Prevalence and Causes of Substance Abuse Among Undergraduate Medical College Students

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1 276 Original Study Prevalence and Causes of Substance Abuse Among Undergraduate Medical College Students Gouri Kumari Padhy, Associate Prof., Dept. of Community Medicine, Hi -Tech Medical College and Hospital. Sangeeta Das, Senior Resident, Dept. of Community Medicine, MKCG Medical College. Trilochan Sahu, Prof., Dept. of Community Medicine, IMS and SUM Hospital. Sourajit Parida, Final Year Medical Student, Hi -Tech Medical College and Hospital. Abstract Background: Increasing substance abuse and its impact on physical and psychosocial health is a worldwide public health concern. Adolescence is the period when initiation of these habits usually takes place. During adolescence students are more vulnerable due to increased academic pressure, peer group influence and increased popularity and availability of substances. Understanding the pattern and circumstances leading to substance abuse will help to go for appropriate interventions to protect the young adults from substance abuse. Aims and Objectives: To find out the prevalence and causes of substance abuse among undergraduate students of three medical colleges of Bhubaneswar. Materials and methods: All the undergraduate students of the three colleges present on the day of survey (1188) were included in the study; data was collected using a pre-tested structured questionnaire. Compilation and analysis of data was done subsequently using proportion and chi square test as statistical test. Results: Prevalence of substance abuse was found to be 45.87% with a male (74.03%). Predominance. Cigarette (72%) was found to be the most common substance of abused followed by alcohol (68%), gutkha (24%) and drugs (23%) Staying in hostel, non-satisfactory intra- familial relationship favoured substance abuse. Curiosity about the substance, academic and peer pressure, family problems were the major initiating factors. Conclusion: Continuing use of these substances in spite of knowledge of hazards associated with them reflected lack of health consciousness and need of proper health education.so, proper counselling with well planned policies should be implemented to root out the evil of substance abuse among the future doctors which will help in providing better health care services to the people. Keywords substance abuse, undergraduate medical students Introduction Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences. Now a day there is an increasing trend for the abuse of psychoactive substances in the developing countries like Address for correspondence: Dr Gouri Kumari Padhy, Flat-203,Subhadra Enclave, Palasuni, Bhubaneswer,Orissa. gouripadhy@gmail.com

2 277 India, which has a great impact on social, cultural, economical and health status of individual and community. Among the youth the students are more vulnerable due to increased academic pressure, peer group influence and increased popularity and availability of substances like alcohol, tobacco etc. But when substance abuse saps out the very spirits of young to-be-doctors who are the future of health care system of India, it is frightening. They are the future health educators and decision makers of the society but they are increasingly giving in to these devastating set of habits. The cause for this adherence to substance abuse should be found out to take steps to stop it among the medical students. Knowledge of prevalence of substance abuse, causes and factors associated with it can be used to root out the problem of substance abuse among the future doctors. In Bhubaneswar, three new medical colleges have been set up where about 1400 students are pursuing their studies to become doctors and promise well to shine as a beacon of hope for Orissa, a state severely traumatised in health sector. They will take care of the people in future; if the doctors are abusers then the situation will be catastrophic. Aims and Objectives To know the prevalence of substance abuse among undergraduate medical students of Bhubaneswar. To find out the type of substance abuse (which are commonly used) To find out the age of initiation of substance abuse. To know the causes of initiation and continuation of abuse. To find out the role of family members in abuse and other associated factors influencing substance abuse. Material and Methods A cross-sectional study was carried out among undergraduate medical students of three medical colleges of Bhubaneswar, Orissa from June 2011 to August The study was conducted in compliance with Ethical principles for medical research involving human subjects. Considering the prevalence of substance abuse among professional students as 23% from previous studies the sample size was calculated to be In order to get the desired sample size all undergraduate students of the three medical colleges of Bhubaneswar were included in this study. Structured, close ended questionnaire was finalized after conducting a pilot study on interns (who were not a part of the actual survey). The questionnaire had three parts, initial part collecting data regarding general information of the student, the second part about the details of substance abuse(type of substance, frequency of use,age at initiation,purpose of initiation, cause of continuation,monetary source, influence and role of family members) and the third part about personality of the student and information regarding non-users. Data were collected on prefixed dates in the months of June and July 2011 after getting permission from the college authorities. Anonymous questionnaire survey was carried out separately for each year students after getting verbal consent and after giving verbal explanation and instructions for how to fill up the same. All the students who were present on the day of data collection (a total of 1188 students of the three colleges) were included in the study. Compilation of data was done manually. Analysis of the data was done by statistical methods like proportion/ percentage and chi-square test. Observation and Results Among the total of 1188 study subjects, 624 were males and 564 were females. Table 1 reflects the socio demographic profile of students in relation to substance abuse. Among the total of 1188 study subjects, 624 were males (52.52%) and 564 were females (47.47%). Overall prevalence of substance abuse was found to be 45.87%. Prevalence of substance abuse among male students (74.03%) was found to be significantly higher than that in female students (14.71%). χ 2 =331, d.f. =1, p< Substance abuse was more common among students of age years (50.12%) than those in the age group of years(46.61%), years (44.47%) and >25years (43.85%). Substance abuse was more prevalent in students belonging to joint families (61.33%) than those belonging to three generation (47.72%) and nuclear families (43.67%). χ 2 =9.24, d.f = 2, p< (74.9%) students having nonsatisfactory level of intra-familial relationship are substance

