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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 38  |  Issue : 1  |  Page : 19-26

Assessment of personality traits in a sample of opioid-dependent patients in comparison with nondependent men


Psychiatry Department, Faculty of Medicine, Cairo University, Cairo, Egypt

Date of Submission19-Jul-2016
Date of Acceptance30-Jul-2016
Date of Web Publication22-Feb-2017

Correspondence Address:
Sally Mohamed
22 214 Street, Degla, Maadi, Post code: 13411
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1105.200716

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  Abstract 

Background
Drug-taking behavior and drug dependence is a multifactorial disorder. Of them, specific gene or an early established trait may act as a predisposing factor. Different environmental factors may act as precipitating and perpetuating factors, whereas individual temperament, personality, and constitutional characteristics act as the vulnerability factors. These vulnerability factors act as the causal determinants of whether or not the predispositions are expressed. Thus, personality is a very important determining factor of drug involvement.
Aim of the work
The aim of this study was to compare the personality profile of synthetic opioid-dependent male patients with the personality profile of non-substance-dependent male participants.
Patients and methods
Groups I and II were selected consecutively and were recruited from Kasr El-Aini Hospital as well as private hospitals in greater Cairo during the period from November 2012 to March 2013. Group I included 30 substance-dependent male patients and group II included 30 non-substance-dependent male participants who were subjected to personality assessment schedule; the addiction severity index was applied only to group I.
Results
The sociodemographic findings of the study found that 80.0% of patients in group I were not working due to substance dependence and only 20% were working, whereas in group II 90% of participants were working and only 10% were not working. An overall 66.7% of patients in group I were divorced and only 26.7% were married, whereas in group II one was divorced and 86.7% were married. As regards the personality test, 73.3% of patients in group I had severe degree of the sociopathic trait, 20% has sociopathic trait difficulty, and only 6.6% did not have sociopathic trait.
Conclusion
Our study showed the effect of opioid dependence in changing behavior and personality traits, emphasizing that diverse maladaptive personality traits and these negative traits are the familial risk factors for substance use disorders. They act as a predisposing vulnerability and predict the onset or age of expression of substance-related problems and tendency to relapse. Impulsive–aggressive personality traits in childhood and adolescence predict early onset of substance abuse.

Keywords: personality-traits-opioid dependence


How to cite this article:
Mohamed S. Assessment of personality traits in a sample of opioid-dependent patients in comparison with nondependent men. Egypt J Psychiatr 2017;38:19-26

How to cite this URL:
Mohamed S. Assessment of personality traits in a sample of opioid-dependent patients in comparison with nondependent men. Egypt J Psychiatr [serial online] 2017 [cited 2017 Aug 23];38:19-26. Available from: http://new.ejpsy.eg.net/text.asp?2017/38/1/19/200716


  Introduction Top


Impulsive–aggressive personality traits during childhood and adolescence predict early onset of substance abuse. One study suggested that irritability or difficult temperament is an early trait that accounts for excess adolescent drug involvement. Investigators found that novelty seeking or openness to experience modulates vulnerability to drug use and drug dependence. According to Robins, one of the most robust indicators of later risk for drug involvement, at least for boys, is an early deviance and conduct problem during childhood and antisocial personality traits later in life. Many studies found that patients with substance use disorder have been characterized by diverse maladaptive personality traits and these negative traits are the familial risk factors for substance use disorders, thus acting as a predisposing vulnerability and predicting the onset or age of expression of substance-related problems and tendency to relapse (Gelderb, 2001).

An addictive personality may be defined as a psychological setback that makes a person more susceptible to addictions. This can include anything from drug and alcohol abuse to pornography addiction, gambling addiction, Internet addiction, addiction to video games, overeating, exercise addiction, work holism, and even relationships with others. The spectrum of behaviors designated as addictive in terms of five inter-related concepts include the following: patterns, habits, compulsions, impulse control disorders, and physical addiction. Such a person may switch from one addiction to another, or even sustain multiple addictions at different times (Sadock et al., 2009).

