World Journal of Medical Sciences 1 (2): 133-139, 2006 ISSN 1817-3055 IDOSI Publications, 2006

Perception of Drug Abuse Amongst Nigerian Undergraduates

1

K.A. Oshikoya and 2A. Alli

Pharmacology and Therapeutics Department, Lagos State University College of Medicine, P.M.B. 21266, Ikeja, Lagos, Nigeria 2 Resident in Community Medicine and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Abstract: This study examined the perception of drug abuse amongst Nigerian undergraduates living off-campus. Students were surveyed at the Lagos State University, Ojo, allowing for a diverse sample that included a large percentage of the students from different faculties and departments. The undergraduate students were surveyed with a structured self-reporting anonymous questionnaire modified and adapted from the WHO student drug survey proforma. Of the 1000 students surveyed, a total of 807 responded to the questionnaire resulting in 80.7% response rate. Majority (77.9%) of the students were aged 19-30 years and unmarried. Six hundred and ninety eight (86.5%) claimed they were aware of drug abuse, but contrarily they demonstrated poor knowledge and awareness. Marijuana, 298 (45.7%) was the most common drug of abuse seen by most of the students. They were unable to identify very well the predisposing factors to drug use and the attending risks. Two hundred and sixty six (33.0%) students were currently taking one or more drugs of abuse. Coffee (43.1%) was the most commonly used drug, followed by alcohol (25.8%) and marijuana (7.4%). Despite chronic use of these drugs (5 years and above), addiction is not a common finding. The study also revealed the poor attitudes of the undergraduates to drug addicts even after rehabilitation. It was therefore concluded that the awareness, knowledge, practices and attitudes of Nigerian undergraduates towards drug abuse is very poor. Considerably more research is needed to develop effective prevention strategy that combines school-based interventions with those affecting the family, social institutions and the larger community. Key words: Drug abuse % knowledge % perception % Nigerian undergraduates INTRODUCTION Drug abuse is a global health and social problem with conditions and problems that vary locally [1]. The use of psychoactive substances among adolescents and young adults has become a subject of public concern worldwide partly because of its potential to contribute to unintentional and intentional injury [2, 3]. Drug abuse and addiction has a universal phenomenon that extends across socioeconomic, cultural, religious and ethnic boundaries [4] and despite the efforts of the various Nigerian tiers of Government and the National Drug Law Enforcement Agency (NDLEA) to stem its tide in the country there has been a consistent rapid rise in the number of cases especially among the young adolescents (10-24 years) [5]. This growth has resulted in an increase in the number of cases of cultism, violent disorders, as well as mental disorders among Nigerian youths [6-12]. Often times, most people take drug abuse for drug misuse. It is therefore pertinent to differentiate the two concepts. While drug abuse, in the context of this study, is used to describe non-medical self administration of a substance to produce psychoactive effects, intoxication or altered body image, despite the knowledge of its potential adverse effects; drug misuse implies that a drug has a proper medical use and is being employed for an incorrect purpose [13]. One major consequence of drug abuse is dependence and addiction, characterised by compulsive drug craving seeking behaviours and use that persist even in the face of negative consequences. These changes are maladaptive and inappropriate to the social or environmental setting, therefore may place the individual at risk of harm [13, 14].

Corresponding Author: Dr. K.A.Oshikoya, Pharmacology and Therapeutics Department, Lagos State University College of Medicine, P.M.B. 21266, Ikeja, Lagos, Nigeria

