on drug
use. Bethesda, MD: National Institute on Drug
Abuse; 1975.

12. Johnston LD, Malley PM, Bachman JG,
&amp;schulenberg JE. Monitoring the Fu-
ture national results on adolescent drug use:
Overview of key findings. Bethesda, MD:
National Institute on Drug Abuse; 2006.

13. Johnston LD, Malley PM, Bachman JG,
&amp;schulenberg JE. Monitoring the Fu-
ture national results on adolescent drug use:
Overview of key findings. Bethesda, MD:
National Institute on Drug Abuse; 2006.

14. Gaidhane AM, Zahiruddin QS, Waghmare L,
Shanbhag S, Zodpey S, Joharapurkar SR. Sub-
stance abuse among street children in Mum-
bai. Vulnerable Children and Youth Studies.
2008;3(1):42–51. Available from: https://dx.
doi.org/10.1080/17450120701843166. doi:10.1
080/17450120701843166.

15. Kandel D, Johnson J, Bird H, Weissman M,
Goodman S, Lahey B, et al.; 1999.

16. Solhkhah R. The intoxicated child. Child and
Adolescent Psychiatric Clinics of North Amer-
ica. 2003;12(4):693–722. Available from: https:
//dx.doi.org/10.1016/s1056-4993(03)00068-3.
doi:10.1016/s1056-4993(03)00068-3.

17. Deas D, Brown ES. Adolescent Substance
Abuse and Psychiatric Comorbidities. The Jour-
nal of Clinical Psychiatry. 2006;67(07):e02–
e02. Available from: https://dx.doi.org/10.4088/
jcp.0706e02. doi:10.4088/jcp.0706e02.

18. Chi FW, Sterling S, Weisner C. Adolescents
with Co-Occurring Substance Use and Mental
Conditions in a Private Managed Care Health
Plan: Prevalence, Patient Characteristics, and
Treatment Initiation and Engagement. Amer-
ican Journal on Addictions. 2006;15(s1):67–
79. Available from: https://dx.doi.org/10.1080/
10550490601006022. doi:10.1080/1055049060
1006022.

How to cite this article: N.M.K., M.S.I.M., S.H. 
Clinical Perception, Demographic Profile With PC 
Among Adolescents With Substance Use Disor-
der. Clinical Medicine Insights. 2021;144−149. ht 
tps://doi.org/xx.xxx/xxx.xx

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https://dx.doi.org/10.1097/yco.0b013e3282f32408
https://dx.doi.org/10.1097/yco.0b013e3282f32408
http://dx.doi.org/10.1097/yco.0b013e3282f32408
http://dx.doi.org/10.1097/yco.0b013e3282f32408
https://dx.doi.org/10.1016/s0740-5472(01)00193-3
https://dx.doi.org/10.1016/s0740-5472(01)00193-3
http://dx.doi.org/10.1016/s0740-5472(01)00193-3
http://dx.doi.org/10.1016/s0740-5472(01)00193-3
https://dx.doi.org/10.1080/17450120701843166
https://dx.doi.org/10.1080/17450120701843166
http://dx.doi.org/10.1080/17450120701843166
http://dx.doi.org/10.1080/17450120701843166
https://dx.doi.org/10.1016/s1056-4993(03)00068-3
https://dx.doi.org/10.1016/s1056-4993(03)00068-3
http://dx.doi.org/10.1016/s1056-4993(03)00068-3
https://dx.doi.org/10.4088/jcp.0706e02
https://dx.doi.org/10.4088/jcp.0706e02
http://dx.doi.org/10.4088/jcp.0706e02
https://dx.doi.org/10.1080/10550490601006022
https://dx.doi.org/10.1080/10550490601006022
http://dx.doi.org/10.1080/10550490601006022
http://dx.doi.org/10.1080/10550490601006022

	Introduction
	Materials and Methods
	Results
	Discussion
	Conclusions