Extraversion, self-monitoring, and loneliness are also common characteristics found in drug addicts. Individuals who score high on self-monitoring are more prone to developing an addiction. High self-monitors are sensitive to social situations; they act how they think others expect them to act. They wish to fit in, and hence they are very easily influenced by others. Likewise, those who have low self-esteem also seek peer approval; therefore, they participate in ‘attractive’ activities such as smoking or drinking to try to fit in (Stannard and Lia, 2011).


  Patients and methods Top


Patients

This research was prospectively conducted as a case–control study and comprised a sample of 60 individuals. The case group consisted of 30 patients recruited from Kasr El-Aini Hospital as well as private hospitals in greater Cairo during the period from November 2012 to March 2013 previously diagnosed with opioid addiction according to DSM IV. They were heterosexuals, with no intoxication or withdrawal symptoms for at least 1 month, hospitalized for at least 2 weeks, and had no previous history of psychotropic medications for at least 1 month before the study. The control group had no individual history of substance abuse and no previous history of psychotropic medications for at least 1 month before the study, and was matched for age and sex to case group individuals. Ethical aspects of the study were approved by the institutional ethics committee and all participants signed an informed consent form before any study procedure.

Procedures

Participants provided information on their age, sex, marital status, education, and profession. Only participants of group I were subjected to the addiction severity index (McLellan et al., 1993). It is a semistructured interview designed to provide a multidimensional assessment of problems presented by patients with substance use disorders to guide initial treatment planning and to allow monitoring of patient’s progress over time. It is designed for use in inpatient and outpatient alcohol and drug abuse. The personality assessment schedule (PAS) (Tyrer, 1988) was used to measure personality traits for both groups; it is designed to formalize the assessment of personality disorders and may be used with participants irrespective of psychiatric status. There are 24 personality variables to be assessed in the schedule. Each can be rated by means of interview with the participant and the interview with an informant. The ratings are made on a nine-point scale for all variables. The scales are specifically designed to record abnormal personality traits and most normal variations will occur between scores 0 and 3; the greater the severity of the trait, the greater will be the rating. Urine sampling using strips was carried out for both groups to ensure nonintake of any substance.


  Results Top


The results of the study showed that the majority of patients in group I (80.0%) were not working and only 20% worked, whereas in group II the majority of them were working ([Table 1]). An overall 66.7% of patients group I were divorced and only 26.7% were married, whereas in group II 0% were divorced and 86.7% (n=26) were married. An overall 93.3% (n=28) of patients in group I had a history of divorce and only 6.7% had no history of divorce, whereas in group II 93.3% had no history of divorce and 6.7% got divorced ([Table 2]).
Table 1 Sociodemographic results with regard to both groups

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Table 2 Distribution of group I as regards the addiction severity index

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Group I suffered medical problems ranging from moderate degree in 46.7% to severe degree in 20% due to opioid dependence. Almost half of the group (56.7%) had severe occupational deterioration due to opioid dependence, and 36.7% had moderate deterioration. The majority of patients in group I (96.7%) had severe alcohol and drug use. Group I suffered legal problems due to opioid dependence, ranging from mild degree in 53.3% to moderate degree in 26.7%. The majority of patients in group I (80%) suffered severe social relationship problems due to substance dependence, and 20% suffered moderate problems. The majority of them had psychological problems due to their opioid dependence, ranging from severe degree in 76.7% to moderate degree in 23.3% ([Table 3]).
Table 3 Description of substance dependence profile in group I

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An overall 53.3% of patients in group I used heroin as their main substance of dependence and 46.7% used tramadol as their main substance of dependence. The maximum duration of drug use in group I was 17 years and the minimum duration was 1 year. An overall 50% of patients in group I experienced depressive symptoms in the last 30 days before going to treatment, 33.3% experienced hallucinations, 66.6% experienced anxiety, 33.3% experienced difficulty in concentration, 86.6% had aggressive behavior that was difficult to control during dependence, 83.3% had a suicidal ideation, 13.3% had attempted suicide, and 26.6% experienced the previous use of psychotropic medications the last 30 days before treatment ([Table 4]).
Table 4 Distribution of the studied groups as regards personality assessment schedule

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An overall 73.3% of patients (n=22) in group I had severe degree of the sociopathic trait, 20% (n=6) had sociopathic trait difficulty, and only 6.6% (n=2) did not have sociopathic trait.