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Experimentation with drugs during adolescence (11-25 years) is common. At this age, they try so many new things. They use drugs for many reasons, including curiosity, because it feels good, to reduce stress, or to feel grown up [15]. Using alcohol and tobacco at a young age increase the risk of using other drugs later. Some teens will experiment and stop, or continue to use occasionally without significant problems. Others will develop addiction, moving on to more dangerous drugs and causing significant harm to themselves and possibly others [15]. Recognizing alcohol dependents and drug addicts at the early stage may be very difficult as they may present with symptoms that mimic most psychiatric and physical illnesses such as anxiety, depression, paranoia and vague physical complaints [16-18]. Several studies in Asia, America and the United Kingdom showed widespread drug use among adolescents and youths, making this a problem requiring global attention [3, 19, 20]. Most of the studies on drug abuse had been conducted in Europe and America. Those carried out in Nigeria were mainly hospital and community based with much focus on the secondary/high school students. Knowing the perception of the undergraduates about drug abuse would enable government to plan a better primary approach to preventing substance abuse among this group of people. This study therefore investigates the awareness, knowledge, attitudes and practices of Nigerian undergraduates towards drug abuse. MATERIALS AND METHODS Lagos is the smallest state but the most populous city in Nigeria with an estimated population of about 15 million inhabitants as of 1991 national census. Two universities are established in Lagos, namely University of Lagos (UNILAG), Akoka and Lagos State University (LASU), Ojo. Each of these institutions has an estimated student population of over 15,000. Only the students of LASU were used for this study and were not accommodated on the campus. LASU has eight faculties, namely Management and Administration, Art and Humanities, Education, Engineering, Sciences, Social Sciences, Medicine and Law. The College of Medicine and Faculty of Engineering are situated outside the main campus and were excluded from the study. Study design: The study was a descriptive type. Only registered students of the University were sampled. The students were identified by their identity cards and were

selected randomly in multistage. The first stage was selection of five faculties by simple balloting. The second stage was at the faculty level. From each faculty, four departments were randomly selected by balloting except for the Law faculty that is not subdivided into departments. The third stage was a proportional sampling of ten students from, at least, four levels in each department. In the Law faculty two hundred students were similarly proportionally selected. This stratification was to ensure good representation of the entire department of the University. 1000 students were interviewed with a structured self-reporting anonymous questionnaire modified and adapted from the WHO student drug survey proforma [21]. Two staff of the Pharmacology department of Lagos State University College of Medicine was trained to administer and retrieve the questionnaires from the students. This staffs was trained on the pattern of distribution. A pilot study was conducted at the Lagos State University College of Medicine, Ikeja, Lagos. The questionnaire was in four sections; section A for the students demography, section B for their awareness and knowledge, section C for their practices and section D for their attitudes towards drug abuse. The data was analysed using EPI-info 2000 statistical package. RESULTS A total of 807 students responded to the questionnaire resulting in 80.7% response rate. An average response of about 21.8% was obtained from students in each of first, second, third and fourth years of their studies. Three (0.4%) responses were obtained from students in their sixth year and above, respectively. Four hundred and twenty seven (53%) were male and 374 (46.4%) were female. Five (0.6%) did not state their ages. The male: female ratio was 1.14. Majority (77.9%) of the students were aged 19-30 years. Only 0.1% was 11-14 years. Five hundred and ninety two (73.2%) were Christians and seven (0.9%) were of unspecified religion. Only 12.9% were married. Awareness and knowledge: Six hundred and ninety eight (86.5%) students claimed they were aware of drug abuse. Television, radio and billboard advertisements were the students major sources of awareness about drug abuse (Fig. 1). These modes of information dissemination cut across the sampled faculties. Table 1 showed that Cocaine, 463 (66.3%) was the most identified drug of abuse, while Morphine and steroids respectively,

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Table 1: Identification of drugs that can be abused by Nigerian undergraduates Faculties ---------------------------------------------------------------------------------------------------------------------------------------------------------------Drug of abuse Cocaine Marijuana Alcohol Heroin Cigarette Coffee/Caffeine Antibiotics Morphine Steroids Amphetamine LSD Phencyclidine Mescaline Edu. (n = 121) 87 76 74 55 54 57 40 26 24 9 4 5 6 Soc. Sci. (n = 154) 102 86 67 73 45 27 32 26 23 11 14 3 3 Art (n = 145) 88 80 80 44 47 51 37 17 23 6 6 9 3 Sci. (n = 143) 85 82 62 46 43 35 45 18 21 11 13 6 2 Law (n = 136) 101 83 62 68 52 48 33 24 20 10 6 3 4 Total (n = 699) 463 407 345 286 241 218 187 111 111 47 43 26 18 % (100) (18.5) (16.3) (13.8) (11.4) (9.6) (8.7) (7.5) (4.4) (4.4) (1.9) (1.7) (1.0) (0.7)

