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 MEERP LTD 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. 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Clinical Medicine Insights. 2021;144−149. ht tps://doi.org/xx.xxx/xxx.xx MEERP LTD CMI 2 (3), 144−149 (2021) 149 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