الفهرس 
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Abstract
In view of the previously mentioned studies prevalence rates of substance use disorder and tramadol use disorder have an incremental pattern worldwide and in Egypt
Anxiety disorders are one of the most common psychiatric disorder and their prevalence have been increasing during the last period whether worldwide or in the middle east.
There is an observed areas of similarity between tramadol use disorder and anxiety disorders from the neurobiological point and the psychosocial point of view
A lot of studies had investigated the prevalence of comorbidity between substance use disorder, tramadol use and anxiety disorders and obsessive compulsive disorder.
Aim of the conducted study:
The aim of the conducted study is to evaluate the comorbidity between different anxiety disorders and obsessive-compulsive disorder among patients with tramadol use disorder and dependence visiting to different health care facilities in Alexandria including El-Hadara university Hospital, El-Mamoura hospital and different private hospitals.
The study was conducted over 150 participants who attended the addiction out patient clinics at El-Mamoura psychiatry hospital, during the period from February 2020 till January 2021 due to the pandemic circumstances.
All patients aged 18-60 years old, diagnosed with tramadol use disorder, donnot have any associated medical condition nor previous history of bipolar or schizophrenia, nor in detoxification or withdrawal symptoms, and accepting to participate in the study with a written consent, have been subjected to do a multiple drug screening test to exclude active intake of other substances (in particular cannabis and other stimulants due to their anxiogenic effect)
After that they were subjected for assessment of their socio demographic data including (gender, age, marital status, familial intake, socioeconomic status, presence of major stressful event at onset of intake and tobacco smoking).
Point prevalence of anxiety disorders, obsessive compulsive disorder or any psychiatric disorder and life time prevalence of anxiety disorders or obsessive compulsive disorder were assessed using SCID-I.
Severity of current anxiety disorders was assessed using Arabic version of BAI (beck anxiety inventory) and severity of current OCD (obsessive compulsive disorder) was assessed using Arabic version of YBOCD (yale brown OCD scale).
Results of the conducted study revealed that:
• 90 % of the studied sample were males, keeping in mind that the addiction clinics at El-Mamoura hospital are dedicated for females only on Sunday
• The mean age of the studied sample is 32.82 ± 7.11 as 63.3 % aged from 25to 40 years old.
• Regarding the marital status, 60 % were married and the rest were either single or divorced
• Regarding the presence of family history of substance intake, 81 participants had a family history while 69 participants don’t.
• 56.7 % of the studied sample had a low socioeconomic level while the others were very low (28.7 %) or middle level, and this was attributed to their low scoring in educational, economic and occupational domains
• 117 participants didn’t have major stressful events at onset of intake
• 138 participants were smokers while only 12 participants weren’t.
• In view of the clinical characteristics of the studied sample, the mean duration of intake was 9.43 ± 6.31 and the mean number of attempts of treatment was 3.25 ± 1.89
• 8 % of the studied sample had major depressive disorder.
• 48 participants reported past history of various subtypes of anxiety disorders and one case reported past history of obsessive compulsive disorder and this was confirmed from the medical records
• The most prevalent subtype of anxiety disorders among the 48 participants (lifetime) was generalized anxiety disorder followed by social anxiety disorder followed by specific phobia
• Most of the cases with social anxiety disorder, had comorbid sub type of anxiety disorders whether generalized anxiety disorder (7 cases) or specific phobia (6 cases) or phobia and generalized anxiety (6 cases).
• 10.7 % of the studied sample had anxiety disorders at the time of assessment (n =16) and no cases had obsessive compulsive disorder,
• No one of the participants developed any subtype of anxiety disorders or obsessive compulsive disorder after tramadol intake.
• The most prevalent subtype among the 16 participants, who had current anxiety disorders, was generalized anxiety disorder followed by social anxiety disorder followed by specific phobia, 6 cases had social anxiety associated with either generalized anxiety disorder or specific phobia
• When assessing the severity of the anxiety among the 16 participants who had current anxiety at time of assessment; 50 % of them had moderate level, using BAI (Beck anxiety inventory).
• When comparing dual diagnosis patients with those with tramadol use disorder only, it was found that
1) Gender difference can play a role as females represent 43.8 % of those with dual diagnosis and only 6 % of those with tramadol use disorder only.
2) Age group can have an influence as the mean age of those with dual diagnosis was 27.13 ± 6.29 and 33.50 ± 6.91 for those with tramadol use disorder only.
3) Marital status can play a role as 62.5 % of patients with dual diagnosis were unmarried while 62.7 % of patients with tramadol use disorder only were married