None of the participants in group II had any sociopathic trait.

  1. An overall 43.3% (n=13) of patients in group I had severe degree of explosive trait, 46.6% (n=14) had personality difficulty, and 10% (n=3) did not have explosive trait.
  2. An overall 90% of patients (n=27) in group II did not have any explosive trait and 10% (n=3) of participants had personality difficulties.
  3. An overall 86.6% of patients (n=26) in group I had sensitive aggressive trait ranging from personality difficulty level to the severe level, and only 13.3% (n=4) did not have sensitive aggressive trait.
  4. An overall 90% of participants (n=27) in group II did not have any sensitive aggressive trait and only 10% (n=3) of the group had personality difficulty.
  5. An overall 43.3% of patients (n=13) in group I had severe degree of passive dependent trait, 30% (n=9) had personality difficulty, and 26.6% (n=8) did not have any passive dependent trait.
  6. An overall 90% of participants (n=27) in group II did not have any passive dependent trait and 10% (n=3) had personality difficulty.
  7. An overall 73.3% of patients (n=22) in group I had severe degree of histrionic trait, 20% (n=6) had personality difficulty, and 6.6% (n=2) did not have any histrionic trait disorder.
  8. An overall 83.3% of participants (n=25) in group II did not have any histrionic trait disorder, and only 16.6% (n=5) had histrionic personality difficulty.
  9. An overall 63.3% of patients (n=19) in group I had severe degree of asthenic personality trait, 33.3% (n=10) had asthenic personality difficulty, and only 3.3% (n=1) did not have any asthenic personality disorder.
  10. An overall 90% (n=27) in group II did not have any asthenic personality disorder and only 10% (n=3) had asthenic trait difficulty.
  11. An overall 53.3% (n=16) in group I had severe anankastic personality trait, 43.3% (n=13) had anankastic difficulty, and only 3.3% (n=1) did not have any anankastic personality trait.


None of the participants in group II had anankastic personality ([Table 5]).

  1. An overall 56.6% of patients (N=17) in group I had severe degree of anxious personality trait, 36.6% (n=11) had anxious difficulty, and 6.6% (n=2) did not have any anxious trait.
  2. An overall 83.3% of participants (n=25) in group II did not have any anxious personality trait disorder and 16.6% (n=5) had anxious difficulty.
  3. An overall 46.6% of patients (n=14) in group I had severe degree of hypochondriacal personality trait, 43.3% (n=13) had hypochondriacal trait difficulty, and only 10% (n=3) did not have hypochondriacal personality trait.
  4. An overall 83.3% of participants (n=25) in group II did not have hypochondriacal personality trait, 16.6% (n=5) had hypochondriacal personality difficulty, and none of them had severe hypochondriacal personality.
  5. An overall 63.3% of patients (n=19) in group I had severe dysthymic personality trait, 30% (n=9) had dysthymic difficulty trait, and only 6.6% (n=2) did not have dysthymic trait.
  6. An overall 90% of participants (n=27) in group II did not have dysthymic personality trait, only 10% (n=3) had dysthymic trait difficulty, and none of them had severe dysthymic personality.
  7. An overall 60% of patients (n=18) in group I had schizoid trait difficulty, 30% (n=9) had severe schizoid personality trait, and only 10% (n=3) did not have schizoid trait.
Table 5 Distribution of the studied groups as regards personality assessment schedule

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None of the participants in group II had schizoid trait.

  1. An overall 53.3% of patients (n=16) in group I had paranoid trait difficulty, 30% (n=9) had severe paranoid trait, and 16.6% (n=5) did not have paranoid trait.
  2. An overall 90% of participants (n=27) in group II did not have any paranoid trait and 10% (n=3) had paranoid trait difficulty.
  3. An overall 50% (n=15) of patients in group I had avoidant trait difficulty, 36.6% (n=11) had severe avoidant trait, 3.3% (n=1) had avoidant personality disorder, and 10% (n=3) did not have any avoidant trait.