Edu. = Education, Soc. Sci. = Social Science, Sci. = Science, LSD = Lysergic acid diethylamide Table 2:Drugs of abuse seen by the Nigerian undergraduates Faculties --------------------------------------------------------------------------------------------------------------------------------------------------------------Drug of abuse Marijuana Coffee/Caffeine Antibiotics Cocaine Heroin Steroids Morphine Amphetamine LSD Phencyclidine Edu. (n = 121) 60 58 39 29 11 10 3 2 2 3 Soc. Sci. (n = 154) 52 37 32 30 15 7 7 2 2 1 Art (n = 145) 56 49 36 33 11 7 5 3 3 1 Sci. (n = 143) 65 38 38 40 10 7 12 9 6 1 Law (n = 136) 65 43 36 34 11 8 8 10 1 0 Total (n = 699) 298 225 181 161 58 39 35 26 14 6 % (100) (28.4) (21.5) (17.3) (15.8) (5.5) (3.7) (3.3) (1.3) (1.7) (0.6)

Edu. = Education, Soc. Sci. = Social Science, Sci. = Science, LSD = Lysergic acid diethylamide

Fig. 1: Sources of information about drug abuse 135

111 (15.9%), were the least identified drugs. Six hundred and fifty two (80.9%) students claimed they had seen some of these drugs before. Marijuana, 298 (45.7%) was the most common drug of abuse seen by most of the students, even at each of the faculties (Table 2). Phencyclidine, Six (0.9%) was rarely seen by the students. Only 44.7% were able to correctly define drug abuse as taking harmful drugs. Table 3 showed that genetic factors 80 (9.9%) and poverty 95 (11.8%) were the least identified predisposing factors; while family and peer influence 371 (46.0%) was the most identified. Table 4 showed that behavioural changes, 468 (58%) was the most-and indiscriminate sexual intercourse 103 (12.8%) the least-identified risks associated with drug abuse. Forty eight percent students believed drug addicts could be rehabilitated, 25.5% believed they could be treated in the hospital, 13.8% believed they could be effectively cured

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Table 3: Predisposing factors to drug use, dependence and addiction Faculties ---------------------------------------------------------------------------------------------------------------------------------------------------------------Edu. Drug of abuse Family/Peer influence Don't fit Depression Low self-esteem Personality Drug availability Poverty Genetic predisposition (n = 121) 75 35 46 50 25 22 17 9 Soc. Sci. (n = 154) 63 31 45 29 30 29 15 17 Art (n = 145) 79 58 49 46 36 22 24 24 Sci. (n = 143) 76 46 42 42 34 28 19 15 Law (n = 136) 78 56 41 45 21 27 20 15 Total (n = 699) 371 226 223 212 146 128 95 80 % (100) (25.1) (15.3) (15.1) (14.3) (9.9) (8.6) (6.4) (5.4)

Edu. = Education, Soc. Sci. = Social Science, Sci .= Science Table 4: Consequences of drug abuse Faculties ---------------------------------------------------------------------------------------------------------------------------------------------------------------Edu. Drug of abuse Behavioural change Health risks Mental/Social imbal. Dependence/addiction Loss of control Compuls. to take drug Indiscriminate sex (n = 121) 96 71 75 64 39 50 23 Soc. Sci. (n = 154) 88 89 83 50 48 37 14 Art (n = 145) 101 91 86 61 54 35 26 Sci. (n = 143) 94 97 74 66 56 40 17 Law (n = 136) 89 76 79 60 42 23 23 Total (n = 699) 468 424 397 301 239 126 103 % (100) (19.3) (17.5) (16.3) (12.4) (9.8) (5.2) (4.2)

