It is essential to identify the factors affecting substance use in order to improve society and reduce the incurred social costs[24]. In the current study, the researchers classified substances into three groups: tobacco, sedatives and other drugs. Long-term exposure to the Bam earthquake did not significantly correlate with the consumption of any of these substances. According to Maclean et al., exposure to natural disasters at a young age does not increase the risk of narcotic use in adolescence and adulthood[24]. One possibility is that 17 years have elapsed since the earthquake, which has acted as an equal time interval as a risk factor for both groups. Another reason could be the high consumption rate of narcotics in Bam residents before the earthquake. According to Moise and Ruiz, substance abuse disorders remained unchanged before and after Hurricane Katrina[25].
the researchers also found that a rise in age is correlated with an increase in the risk of sedative use, which is consistent with the study by Palamar et al. in 2019[26]. It has been reported that the severity of insomnia is 30% higher in the elderly[27]. Nevertheless, it has also been suggested that this higher consumption rate is not only due to insomnia treatment; rather, benzodiazepine was prescribed to 20% of people with dementia, which can explain the high rate of sedative use by the elderly[27]. At any rate, due to the simultaneous rise in mortality rate and the use of these medications by the elderly, further studies are warranted.
The researchers found that tobacco and narcotic use is higher in men than women are. Another study after Hurricane Katrina showed that men had more substance abuse disorders than women did. This study also indicated that men had more substance abuse before and after Hurricane Katrina in the studied region[25]. Another possible explanation is that men were unequally exposed to disaster-induced chronic stress, e.g., reduced socioeconomic status and loss of jobs and income, which exacerbated substance use. This justifies the provision of preventive and therapeutic interventions for the target gender groups to maximize the positive outcomes in high-risk regions after disasters[25].
The researchers also found that single people consumed all three groups of substances (tobacco, sedatives, and other substances) more than married people. The literature shows that marriage is a major institution influencing people’s life and welfare. It has also been shown that married people have better physical and mental health. For instance, the level of substance uses and depression is lower in married people and they live longer than single people[28]. Two reasons are suggested for this. First, marriage helps promote self-esteem, e.g., it reduces stress in personal or even professional life (having a shoulder to lean on helps personal identity). Second, married people have a higher chance of having a stable and supportive intimate relationship and suffer from loneliness less than single people[28, 29].
The researchers also found that those with lower education levels consume sedatives and other narcotics more than those with a higher level of education. Previous studies have also noted that the level of education affects the risk of narcotic or alcohol abuse. A study in Copenhagen measures the level of education, smoking, and drinking alcohol. It was found that those with the lowest level of education were mostly chain smokers and drank a lot of alcohol[30]. Kumar et al. reported that in New Delhi addiction treatment centers, 21% of the addicted people were illiterate or had only primary education[31]. A higher level of literacy may reduce the tendency to narcotic use due to higher awareness of health literacy. Therefore, it is suggested that the health literacy of society be promoted as an addiction prevention factor.
According to Becker et al., unemployment is directly correlated with the use of sedatives[32]. We also found that the use of sedatives is higher among unemployed people. This could be because unemployed people have a lower income than employed ones. Conway et al. showed that a low income level is correlated with higher sedatives use[33]. Still, more studies on this subject are warranted.
The researchers also showed that sedatives use is higher in those who had lost a loved one in the Bam earthquake. This finding is consistent with previous studies, showing a rise in sedatives and anti-depressant medications post-disaster [34–36]. This could be due to the social context of the earthquake; when many people lose their families, it disrupts the integrity of the social network, causes loss of spirits, irregularity, and disintegration, which negatively affects mental health and, in turn, increases the use of sedatives[34, 37].