All members of group II had avoidant trait difficulty and none of them had severe or avoidant trait disorder.


  Discussion Top


As regards the sociodemographic data, this study is consistent with other studies that indicate that opioid dependence results in significant costs to society through unemployment, homelessness, family disruption, loss of economic productivity, social instability, and criminal activities (WHO/UNODC/UNAIDS, 2004).

According to our results, divorce rates were high among substance-dependent men (66.7%), and it was 0% among non-substance-dependent men. The findings of this study are consistent with the study by Marshal (2003), who stated that there were destructive effects of drug abuse found in husbands who used drugs, especially opiates, and were predictive of lower marital quality and increased marital instability over 1 year.

An overall 93.3% of participants in group I had a history of divorce and only 6.7% had no history of divorce, whereas in group II 93.3% had no history of divorce and only 6.7% were divorced.

The findings of our study are consistent with those of Skinner and Aubin (2010), who stated that substance abuse can affect overall marital satisfaction and quality. According to their study, marital distress is reported more frequently among spouses suffering from or dealing with a spouse battling alcoholism. Distress and anger were associated with high levels of drug abuse in a marriage. Opiate use can increase negative and hostile communication, and lead to less warmth and unity in the relationship. With the breakdown of communication, marital distress and other troubles started to affect the marriage and resulted in greater marital dissatisfaction and divorce (Skinner and Aubin, 2010).

Our finding is consistent with the study by Al-Amal Hospital (1997) on 160 participants whose age ranged from 20 to 40 years and the mean age was 29 years. The duration of abuse for all participants ranged from 1 to 30 years and the mean duration was 9.5±6.6 years (Hafeiz, 1995).

An overall 53.3% of patients in group I used heroin as their main substance of dependence and 46.7% used tramadol as their main substance of dependence. According to the study by

Abolmagd (2013) in Egypt on 782 Egyptian tramadol users admitted in three private (nongovernmental) hospitals at greater Cairo and one governmental hospital (Cairo University, addiction unit), tramadol use exceeded 70% of all admitted patients. There was a sharp upswing rise in tramadol use in the past 5 years in Egypt (Abolmagd, 2013).

Tramadol’s prevalence is mostly noted due to its wider availability and cheaper prices compared with other types of abused drugs. The study by Fawzi (2011) on 640 patients mostly comprised adults (67.9%), which could be attributed to their involvement in prescribed and nonprescribed uses of tramadol. Seventy-seven percent of the patients were male. This was attributed to tramadol abuse related to its alleged enhancement of sexual performance. Moreover, that study stated that tramadol oral intake was the highest (96.8%) as it is more prevalent and in an easily administered form, whereas rectal suppositories have been used by some addicts at times of shortage. This could be attributed to the fact that many drug addicts use tramadol as a stimulant, to give them energy and power to work or to study, especially in school and university age, or to improve their sexual performance, as most people have a false concept about tramadol that it acts as a sexual enhancer; hence, many men use it to prolong their ejaculation period, especially premature ejaculators. Moreover, the availability of the drug and its cheap price (a strip is almost one dollar) in Egypt facilitate its use and dependency.

As regards the psychological problems, the findings of the study are consistent with many studies, which found that chronic drug intake, especially opiates, is associated with a broad range of psychiatric manifestations ranging from intensely dysphoric withdrawal symptoms, depression, impulse control symptoms, intense anxiety, psychotic symptoms, especially paranoid delusions and hallucinations, to suicidal and self-injurious behavior. These psychiatric disorders occur in addition to tolerance, withdrawal, and intoxication symptoms of the different types of drugs (WHO, GENEVA, 2004e).

As regards the personality traits between the two groups, the study findings are consistent with the study by Kaplan and Sadock (2000), which stated that personality integrity plays an important role in both marital and sexual health; the presence of personality pathology may predispose to psychiatric illness and sexual dysfunction. Most of the studies reported on personality characteristics of sexually dysfunctional patients rather than patients with sexual dysfunction (Kaplan and Sadock, 2000).

