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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 28
| Issue : 2 | Page : 156-160 |
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Substance abuse among medical students of a Nigerian University: Prevalence, factors influencing use, and effects on academic performance
Chinedu A Idoko1, Ikechukwu C Chidolue2, Chinelo I Idoko3, Chibueze K Eze4, Emmanuel Ucheya5
1 Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
2 World Health Organization, Enugu Field Office, Enugu, Nigeria
3 Department of Business Administration, Enugu State University (ESUT) Business School, Enugu, Nigeria
4 Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
5 Department of Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| Date of Submission | 12-Sep-2022 |
| Date of Decision | 30-Nov-2022 |
| Date of Acceptance | 08-Jan-2023 |
| Date of Web Publication | 21-Mar-2023 |
Correspondence Address:
Chinedu A Idoko
Department of Community Medicine, College of Medicine, University of Nigeria, Enugu
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_73_22
Background: Substance abuse is simply the use of illegal drugs, prescription/over-the-counter drugs as well as alcohol for purposes other than they are designated for, or in excessive amounts. Indulgence in these is high among students, with attendant negative consequences. Objectives: The objectives of this study were to determine the prevalence of substance use among the students, factors influencing use and the effect on academic performance. Materials and Methods: It was a cross-sectional descriptive study with respondents selected by simple random sampling. Structured questionnaires were self-administered and data analyzed using Statistical Package for Social Sciences (SPSS). Results: Caffeine (170/300, 56.7%) happened to be the substance mostly abused and cannabis least abused (6/300, 2%). The major reason for the excessive usage of caffeine was for alertness (215/300, 71.7%) during exams period. There was no significant association between drug use prevalence and improvement in respondents reading pattern/ability to effectively concentrate at lectures. However, there existed a significant association between respondents’ sociodemographics (age, sex) and prevalence of substance use (p < 0.05). Conclusions: Substance abuse is common among medical students and it is influenced by some sociodemographic factors. Substance use had no significant effect on the academics of the study participants. Stress management strategies/courses should be included in the medical education curriculum. Keywords: Academic performance, medical students, Nigerian University, prevalence, substance abuse
How to cite this article:
Idoko CA, Chidolue IC, Idoko CI, Eze CK, Ucheya E. Substance abuse among medical students of a Nigerian University: Prevalence, factors influencing use, and effects on academic performance. Int J Med Health Dev 2023;28:156-60 |
How to cite this URL:
Idoko CA, Chidolue IC, Idoko CI, Eze CK, Ucheya E. Substance abuse among medical students of a Nigerian University: Prevalence, factors influencing use, and effects on academic performance. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:156-60. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/156/372159 |
| Introduction | |  |
There has in recent times, been a rapid increase in substance use among young people. This is fast becoming a major public health challenge, not just in Nigeria but the world over.[1] Cannabis remains the most widely used illicit substance in the African Region.[1] The highest prevalence and increase in use are being reported in West and Central Africa with rates between 5.2% and 13.5%.[2] Amphetamine-type stimulants such as “ecstasy” and methamphetamine now rank as Africa’s second most widely abused drug types.[3] Other substances that were used by children and youth surveyed in Sierra Leone, included benzodiazepines such as diazepam, chlorpromazine, and different inhalants, while 3.7% were injection drugs.
Substance abuse is the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Such drugs are on the rise among students, with negative consequences such resultant academic difficulties,[4] health/mental-related problems, poor peer relationships, and involvement in crimes.[5] Furthermore, these consequences affect not just the users but a rebound effect on the members of the family, the community, and the larger society.
The use of psychoactive substances causes significant health and social problems for users as well as negatively affecting their families and communities. World Health Organization (WHO) estimated that 0.7% of the global burden of disease in 2004 was due to cocaine and opioid use, with the social cost of illicit substance use being in the region of 2% of GDP in the affected countries.[1]
Several factors account for drug abuse among young people and students. These factors include but are not limited to poverty, need for improved concentration in school and pressure from peers. Several theories have been propounded to explain why people abuse drugs. Such theories include personality theory which says that people with low self-esteem and poor impulse control are at higher risk of drug abuse. However, the learning theory says that drug abuse occurs as a result of conditioning, social, or instrumental learnings.[6]
Substance abuse among students is a big threat to the educational institution and invariably to the progress of any community. The increased prevalence of substance abuse is now a major public health challenge. It is of course inferable that with the rise in substance abuse comes a commensurate upscale of social vices, with crimes such as rape, robbery, cultism, and other forms of criminal activities escalating. Mental health problems caused by substance use is also evident with an epidemic of naked/semi-naked young people parading the streets in many cities and suburbs. It is important to note that mental health issues significantly impinge on the quality of life of affected individuals even after they have been stabilized.
This study seeks to investigate the prevalence of substance use among medical students of the University of Nigeria, the factors influencing use, and effects on students’ academic performance.
| Materials and Methods | | |
Study area
This study was carried out in Enugu at the Medical campus of the University of Nigeria (Ituku-Ozalla).[7]
Study design
This was a cross-sectional study.