3 278 Table 1 Socio demographic profile and substance abuse Gender Total Subjects Substance Abusers No. % Male Female Total Age > Type of family Nuclear Joint Three generation Intrafamilial relationship Satisfactory Non satisfactory Place of staying Home College hostel Private hostel abusers while only 297(34.65%) students having satisfactory level of intra-familial relationship are abusers and this difference was significant. χ 2 =155, d.f.=1, p< Substance abuse was more prevalent among students who were staying in private hostels (61.83%) and college hostel (45.97%) than those who stay at home (22.23%). This difference was also significant. χ 2 =67.41, d.f=2, p<0.001 Table 2 displays data regarding pattern of substance abuse. Among all substance abusers 397 (72.84%) smoke cigarette, 372 (68.25%) take alcohol, 134 (24.58%) take gutkha, 128 (23.48%) take medication, 178 (32.66%) take both alcohol and cigarette and 134(24.58%) take all the three i.e. alcohol, cigarette and gutkha.among female abusers 56 (67%) use medications,17(20.4%) smoke cigarette and 10 (12%) consume alcohol. Table 3 reflects data regarding factors precipitating substance abuse. The age of initiation for smoking cigarette, taking alcohol and consuming medication was >18 years in 249 (62.7%), 229 (61.5%) and 109 (85.15%) of abusers respectively. Whereas it was less than 18 years for abusers of gutkha. 51 (38.05%) of abuser started habit of taking gutkha at the age of years. The main purpose for initiation of abuse was curiosity for cigarette (45.84%) and alcohol (35.84%) while the purpose was casual for gutkha (25.37%) and academic pressure for medication (67.18%).53.65% students smoking cigarette continued smoking casually where as 63.44% students taking alcohol and 61.94% students taking gutkha continued these for deriving pleasure. All the students taking medication continued the same to get relief from their problem temporarily. 98% students abusing substances were aware of the Type of substance Table 2 Distribution of users as per the pattern of substance abuse Male (N=462) Female (N=83) Total (N=545) No. % No. % No. % Cigarette Alcohol Gutkha Medication Alcohol + Cigarette Alcohol + Cigarette + Gutkha

4 279 Table 3 Distribution of users according to age at initiation, purpose of initiation and purpose of continuation Age at initiation Cigarette (n=397) Alcohol (n=372) Gutkha (n=134) Medication (n=128 No. % No. % No. % No. % > < Purpose of initiation Curiosity Academic pressure Pleasure Failure in love Adulthood feeling Casual Peer pressure Family tension Health problems Purpose of continuation Casual Temporary relaxation For pleasure adverse effects of substance abuse on physical, mental and social aspects of life (Fig. 1). Most of the abusers used cigarette (63%) and gutkha (77%) regularly whereas alcohol (52%) was used occasionally (Fig. 2). 68% of substance abusers began their practice in college while 22% abusers had already started in the school (Fig. 3). Fig. 1 Pie chart showing awareness about the adverse effects of substance abuse among users UNAWARE 2% Pocket money given to them by their family members was the main source of money to buy these substances among all abusers. The major causes of not using substances by the nonuser students included knowledge of harmful effect (36%), female sex (32%), fear of being caught (23%) and moral unacceptability (9%). 67% non abusers had advised their friends to give up the substance abuse. AWARE 98%

5 Fig. 2 Bar diagram showing frequency of substance abuse among users REGULAR OCCASIONAL FORMER ALCOHOL CIGARETTE GUTKHA Fig. 3 Pie chart showing starting environment of substance abuse among users SCHOOL 22% RELATIVE S PLACE 2% HOME 8% COLLEGE 68% Discussion The overall prevalence of substance abuse among medical undergraduate students of Bhubaneswar was found to be 45.87% with a higher prevalence among males (74.03%) than females (14.71%). Our study showed higher prevalence in comparison to a study by S K Palo, N C Sahani and R M Tripathy 5 where the overall prevalence of substance abuse among the professional college students of Berhampur was found to be 23.1%( prevalence among males was 32.5%) 5. There was also high prevalence among females (14%) in our study in comparison to the study at Berhampur (4%). Cigarette smoking was found to be the most common type of substance abuse (72.84%) followed by alcohol (68.25%), gutkha (24.58%) and medication (23.48%) in this study which was comparable with the study of S K Palo, N C Sahani and R M Tripathy 5 among the professional college students of Berhampur who found out prevalence rates of 56.7% and 51.8% for cigarette and alcohol respectively. 29% male substance abusers take gutkha which is less as compared to the study of D N Sinha and P C Gupta 6 on the prevalence of daily smokeless tobacco among male college students which was reported to be 43%. Our study showed a higher prevalence of drug abuse among the medical students (23.4%) in comparison to the professional college students (8.4%) of Berhampur reported by S K Palo, N C Sahani and R M Tripathy 5. This reflected the vulnerability of medical students to abuse drugs which might be because of their knowledge about the therapeutic effects of drugs and because of its easy accessibility to them. Drug abuse (medication) was seen more among females (67.46%) than males (15.58%). 86 (69%) students taking drugs cited academic pressure as the cause for their abuse while 40 (31%) students attributed health problems to be the cause. This showed some additional academic pressure on medical students which made them addicted to certain abusing drugs like sedatives, amphetamines etc. These students mentioned that they continued these drugs for getting relaxation from their respective health problems. This could be compared with the study by N N Naskar and S K Bhattacharya 4 among the medical students of Calcutta in 1993 who found a prevalence of drug abuse to be 48.9% P Kumar and D Basu 2 of PGI, Chandigarh found out stress as a major risk factor for medical students for substance abuse. Prevalence rate of 44.47% in the age group years indicated the increasing trend of substance abuse among

