Pain Perception, Resilience, Failure Tolerance and Aggression of Women and Men Treated with Methadone in Tehran, Iran

Introduction ... [1, 2]. Among the very limited treatment options for substance abuse, a methadone maintenance program is an effective drug treatment that leads to the gradual replacement of opioids with methadone to reduce abuse [1, 3]. Based on research evidence, physiological and epidemiological dimensions of substance abuse and its treatment are different in men and women due to external and internal factors [4]. ... [9-5]. One of the effective factors in drug abuse is pain perception [10]. ... [11]. Studies have shown that people with intolerance or low resilience turn to drugs to reduce the pain and stress caused by physical and psychological illnesses [12]. ... [13-16]. They are also more likely to fail, and this can lead to increased drug use and addiction [17, 18]. ... [19-22]. Failure and other negative emotions such as depression and irritability are common causes for aggression [23]. ... [24-27]. Aim (s) This study aimed to compare the psychological variables of pain perception, resilience, failure tolerance, and aggression in women and men with methadone treatment. Research Type This research is descriptive research with a causal-comparative method. Research Society, Place and Time The statistical population of the present study was men and women with drug abuse in Tehran who had referred to addiction treatment clinics in the summer and autumn of 2019. Sampling Method and Number To select the sample group by multi-stage random cluster sampling method, in the first stage, out of 22 districts of Tehran Municipality and in the second stage, among addiction treatment centers in control of the supervision of the Association of Addiction Treatment Centers in each of these areas, a clinic (Three clinics in total) and in the third stage, 300 people, including 150 men and 150 women, were randomly selected from the people treated with methadone in these selected centers. .... [27]. Used Devices & Materials McGill pain scale [28, 29] with Cronbach's alpha 0.87, Connor and Davidson resilience scale [30] with Cronbach's alpha 0.84, failure tolerance questionnaire [31, 32] with Cronbach's alpha 0.72, and Bass and Perry aggression questionnaire [33, 34] with Cronbach's alpha of 0.71, were the tools used in this study. Statistical Analysis After examining the assumptions of parametric tests such as continuity of variables in terms of measurement and normalization of data distribution using Kolmogorov-Smirnov test and establishing homogeneity of variance of variables also the similarity of the two groups in demographic variables of age, education, and work experience, Paired sample t-test was used for data analysis. Finding by Text The highest frequency among the 300 samples, (42%) was related to people between 22 and 26 years (126 people), with bachelor's degree (141 people; 47%) and 11 to 15 years of work experience (150 people; 50%) and the lowest frequency was between 32 and 36 years old, with Ph.D. and above 15 years of work experience (Table 1). The normality of the data distribution of variables was checked and confirmed by the Kolmogorov-Smirnov test (p>0.05). The mean of all variables of the study was different in men and women, but only the difference between pain perception, failure tolerance, and aggression with values was respectively 4.152±0.521, 4.208±0.303 and 3.621 21±0.211 which were significant in women and 3.258±0.359, 3.247±0.137, and 4.188±652 in men who treated with methadone maintenance program at the level of p<0.05 (Table 2). Mean values showed that in women, pain perception and tolerance of failure were more and less aggression compared to men (p<0.05) but no significant difference was observed between resilience between women and men (p >0.05; Table 2). Main Comparison to the Similar Studies According to the results of this study, for women, the process of quitting methadone is more difficult than for men. In general, the results of the study are consistent with studies that have confirmed gender differences in substance abuse disorders and their treatment [4] … [5]. Researchers have shown that the brain is a biological process that triggers addiction and the capacity to change behavior [35]. Therefore the perspective of the nervous system and biology improves the study from a scientific perspective. In explaining the results of the present study, this view has been tried to be considered. The first finding of the present study was a higher perception of pain in women addicted to methadone than men. Studies show that pain tolerance is lower in people with methadone addiction than in normal people [36]. While pain tolerance is different in men and women; although the difference in pain sensitivity and perception between men and women is partly due to social conditions and psychosocial factors, many laboratory studies have attributed this difference to biological mechanisms and sex hormones [37]. The results of studies show that gender differences in pain and its relief are due to an interaction between genetic, anatomical, physiological, neurological, hormonal, psychological, and social factors that regulate pain differently in both sexes [38]. ... [39, 40]. The present study also showed a higher rate of pain perception in women treated with methadone compared to men. This finding can be explained by examining the status of the menstrual cycle of women in the sample group and the effects of estrogen on pain sensation and perception and its interaction with the analgesic properties of methadone in women's pain tolerance. Another result showed that the resilience of addicted men and women treated with methadone was not different. Evidence shows that resilience is affected by gender and in comparison with men, women show different reactions in stressful situations [41]. However, such a result was not obtained in this study. Perhaps this difference can be related to the cultural, educational, and socio-economic status of the sample group. This result can also be attributed to the equal desire of men and women for withdrawal. This finding can be interpreted positively, as this lack of differences in the resilience of men and women in the process of quitting substance abuse can indicate a reduction in non-biological gender differences. Differences such as differences in psychological abilities as internal factors and differences in negative outlook and other cultural and social gender factors as external factors. Another finding of the present study was that failure tolerance was lower in women with methadone treatment substance abuse disorders compared to men. According to the behavioral inhibitor and behavioral activator brain systems presented in reinforcement sensitivity theory, the behavioral inhibitor system is more active in women than men. As a result, women are more likely to fail or feel frustrated. When addicted people are in the process of withdrawal, the activity of the behavioral inhibition system increases due to the lack of drugs, in other words, the lack of rewards. Increased activity of this system in men is considered inactivity in the male brain system and reduces the severity of the behavioral activation system, but in women, it doubles the activity of the inhibitory system and causes more severe failure symptoms in women. ... [42]. When quitting methadone, due to the presence of a pleasant stimulus with reward symptoms, namely methadone, the behavioral activation system in people quitting with methadone is activated. On the other hand, due to the limited consumption in terms of the amount of substance consumed and the time of consumption, the behavioral inhibition system becomes more active. The behavioral activation system has a facilitating role in the activity of the behavioral inhibition system and raises the level of activity of the behavioral inhibition system. Due to the higher level of behavioral inhibition system in women in normal situation, the increased activity of this system is doubled and leads to much greater failure in women treated with methadone than in men. The more severe the failure, the more difficult it is to tolerate and the more intolerant the failure, and this is what happens to women on methadone treatment compared to men. The latest finding of the present study was a higher rate of aggression in methadone-addicted men compared to their female counterparts. Higher levels of anger, aggression, and aggressive and harmful behaviors in men than in women can be attributed to higher levels of the male hormone testosterone in men. In addition, men are considered to be stronger and more superior due to their mainly larger physical appearance, more voluminous muscles, and more physical strength. ... [43]. Because in the present study, men felt more failure than women, consequently, the aggression that led to the feeling of failure was more in men than women. Limitations The limitations of the present study include not considering variables such as marital status, type of job and income, having or not having children, duration of addiction, amount of substance used before entering the treatment plan, number of withdrawal measures, and types of previous methods for quitting, that can have many effects on the study. Suggestions It is suggested that in future research, anxiety and anger control training be performed in treated men. The implementation of failure protocols based on different psychological approaches in women treated with methadone is also suggested in future studies. Conclusions In the process of methadone withdrawal, women perceive more pain and tolerate less failure than men, and men are more aggressive than women. Therefore, the process of methadone withdrawal seems to be more difficult for women than men. Clinical & Practical Tips in Police Medicine The use of the results of the present study in the treatment of criminals with drug abuse can be expressed according to their gender in police medical centers and other medical units of the p

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