The study findings are consistent with those of McGovern et al. (2006), who found that several co-occurring disorders were extremely common among opiate addicts − several mental illnesses (16–21%), antisocial personality disorder (18–20%), and borderline personality disorder (17–18%).

These findings are also consistent with the findings of Krampe et al. (2006), who concluded that high predicative values suggest that chronicity and personality disorder rank among the most important characteristics of addiction severity.

The findings of our study are consistent with the study by Birnbaum et al. (2011), who stated that, although sociopathic characteristics were predominant in opiate addiction, depressive and psychotic features were also frequently observed. To test the hypothesis of their study, three types of individuals who became addicted to opiates were studied (rather than a single, predominant personality style); 53 opiate addicts were given the Loevinger Sentence Completion Test, the Bellak Ego Functions Interview, and the  Rorschach test More Details. Variables derived from these three procedures were subjected to cluster and discriminate function analyses. Three groups of addicts were identified: those primarily with impaired interpersonal relationships and affective lability (42%), those primarily characterized by thought disorder and impaired ego functioning (30%), and a group with diminished ideational and verbal activity (28%). Comparison of the assessment of these three groups with independently defined normal, neurotic, and schizophrenic samples provided support for three opiate-addicted personality types, each respectively characterized as character disordered, borderline psychotic, and depressed. Although there seems to be a predominance of character-disordered individuals who become addicted to opiates, the data indicated several additional types of opiate addicts with different types of psychopathology who may require different approaches for management and treatment (Birnbaum et al. (2011)).

Although this study did not uncover specific personality disorder that includes addiction severity, it suggests that traits initiating personality disorders that are responsible for their addiction severities. PAS test in our study, rating for more than 24 traits and variables, facilitated the tracking of specific personality traits from the summation of four different subtraits. This could explain why in this study sociopathic traits, obsessive traits, avoidant, and paranoid traits were specifically found to be associated with opioid-dependent patients.

Statistics

Statistical evaluation of the results of the work: The results were analyzed using the Statistical Package of Social Science (SPSS) computer software program, version 10.1 (SPSS Inc., Chicago, Illinois, USA).

Qualitative data were presented as mean±SD for normally distributed data and as medians and percentiles for skewed data. Qualitative data were presented in the form of frequencies and percentages.

For normally distributed parameters, differences among groups were tested using Student’s test and the one-way analysis of variance with post-hoc test, whereas for skewed data Mann–Whitney rank sum test and Kruskal–Wallis analysis of variance were used. For qualitative data, differences among groups were tested using Pearson’s χ2-test and Fischer’s exact test.

To study the relationship between two variables, Pearson’s and/or Spearmen’s correlation coefficients were calculated. All tests are tailed and considered statistically significant at P value less than 0.05.


  Conclusion Top


The mean age of group I (opioid dependent men) was 30 years with an SD of 6.08, whereas the mean age of group II (nondependent men) was 25 years with an SD of 4.15.

An overall 80.0% of patients (n=24) in group I (opioid-dependent men) were not working and only 20% were working, in comparison with group II in which 90% (n=27) were working and only 10% (n=3) were not working. This showed how much opioid dependence caused them occupational deterioration and losses.

An overall 66.7% of patients (n=20) in group I were divorced and only 26.7% (n=8) were married, whereas in group II no one was divorced and 86.7% (n=26) were married.

An overall 53.3% of patients (n=16) in group I used heroin as their main substance of dependence and 46.7% (n=14) used tramadol as their main substance of dependence, emphasizing the prevalence and the widespread use of tramadol in Egypt due its cheap price, its availability, and the belief by our culture that it gives more power and energy and increases sexual performance.

