Reviewer’s report
Title: 
Quality of Life and its Related Factors in 
Women with Substance Use
Disorders Referring to Substance 
Abuse 
Treatment Centers
Version: 
3 
Date: 
04 May 2020
Reviewer's report:
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This is an important topic and I think the particular context of Iran is important
for us to here about.
I think there is some key work to be undertaken on the paper
1. THere needs to be more considered context about quality of life in broad
female populations in Iran if that is available 
- ie I think the reader needs some
comparison of any norms that can be used as a reference for the sample
2. It will be useful to have more clarification of the drug use and related
problems/severity of dependence - this is made harder by the use of different
terms that are used interchangeably - addiction, substance users, illicit drug users
substance abusers etc etc. First, I would be keen to see some evidence about the
severity of problems and dependence if that is possible. I suggest that terms such
as drug use disorders and drug dependence be employed and measures of these
would be useful - I would imagine that there would be some variance in the
severity of harm and dependence? I this is not available I think this needs to be
considered as a critical limitation of the study - drug use disorders and
dependence are not unitary phenomena and I would imagine the severity of
disorders would be related to quality of life
3. The range of ages is significant and I would imagine would have some impact
on quality of life - perhaps some consideration of this should be given
4. Is it possible to get some sense of how many refused to take part and is there
any data/information that would help interpret the potential presence of selection
bias?
5. Is it possible to unpack whether poor quality of life contributed to drug use or
the other way round - at the very least this issue might be considered in the
discussion?
6.The methods require more formal detail about the participants (severity of
problem) and the approaches - apart from the SF 36 it is hard to glean any
information about the reliability and validity of the instruments/approaches to
measure drug use and other key variables- other than a statement that
questionnaires were used
7. The statement in the discussion that low quality of life is probably due to the
increase in dopamine is not defensible in a study of this kind - we have no idea
about the causes of low quality of life nor whether they preceded drug use,
coincided with or were an outcome of drug use, whether the rates are
comparable to a normative sample or other factors - at the very least drawing on
other studies that have identified links between drug use and impacts on quality
of life would be important here to try to understand what might be contributing.
8. In short a more critical analysis of how QOL and drug use might be connected
and detail on how the data were gathered, how limitations might influence the
findings and specifics of the experiences identified in this sample would be
important. 
Some minor issues 
1. in the abstract - drug addiction is caused by illegal use of addictive drugs -
well not only is this a bit tautological but also drug dependence arises from the
use of legal drugs (eg tobacco; some pharmaceutical drug use etc)
2. Line 20 under background - 200 billion drug users??
3.Line 48 under background - 1.9% to 100% of users have hepatitis C - this
needs some unpacking as it is an extraordinary range
Are the methods appropriate and well described?
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No
Does the work include the necessary controls?
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authors.
Unable to assess
Are the conclusions drawn adequately supported by the data shown?
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Unable to assess
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
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require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
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