Study population
The study was conducted among medical students (in their 4th to 6th year studying Medicine and Surgery) at the College of Medicine, Ituku-Ozalla campus of the University of Nigeria.
Inclusion criteria
Medical students of the University of Nigeria, Ituku-Ozalla campus who were available and willing to participate in the study.
Exclusion criteria
Medical students of the University who were unavailable and unwilling to participate in the study.
Study instrument
The modified WHO student drug use questionnaire[8] (consisting of 37 items) was used to assess drug use among the students. The questionnaire was self-administered and validated among the law students of the Enugu State University (ESUT) by the researchers.
Sampling technique
Stratified sampling method was used to select the 4th to 6th year students of medicine and surgery for the study. Simple random sampling method was subsequently used to select students for data collection. Summarily, the total number of samples was divided equally among the different levels and individuals were chosen at random until the required sample size was achieved.
Sample size determination
The minimum sample size for the study was determined using the formula[9] for estimating sample size for a prevalence study.
where N = minimum sample size; Z = standard deviation which is 1.96 at 95% confidence limit; P = prevalence from a previous study[10] was 79% (0.79); D = 5% (0.05) the margin of tolerable error using 95% confidence limit.
Using the 10% attrition rate: 10% of 254.8 = 25.48. Estimated sample size approximately = 280 students.
Data analysis
Data were analyzed using Statistical Package for Social Sciences (SPSS). Statistical associations were tested using Pearson’s chi-square. A P-value of <0.05 was set as a criterion for establishing statistical significance. Results were presented in tables and a histogram.
Ethical considerations
Ethical approval was obtained from the Health Research Ethics Committee of University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu with IRB00002323 dated 07/06/2022. Verbal informed consent was obtained from the participants after assurance of utmost confidentiality. Information sought for and obtained were without bias and strictly restricted to the research purpose.
| Results | | |
[Table 1] captures the association between prevalence and participant’s perceived reasons for substance use. P-value 0.00 indicates no significant statistical association between the prevalence of substance use and improvement in respondents reading pattern or ability to effectively concentrate during lectures. | Table 1: Showing association between prevalence and participant’s perceived reason for substance use
Click here to view |
[Table 2] represents the effects of substance use on academic performance. 12.33% (37) of respondents acceded to significant improvements in their academic performance with substance use; 49.67% (149) had noticed no significant improvement in their academic performance while 18.30% (55) were uncertain.
[Table 3] captures a statistically significant association between sociodemographic factors of age and gender and prevalence of substance abuse. | Table 3: Showing the association between prevalence of substance use and age, gender and other socio-demographic factors of respondents
Click here to view |
[Figure 1] reflects the prevalence of substance abuse. It shows that caffeine (170/300, 56.7%) was substance mostly abused with cannabis least abused (6/300, 2%). Alcohol and carbonated drinks percentages/frequency was 11.30% (34/300) and 18% (54/300), respectively. | Figure 1: A histogram showing the prevalence of substance abuse. Caffeine (170/300, 56.7%) happened to be the substance mostly abused amongst others while cannabis is the least abused (6/300, 2%). Alcohol and carbonated drinks were 11.30% (34/300) and 18% (54/300) respectively
Click here to view |
| Discussion | | |
It is evident from the study that over 50% of the study population are aware of substance abuse and prototypes that qualify as substances with generality agreeing they have used at least one of the listed substances at some time. Caffeine (56.7%) was found the most used substance with Cannabis (2%) the least. This favorably conformed with findings in a study of psychoactive substance use among medical students in a Nigerian university,[11] where a mild stimulant was the most used substance recording 33.3% while strong stimulants like Cannabis were less used at less than 1%. Also, in another study conducted among Medical Students in a Canadian University,”[12] “Prevalence of, and factors associated with substance use among Canadian medical students; higher rates of cannabis use, and lower rates of tobacco were noted.” These findings are of essence as medical students’ substance use may indicate inability to cope with stress and risk of burnout, it may also serve a bird view of their future patient counseling practices on substance use.[13]
In a similar study conducted in Kenya,[13] prevalence of substance use among students in a Kenyan University: a preliminary report, it was found that the relative use of drugs like heroin, cocaine, amphetamines and LSD were low (<5%). This is in keeping with low prevalence of substances like heroin and cocaine which was found to be under 1% in this study.
It is interesting to note that in this study, the frequency of use of substances increased during examination periods from an initial 7 (2.3%) to 12 (4.0%). The number of respondents with claim of rare indulgence in any of the substances during non-examination periods conversely reduced from 112 (37.3%) to 63 (21.0%). This is obviously attributable to increased stress associated with exam preparations and the effort to keeping wake and alert.