Edu. = Education, Soc. Sci. = Social Science, Sci. = Science, Imbal. = Imbalance, Compuls. = Compulsion Table 5: Drugs of abuse experienced by Nigerian undergraduates Faculties ---------------------------------------------------------------------------------------------------------------------------------------------------------------Edu. Drug of abuse Coffee/Caffeine Alcohol Cocaine Tobacco Marijuana Morphine Heroin Phencyclidine Amphetamine LSD (n = 121) 28 17 8 3 4 0 1 0 0 0 Soc. Sci. (n = 154) 21 12 1 3 2 0 0 0 0 0 Art (n = 145) 21 19 11 8 5 1 1 0 0 1 Sci. (n = 143) 24 11 2 3 3 2 0 3 2 0 Law (n = 136) 21 10 4 4 6 2 2 0 0 0 Total (n = 699) 115 69 26 21 20 5 4 3 2 43 % (100) (43.2) (25.9) (9.8) (7.9) (7.5) (1.9) (1.5) (1.1) (0.8) (0.4)

Edu. = Education, Soc. Sci. = Social Science, Sci. = Science, LSD = Lysergic acid diethylamide

when treated. Fourteen percent believed they could be treated with herbal drugs/spiritual intervention and 18.5% believed there is tendency for re-occurrence of addiction even after treatment. Practices: Two hundred and sixty six (33.0%) students were currently taking one or more drugs of abuse. Coffee 136

(43.1%) was the most commonly used drug, followed by alcohol (25.8%) and marijuana (7.4%).Their use cut across all the faculties (Table 5). One hundred and one (38.0%) were taking them occasionally, 64(24.1%) daily, 52 (19.6%) weekly and 49 (18.4%) monthly. Sixty four (24%) were single drug users and 202 (75.9%) multiple users. Coffee and alcohol are two the drugs that were used singly.

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Major source of the drugs was by an unidentified means 163 (61.3%) and chemist/shop assistance 147 (55.3%). One hundred and eighteen (44.4%) students obtained the drugs from their friends, 39 (14.7%) by doctors prescriptions and 38 (14.3%) from pharmacy. Only 16 (6.0%) students started taking the drugs in less than one week and seven (2.6%) less than one month. Twenty (7.5%) students started taking the drugs in the last six months and one year respectively. One hundred and twenty five (47.0%) have been taking the drugs since five years back and 78 (29.3%) over five years. Drugs were used mainly to keep the students awake and alert 112 (42.1%), to read and pass examinations 87 (32.7%) and to make them feel happy/high 76 (28.6%). Drugs were least used to induce sleep 52 (19.6%) and to boost confidence 47 (17.7%). Other reasons for using drugs by the students were to get them out of depression 77 (29.0%), to cope with life problems 72 (27.1%), to reduce stress 70 (26.3%) and non-specified reasons 65 (24.4%). One hundred and fifteen of those students taking drugs have just increased the quantity of the drugs they started with. Sixty three (54.8%) increased the drug dose because low dose or quantity appears not to have good effect on them over time, 42 (36.5%) because they have free access to the drugs, 42 (36.5%) because they were rich enough to afford it and 44 (38.3%) had no reasons. Attitudes: Only 171 (21.2%) students would associate with drug addicts, even after rehabilitation; 378 (46.8%) would neither marry nor allow their family member to marry a drug addict, 301 (37.3%) would not employ a drug addict, even after rehabilitation. Four hundred and seventy five (58.9%) students preferred drug addicts live in a rehabilitation home, 84 (10.4%) preferred they live with their family, 82 (10.2%) preferred they live in a hospital, 38 (4.7%) preferred they live with their friends and 29 (3.6%) preferred they live on the street. Corrective measures that the students would take on drug addicts are health education 519 (64.3%); taking them to hospital for treatment 193 (23.9%); taking then to seek alternative therapies 187 (23.2%) such as herbal medications, spiritual intervention and prayer deliverance; reporting them to the appropriate authorities133 (16.5%); complete dissociation from them 33 (4.1%); and providing more funds to them 28 (3.5%). DISCUSSION A high response rate obtained from this study had similarly been reported in Nigeria [22]. The high response

