گزارش برنامه محيط كار عاري از مواد مخدر در بيمارستان دكتر مسيح دانشوري

A Report of Drug Free Workplace Program in Dr. Masih Daneshvari Hospital

اﻣﺮوزه ﻣﺼﺮف ﻣﻮاد ﻣﺨﺪر و ﻣﺤﺮك ﯾﮏ ﻣﻌﻀﻞ ﺑﺰرگ در اﯾﺮان اﺳﺖ. ﺑﻄﻮر ﻣﻌﻤﻮل ﻣﻌﺘﺎدﯾﻦ اﯾﺮاﻧﯽ ﻣﺮد، ﻣﺘﺎﻫﻞ و ﺷﺎﻏﻞ ﻣﯽ ﺑﺎﺷﻨﺪ. ﮐﺎراﯾﯽ ﮐﺎرﻣﻨﺪان ﻣﻌﺘﺎد ﺷﺎﻏﻞ در ﺣﺪود دو ﺳﻮم ﻇﺮﻓﯿﺖﺷﺎن اﺳﺖ. اﯾﻦ اﻓﺮاد در رﺳﯿﺪن ﺑﻪ ﻣﺤﻞ ﮐﺎر 3 ﺑﺮاﺑﺮ ﺗﺎﺧﯿﺮ ﺑﯿﺸﺘﺮ دارﻧﺪ. ﻫﻤﭽﻨﯿﻦ ﻏﯿﺒﺖ از ﮐﺎر ﻧﯿﺰ در اﯾﻦ اﺷﺨﺎص ﺑﯿﺸﺘﺮ ﻣﺸﺎﻫﺪه ﻣﯽ ﮔﺮدد. از اﯾﻦ رو ﺑﻬﺮه وري ﺷﻐﻠﯽ و ﻋﻤﻠﮑﺮد ﭘﺎﯾﯿﻦ ﺗﺮي دارﻧﺪ. ﻟﺬا ﺿﺮوري اﺳﺖ ﺗﺎ ﺑﺮاي اﯾﺠﺎد ﻣﺤﯿﻂ ﻫﺎي ﮐﺎري ﻋﺎري از ﻣﻮاد ﻣﺨﺪر و داﺷﺘﻦ ﮐﺎرﻣﻨﺪاﻧﯽ ﺑﺎ ﺑﯿﺸﺘﺮﯾﻦ ﮐﺎراﯾﯽ و اﺛﺮﺑﺨﺸﯽ، ﺑﺮﻧﺎﻣﻪ رﯾﺰي ﻫﺎﯾﯽ ﺻﻮرت ﭘﺬﯾﺮد. اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﻣﻨﻈﻮر ارزﯾﺎﺑﯽ اﺛﺮﺑﺨﺸﯽ ﺑﺮﻧﺎﻣﻪ ﮐﻤﮏ ﺑﻪ ﮐﺎرﻣﻨﺪان ﺑﯿﻤﺎرﺳﺘﺎن دﮐﺘﺮ ﻣﺴﯿﺢ داﻧﺸﻮري اﻧﺠﺎم ﮔﺮﻓﺘﻪ اﺳﺖ. ﻃﯽ ﺳﺎل ﻫﺎي 89 ﺗﺎ 93، از 1000 ﮐﺎرﻣﻨﺪ ﺗﻤﺎم وﻗﺖ ﯾﺎ ﭘﺎره وﻗﺖ ﺷﺎﻏﻞ در ﺑﯿﻤﺎرﺳﺘﺎن ﻣﺴﯿﺢ داﻧﺸﻮري ﺑﻄﻮر ﺗﺼﺎدﻓﯽ ﻧﻤﻮﻧﻪ آزﻣﺎﯾﺶ ادرار ﺑﺮاي ﺗﺸﺨﯿﺺ ﻣﺼﺮف ﻣﻮاد ﻣﺨﺪر و ﻣﺤﺮك ﮔﺮﻓﺘﻪ ﺷﺪ. اﻓﺮادي ﮐﻪ در ﻣﺮﺣﻠﻪ دوم وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ )14 ﻧﻔﺮ( ﺣﺪاﻗﻞ داراي دو ﻧﺘﯿﺠﻪ ﻣﺜﺒﺖ آزﻣﺎﯾﺶ ادراري ﺑﺮاي ﺗﺸﺨﯿﺺ ﻣﺼﺮف ﻣﻮاد ﺑﻮدﻧﺪ و ﺑﺮاي ﻣﺪت 4 ﺳﺎل ﭘﯿﮕﯿﺮي ﺷﺪﻧﺪ. ﯾﮏ ﭘﺰﺷﮏ ﺑﺮاي ﻣﺸﺎوره در ﻃﻮل ﺑﺮﻧﺎﻣﻪ ﺗﺮك ﻣﻮاد ﺣﺎﺿﺮ ﺑﻮد. در اﺑﺘﺪاي ﻣﻄﺎﻟﻌﻪ و ﻧﯿﺰ در زﻣﺎن ﭘﯿﮕﯿﺮي، از ﺑﯿﻤﺎران در ﻣﻮرد اﺳﺘﻔﺎده از ﻣﻮاد ﻃﯽ 30 روز ﮔﺬﺷﺘﻪ و ﻫﻤﭽﻨﯽ در ﺳﺎل ﮔﺬﺷﺘﻪ ﺳﻮال ﮔﺮدﯾﺪ. ﭘﺎﺳﺦ ﻣﻨﻔﯽ ﺑﺮاي ﻣﺼﺮف ﻣﻮاد ﺑﻌﻨﻮان ﺗﺮك در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺗﻤﺎم ﺑﯿﻤﺎران ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﻣﺮد )100%( ﺑﻮدﻧﺪ ﮐﻪ ﻣﺘﻮﺳﻂ ﺳﻨﯽ37/23±6/90 ﺳﺎل داﺷﺘﻨﺪ. 92/9% اﯾﺸﺎن ﺗﺠﺮﺑﻪ ﻣﺼﺮف ﺳﯿﮕﺎر داﺷﺘﻨﺪ. ﻣﺘﻮﺳﻂ ﺳﻦ ﺷﺮوع ﻣﺼﺮف ﻣﻮاد در آﻧﻬﺎ26/25±5/79 ﺳﺎل ﻣﺤﺎﺳﺒﻪ ﺷﺪ. ﮐﻤﺘﺮﯾﻦ ﺗﻤﺎﯾﻞ ﺑﺮاي ﺗﺮك ﺳﯿﮕﺎر در درﺟﻪ اول ﺑﯿﻦ اﻓﺮادي ﺑﻮد ﮐﻪ ﻣﺼﺮف ﺷﯿﺮه داﺷﺘﻨﺪ )2ﻧﻔﺮ(. در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻣﺘﻮﺳﻂ دوره ﺗﺮك در ﺑﯿﻤﺎران 160/75±85/28 روز ﺑﻮد. ﺑﺮ اﺳﺎس ﻧﺘﺎﯾﺞ ﺑﺪﺳﺖ آﻣﺪه ﺑﻪ ﻧﻈﺮ ﻣﯽ رﺳﺪ ﮐﻪ وﺟﻮد ﯾﮏ ﭘﺰﺷﮏ ﯾﺎ ﺗﯿﻢ ﭘﺰﺷﮑﯽ ﻣﻘﯿﻢ ﺑﺮاي ﺗﺮك ﻣﺼﺮف ﻣﻮاد ﻣﻮﺛﺮﺗﺮ ﺑﻮده و ﺑﺎ درﺻﺪ ﭘﺎﯾﯿﻦ ﺗﺮ ﻋﻮد ﻣﺼﺮف ﻫﻤﺮاه اﺳﺖ.