6 281 young students. The students in the age group year were more vulnerable for substance abuse as about 38% abusers initiated in this age group. Mohan D 3 (1980) observed that 41.9% of users initiated it in the age group of years, which was comparable with this study. Students having nuclear family had the least prevalence of 43.6% which showed that more parental control is responsible for the low prevalence in such families. Fear of being caught by parents might be attributed to this result. Intra - familial relationship also affected the students for abusing substance as 74.92% abusers did not have satisfactory intra-familial relationship. This was comparable with the study of Benegal V, Kulbhushan, Seshadri S, Karott M 1 where it was found that 55% of children in Bangalore with substance abuse belonged to broken family. Students staying in hostels constituted the majority of substance abusers. This showed lack of parental control led to this increased prevalence among students staying in hostels. Curiosity about the substance was the cause of initiation for about 46% substance abusers. Academic stress, peer pressure, failure in love matters also accounted for initiation among majority of abusers.98% of substance abusers were aware of the adverse effects of substance abuse but were continuing the same. This showed carelessness towards self health and lack of proper health education. 68% of substance abusers began their practice in college while 22% abusers had already started in the school. This showed that college environment favoured substance abuse. A major limitation of the study was that all the three medical colleges were private colleges where tuition fees were much higher than the government medical colleges. So, most of the students pursuing studies in these colleges belonged to more affluent families than other government medical colleges, thereby introducing selection bias. Conclusion High prevalence of substance abuse among medical undergraduates is a major issue which needs to be tackled by experienced hands. Majority of abusers take more than one substance and initiated the process before age of 20. Intensive search for abusers should be carried out regularly to trace all students abusing one or more substances. Guidance can be sought from 2004 s Leadership Conference on Medical Education in substance abuse 7. Summary The purpose of doing the study on medical undergraduate students of three new medical colleges of Bhubaneswar was to find out the prevalence and causes of substance abuse among the future doctors of Odisha, a state severely traumatised in health sector. All the students of the three colleges were included in the study; data was collected in a structured questionnaire. Compilation and analysis of data collected was done subsequently. Prevalence of substance abuse was found to be 45.87% with a male predominance (74.03%). Cigarette was the most common substance to be abused followed by alcohol, gutkha and drugs respectively. Staying in hostel, non satisfactory intra- familial relationship favoured substance abuse. Curiosity about the substance, academic and peer pressure, family problems were the major initiating factors for substance abuse. Continuing use of these substances in spite of knowledge of hazards associated with them reflected lack of health consciousness and proper health education given to students. So, proper counselling well planned policies, special classes should be done to root out the evil of substance abuse among the future doctors which will help in providing better health care services to the people. References 1. Benegal V., Kulbhushan., Seshadri S., Karott M. Drug Abuse Among Street Children in Bangalore. A Project in collaboration between NIMHANS, Bangalore and the Bangalore Forum for Street and Working Children. Monograph funded by CRY Kumar P., Basu D. Substance abuse by medical students and doctors. Journal of Indian Medical Association; 98: , Mohan D. Drug Problems in Socio-Cultural context, WHO, Geneva; pp , Naskar N.N., Bhattacharya SK. A study on drug abuse among the undergraduate medical students in Calcutta. Journal of Indian Medical Association. 97 : 20-21, 1999.

7 Palo S.K., Sahani N. C., Tripathy R. M. Epidemiology of substance abuse among professional college students of Berhampur town. Orissa. Journal of Community Medicine. Vol.4, No 1, ( assessed on ) 6. Sinha Dhirendra N. and Gupta Prakash C. Indian Journal of Public Health. 48 (3): pp , July- Sept Wyatt S.A., Vilensky W., Manlandro J.J., Dekker M.A. Medical Education in Substance Abuse: From Student to Practicing Osteopathic Physician. Journal of American Osteopathic Association, 105 (6 Suppl 3):pp 18-25, 2005.