The personality traits in opioid-dependent patients assessed using PAS were as follows: 73.3% of patients had severe degree of sociopathic trait; 43.3% had severe degree of explosive trait; 86.6% had sensitive aggressive trait ranging from personality difficulty level to the severe level; 43.3% had severe degree of passive dependent trait; 3.3% had severe degree of histrionic trait; 63.3% had severe degree of asthenic personality trait; 53.3% had severe anankastic personality trait; 56.6% had severe degree of anxious personality trait; 36.6% had anxious difficulty; 46.6% had severe degree of hypochondriacal personality trait; 63.3% had severe dysthymic personality trait; 60% had schizoid trait difficulty; 53.3% of group I had paranoid trait difficulty; and 50% had avoidant trait difficulty.

Clinical implications

Further studies and research studies are needed to address the prevalence and epidemiology of tramadol use in Egypt and the belief of the community about tramadol use in improving the sexual performance. Moreover, further awareness campaigns about tramadol dependence must be carried out among school age and college students to modify the belief about tramadol use for their academic achievement and addressing the different consequences of tramadol abuse.

Treatment of opioid dependence should be taken in more different aspects such as focusing on addressing the changes in personality caused by the substance and addictive behavior, the fingerprints opioid addiction made in changing personality and behavior.

Further epidemiological studies are required to address the relation between different types of substances and its relation with different personality types in addicts, emphasizing the link between the type of substance and the type of personality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[14]

 
  References Top

1.
Abolmagd S (2013). Tramadol use in Egypt: the emergence of a new public health problem. Can J Addict Med 4:5.  Back to cited text no. 1
    
2.
Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL (2011). Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med 12:657–667.  Back to cited text no. 2
    
3.
Fawzi M (2011). Medico legal aspects concerning tramadol abuse. The New Middle East Youth Plague: an Egyptian overview 2010. J Forensic Res 2:130. Egyptian Journal of Forensic Sciences Volume 1, Issue 2, Pages 99–102, June 2011 Some medico legal aspects concerning tramadol abuse: the new Middle East youth plague 2010. An Egyptian overview  Back to cited text no. 3
    
4.
Gelderb V (2001). Shorter Oxford text book of psychiatry. 4th ed. Oxford: Oxford University Press. 157-158.  Back to cited text no. 4
    
5.
Kaplan , Sadock (2000). Comprehensive textbook of psychiatry. Baltimore: Lippincott Williams & Wilkins.  Back to cited text no. 5
    
6.
Krampe H, Wagner T, Stawicki S, Bartels C, Aust C, Kroener-Herwig B et al. (2006). Personality disorder and chronicity of addiction as independent outcome predictors in alcoholism treatment. Psychiatr Serv 57:708–712.  Back to cited text no. 6
    
7.
McGovern E, Brown RA, Ramsey SE, Niaura R, Abrams DB, Goldstein MG (2006). Addiction severity services and co-occurring disorders; prevalence estimates. Treatment practices and barriers. J Subst Abuse Treat 31:267–275.  Back to cited text no. 7
    
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McLellan AT, Grisson G, Durell J, Alterman AI, Brill P, O’Brien CP (1993). Substance abuse treatment in the private setting: are some programs more effective than others? J Subst Abuse Treat 10: 243–254.  Back to cited text no. 8
    
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Sadock BJ, Sadock VA, Mason S (2009). The addictive personality. Psychol Today 16:865–958.  Back to cited text no. 9
    
10.
Skinner MD, Aubin HJ (2010). Craving’s place in addiction theory: contributions of the major models. Neurosci Biobehav Rev 34:606–623.  Back to cited text no. 10
    
11.
Stannard L, Van der ham L (2011). Addictive personality disorder symptoms. Livestrong. Retrieved on 26 November 2012  Back to cited text no. 11
    
12.
Tyrer P (1988). Personality disorders: diagnosis, management and course. Kent, England: Wright/Butterworth Scientific. 43–62.  Back to cited text no. 12
    
13.
WHO, GENEVA (2004e): Neuroscience of psychoactive substance use and dependence. p.81  Back to cited text no. 13
    
14.
, WHO/UNODC/UNAIDS (2004). Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention. Treatment outcome. Guidelines I. World Health Organization. Position paper. United Nations. Office on Drugs and Crime III.UNAIDS. ISBN 92 4 159115 3 (NLM classification: WM 284).  Back to cited text no. 14
    



 
 
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