Substance abuse is a major obstacle in Iran. The majority of addicted people in Iran is likely to be male, married and employed. Actual function of substance abuser employees is at about two thirds of their capability and they are three times more likely to be late for work. They have higher rate of absenteeism in work and lower productivity in their job and performance. Our country needs some program which makes drug-free work places, because it is essential to have employees with the highest possible efficiency. We conducted this study to assess the efficacy of Employee Assistance Programs on substance abuse treatment of Dr. Masih Daneshvari hospital. Firstly, the study collected data of 1000 full or part time employees of Dr. Masih Daneshvari hospital between Mars 2010 and June 2014. They were randomly assigned to do urine analysis. The individual who had at least two times positive urine analysis were considered as drug abusers and followed up for a period of four years. A physician was available for consultation during the program. At baseline and follow-up interviews, the participants were asked about substance abuse in past 30 days and also in past year. A negative answer to use of all substances was defined as abstinence. All participants were male (100%). Their mean age was 37.23±6.90. Experiencing any type of tobacco amongst participants was 92.9%. The mean age of starting substance abuse was 26.25±5.79 years. In this study the mean of abstinence period of the participants was 160.75±85.28 days. Concerning substance abuse treatment and having our experience, the quit process in workplace with a resident physician or medical team, sounds to be more effective and has the lowest rate of relapse.