rate may be as a result of the high level of education of the undergraduates when equally compared with the result of Lawoyin et al. [23] in Nigeria, where a low response rate was obtained among secondary school students. The male: female ratio showed no significant gender predominance since drug abuse is a problem of both gender [24]. Majority of the students were aged 19-30 years i.e. the adolescents and young adults who are very vulnerable at experimenting and using drug of abuse [15, 22, 23]. The high level of awareness of drug abuse claimed by the students did not correlate well with both their ability to classify and identify those drugs. This might have resulted from a deficiency in or deviation from the theme of the subject of drug abuse during information dissemination from the media (their major source of information). Marijuana was the most commonly seen drug by most of the students, even at each of the faculties. This may be explained by the much noise made by the Nigerian government in the past about the seizures of marijuana (cannabis) and cocaine, declaring them as banned drugs [4, 5, 24]. Similarly, Knowledge of marijuana might have been handed over by the ancestors of the students since a long tradition of its use for culinary, medicinal and ceremonial purposes in Sub-Saharan Africa countries, including Nigeria, has been documented [25]. Only a handful number of the students were able to correctly define drug abuse as use of harmful drugs. Majority of them took drug abuse for misuse. The students demonstrated poor knowledge of the predisposing factors to using drugs and the risks associated with. Inspite of all the listed factors that could predispose one to drug abuse [16]; only family and peer influence was fairly identified by 46.0% of the undergraduates. Despite the claim by majority of the students that they were well aware of drug abuse, behavioural changes were the only risk factor linked with drug abuse and addiction by 58.0% of the students. Behavioural changes and other factors had been previously reported [26,27]. Poor knowledge was similarly established amongst the undergraduates on the treatment of drug addiction. Herbal and spiritual interventions in the treatment of drug addiction have not been documented; however treatment recommendations for such patients with substance use disorders have been documented by the American Psychiatric Association [15]. The principle of treatment involves clinical management [28], Psychological treatments [29] and Psychosocial interventions [30]. None of these principles was well identified by the undergraduate students.

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Coffee, the most abused drug by the students, is an approved recreational drug along with cigarette [31]. While cessation of cigarette could result in anxiety, irritability, inability to concentrate, hunger and a craving for cigarette; chronic caffeine use (caffeinism) is associated with anxiety, restlessness and insomnia [31]. Cocaine and marijuana were among the least drugs abused by the students. The 7.4% used rate of marijuana found in this study had similarly been reported by Adelekan et al. [32]. Therefore the pattern of marijuana abuse amongst undergraduates in Nigeria has not significantly changed. A larger percentage of the students obtained the drugs from undisclosed sources and from their friends, thus indicating free access to the drugs in our environment. Despite chronic use of the drugs (5 years and above), addiction is not a common finding. Only a very few of them had increased the current dose of their drugs. The main reasons why the students took drugs were mainly to keep them awake and alert, to read and pass their examinations, to make them feel happy/high, to get them out of depression, to cope with life problems and to reduce stress, which are problems of adolescents [15]. The study also revealed the poor attitudes of the undergraduates to drug addicts even after rehabilitation. Majority of the undergraduates would not associate with, marry or allow their relation to marry drug addicts, thus predisposing them to seeking drugs again and subsequently addiction. Health education, as indicated by 64.3% of the students, is a very good measure of rehabilitating drug addicts. It was concluded from this study that the awareness, knowledge, practices and attitudes of Nigerian undergraduates towards drug abuse is very poor. Trend of drug use amongst the undergraduates has not significantly changed from the way it was reported fourteen years ago by Adelekan et al. [32]. Schools have been recognized as social structures which can provide an educational setting in which the total health of the child, during the impressionable years can be modified. It should equally be regarded as a social unit providing a focal point to which health planning for all other community settings should be related. Therefore, incorporating drug abuse into the General African Studies, as part of the undergraduates curriculum; intense mass media campaigns; youth clubs and activities; and community-base movements will go a long way in preventing drug abuse amongst Nigerian undergraduates. Considerably more research is needed

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