Results of this study indicate most participants inclination to no improvement in their overall academic performance with indulgence in drugs/substances. This however is in direct contradiction to a study carried out in Taraba State Nigeria which reflected a strong link between substance abuse and the academic performance of students.[14]
The issue of academic-related stress was again seen in a study conducted among Malaysian medical students; prevalence and sources of stress among Universiti Sains Malaysia Medical Students. The prevalence of stress among the medical students was 29.6%. The top 10 stressors were academic-related.[15] This is also reflected in similar studies that worked on substance use among medical students and boarding secondary school adolescents.[16],[17]
This study had revealed a statistically significant relationship between sex and gender and substance abuse which favorably compares with a similar study where a greater prevalence of substance abuse was found in men.[18]
Finally, the research revealed that although the majority of participants claimed academic stress an influencing factor in their usage of substances, it did not in any way improve academic performance or any other important factor such as learning, reading, memory, and attention.
There may be a benefit in exploring role other factors like one’s tribe, ethnic origin, race play in substance abuse as well as ascertain the determinants of the relationship. Furthermore, an insight into the prevalence of disorders resulting from substance use and effects of interventions geared toward rescinding the attendant effect among students in medical institutions cannot be overemphasized.
| Conclusion | | |
Substance use had no significant effect on the academics of the study participants.
Recommendations
Academic stress was seen to be the largest contributory factor that led to the use of substances in this research. It is therefore desirable that counseling be introduced into the curriculum. Findings also point to need to utilize and improve guidance and counseling support services in tertiary institutions of learning.
Limitations
Only clinical medical students were assessed. However, the study involved a good number of participants to make up for what it lacked in variation of students based on study course.
Financial support and sponsorship
The authors of this paper reported no financial disclosures.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | World Health Organization. Substance Abuse. 2015. Available from: https://www.afro.who.int/health-topics/substance-abuse [Last accessed on 11 November 2022].  |
| 2. | World Health Organization, United Nations Office on Drugs and Crime, UNESCO. Assistant Director-General for Education, 2010–2018 (Qian Tang) writer of foreword. Education sector responses to the use of alcohol, tobacco, and drugs. 2017. Available from: https://unesdoc.unesco.org/ark:/48223/pf0000247509. |
| 3. | The United Nations Office on Drugs and Crime (UNODC). World Drug Report 2018. Vienna, Austria: The United Nations Office on Drugs and Crime (UNODC); 2018. |
| 4. | Maddahian E, Newcomb MD, Bentler PM Adolescents’ substance use: Impact of ethnicity, income, and availability. Adv Alcohol Subst Abuse 1986;5:63-78. |
| 5. | Aguocha CM, Nwefoh E Prevalence and correlates of substance use among undergraduates in a developing country. Afri Health Sci 2021;21:875-83. |
| 6. | United Nations Office on Drugs and Crime. Drug use in Nigeria. 2018. Available at: https://www.unodc.org/documents/data-and-analysis/statistics/Drugs/Drug_Use_Survey_Nigeria_2019_BOOK.pdf [Last accessed on 18 March 2020]. |
| 7. | Idoko CA, Nwobodo EO Trends in rape cases in a Nigerian state. Afr Health Sci 2020;20:668-75. |
| 8. | Smart R, Hughes P, Johnson L A Methodology for Student Drug Use Surveys. Toronto, Canada: WHO Offset Publication; 1980. p. 50. |
| 9. | Onwasigwe CN Principles and Methods of Epidemiology. 2nd ed. Enugu, Nigeria: El ‘Demak Limited Publishers; 2010. p. 11. |
| 10. | Imran N, Haider II, Bhatti MR, Sohail A, et al. Prevalence of psychoactive drug use among medical students in Lahore. Ann King Edward Med Univ 2011;17:338. |
| 11. | Arora A, Kannan S, Gowri S, Choudhary S, Sudarasanan S, Khosla PP Substance abuse amongst the medical graduate students in a developing country. Indian J Med Res 2016;143:101-3. |
| 12. | Bahji A, Danilewitz M, Guerin E, Maser B, Frank E Prevalence of and factors associated with substance use among Canadian medical students. JAMA Netw Open 2021;4:e2133994. |
| 13. | Odek-Ogunde M, Pande-Leak D Prevalence of substance use among students in a Kenyan University: A preliminary report. East Afr Med J 1999;76:301-6. |
| 14. | Drug Abuse and its Effects on Academic Performance of Secondary School Students in Bali Local Govt. Available from: https://www.researchgate.net/publication/341655107 [Last accessed 11 Nov 2022]. |
| 15. | Yusoff M, , Bahri S, et al. Prevalence and sources of stress among Universiti Sains Malaysia Medical students. Malays J Med Sci 2010;17:30-7 |
| 16. | Chinawa M, Manyike JC, Obu PA, Odetunde HI, Uwaezuoke O, Ikefuna SN, et al. Substance use among medical students attending two Nigerian universities. Int Neuropsych Dis J 2014;3:2734. |
| 17. | Manyike PC, Chinawa JM, Chinawa AT, et al. Correlates for psycho-active substance use among boarding secondary school adolescents in Enugu, South East, Nigeria. BMC Pediatr 2016;16:78. |
| 18. | MCHugh RK, Votaw VR, Sugarman DE, Greenfield SF Sex and dender differences in substance use disorders. Clin Psychol Rev 2018;66:12-23. |
[Figure 1]
[Table 1], [Table 2], [Table 3]
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