Setting of the study
Minia Hospital of Mental Health and Addiction Treatment is the official psychiatric hospital in Minia governorate (over 5 million people). It is located at New Minia city that is at north-east of the Nile. It provides services for psychiatric patients and patients of substance abuse. Its inpatient capacity is 50 beds (40 for male patients and 10 for female patients).
It provides an outpatient clinic service on daily basis and a Hot Line clinic for substance use disorder patients on twice weekly basis. Frequency of attendance to Hot Line clinic is around 20–30 clients per week. The Hot Line clinic is managed by three psychiatrists and two psychologists well trained in the field of addiction.
The management plan is carried out either through hospitalization or on outpatient basis by pharmacotherapy, psychotherapy (individual and group), and regular follow-up by phone calls with psychologists.
Subjects of the study and size of the sample
All clients attending outpatient addiction clinic of Minia Psychiatric Hospital in the duration of 6 months (between the 1st of December 2014 and 31st of May 2015) were subjected to screen for effect of substance abuse on the pattern of patients’ lives and evaluation of severity of addiction.
Patients aged 18–60 years, whether males or females, with a positive history of substance use disorder were included in the study, provided that they gave oral and written consent to participate in the procedure of the study, while patients less than 18 or more than 60 years of age, those with chronic medical illness, those with acute intoxication or withdrawal symptoms or substance-induced psychosis, and those who refused to be involved in the study were excluded.
The final population sample of the present study included 103 patients of both sexes (95 males and 8 females) who had substance use disorder. They were diagnosed according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems, Diagnostic Criteria for Research (ICD-10) .
The history of addiction is taken from each client and includes onset of addiction, probable causes of substance abuse, types, and amount of consumption of different substances, decision, and duration of periods of abstinence, number and factors behind relapse, causes of shifting from or adding one substance to another.
The agreement of the Ethical Scientific Committee of Minia Faculty of Medicine was obtained before the start of the research.
Tools of the study
Urine analysis screen for substances of abuse
This was done in the Minia Hospital of Mental Health and Addiction Treatment laboratory by an experienced technician using 2 types of urine kits; the first is specific only for tramadol (DiaSpot Rapid One-step Test Device) and the second (ACON Urinalysis Reagent Strip) test for 6 different substances: THC (cannabis), BAR (barbiturate), COC (cocaine), AMP (amphetamine), MOP (morphine), and BZO (benzodiazepines).
Addiction Severity Index (ASI) 
The Addiction Severity Index (ASI) is a semi-structured interview originally made to assess in details problems presented by patients with substance use disorders. It was designed to guide primary treatment planning and allow follow-up of patient progress over time. Information is collected on seven functional areas mostly affected by substance use: medical status, employment and support, drug use, alcohol use, legal status, family and social status, and finally psychiatric status.
Each section includes questions about the duration, frequency and severity of problems over the whole patient’s life and in the past 30 days. At the end of the assessment of each functional area, patients are asked to rate how troubled or annoyed they have been by these problems over the past 30 days and the degree to which they feel they need treatment. A 0–4 scale is used for such ratings. For each functional area, the interviewer also makes severity ratings that reflect the magnitude of the interviewer’s convection that patient needs additional treatment, on a scale from 0 to 9 .
The ASI has been extensively studied regarding joint reliability, test-retest reliability, and internal consistency of composite scores, with generally excellent results. Hodgings et al.  demonstrated average joint reliability scores of 0.89. Concurrent, predictive, and discriminant validity have been demonstrated in a range of patient populations and treatment settings .
Addiction Intensity Scale (AIS)
It is formed of 4 sections (moderate, severe, catastrophic, and terminal), and each one gives one point for each item checked and the total is calculated. If the score for each section is equal to or greater than the score in the parentheses below this score, this means that the examined subject meets the criteria for that level of addiction. The highest level for which one meets the criteria is his/her overall addiction intensity score (AIS).
The first step for anyone using the ERP (exposure and response prevention therapy) is to measure the intensity of your addiction. The Addiction Intensity Scale (AIS) can help .
Data analysis and statistical methods
The data collected were recorded on a separate file for each subject who was given a code.
Data analysis was done by the Statistical Package of Social Sciences (SPSS) Version 15.0 for Windows .
The data were summarized using the mean and standard deviation for quantitative data and percent for qualitative data.
Descriptive statistics of the study participants were conducted.
Fisher’s exact test for qualitative data was used between each two groups like poly-substance and one substance groups and male and female groups.
Differences between studied groups were considered statistically at P value < 0.05.