Abstract

Background: Although substance misuse pattern is of growing worldwide concern, European countries have not been left out as they are uniquely going through a dynamic phase of drug misuse pattern. It is perhaps appalling, that little or no attention has been given to university students in aspects of drug policy and adoption of potential interventions necessary to curb this act. Consequently, this study aims to study the prevalence of substance misuse among students at a post-92 university in London.

Methods: A descriptive cross-sectional design using a convenience sampling technique was used. A sample of 150 students were required for the study. The recruitment process involved using a selfadministered questionnaire which was disseminated via email, classrooms and in the library.

Results: The findings showed that majority of respondents were young people within the age group of 18-24 years and a higher proportion of respondents were female students. This study reveals the prevalence of substance use among students being 36 (24%), of the sample respondents who have taken drugs for non-medical purposes at least once. Cannabis and Cocaine remained the most commonly abused drugs in the university which is consistent with national evidence in the (United Kingdom) UK.

Conclusion: It is therefore recommended that public health interventions targeted towards preventing substance misuse trends among students should be designed to raise awareness on its harmful implications thereby reducing its prevalence in younger generations.

Keywords: prevalence; substance misuse; university; college; higher education.

Citation: Sodunke T. Prevalence of substance misuse among students in a higher institution in the London, UK. J Clin Images Med Case Rep. 2021; 2(4): 1270.

Introduction

Globally, it is now well ascertained that substance misuse is an issue of important public health significance [1]. European countries have not been left out as they are uniquely going through a dynamic phase of drug misuse pattern. Consequently, the aftermath of this misuse now poses a threat to health and wellbeing, safety, security of lives, and long-term sustainable development which is a concern that urges our public health attention [2-4]. Nevertheless, it is noteworthy to point out that the time span in a university setting is a period that allows for independence and freedom from adult guidance or family supervision. Thus, constituting an atmosphere of academic pressures, freedom of choice and new social groups [5]. This then results in exposure to certain traits appreciated by the youth culture, which mostly differs from parental norms. For example, unhealthy behaviours such as smoking, alcoholism and drug use [4]. The commonly used drug types consumed by these young adults include cannabis, alcohol, opiates, crack and cocaine among others [6]. More importantly, cannabis and cocaine remained the most commonly abused drugs in the university which is consistent with national evidence and major studies [7,8] in the UK.

Despite the impact of this drug misuse culture on the younger generations, there remains a paucity of evidence on this aspect among students at university and higher education in the UK [9]. The prevalence of drug use which is estimated to be about 9.0% is continually on the rise. The British Crime Survey maintains that about 8.6% of adults had consumed illicit drug in the previous year which remains a burden to individuals and the society [10,11]. According to the European Monitoring Centre for Drugs and Drug Addiction, the total number of Drug-Related Deaths (DRDs) that occurred in the UK was approximately 3,070 which is a 13% increase from 2014 and has been the highest number recorded till date. Prior surveys of the general population have shown that uptake of drugs by young adults is higher in comparison with the older people [6]. It is perhaps appalling, that little or no attention has been given to students in further and higher education in terms of drug policy and the use of potential interventions necessary to curb this act [12].

Furthermore, problems associated with substance misuse are its negative health implications which are not only lifethreatening to the individual but are of a detrimental effect to their parents and family members [9]. Attempts have been made to explain the fluctuations in these drug use patterns among students and other youths especially in association with the social factors that interplay in their daily life. Possible explanations of the social situations include marital status, living arrangements, employment and educational status [13,14]. A classic example in relation to living arrangements was reported in a study of University students in Northern Ireland, Wales and England who stated an increase in prevalence of illicit drug use among students who lived away from their parents [15]. This idea is in correlation with a research undertaken amongst first year students in the US which suggested a rise in the likelihood of initiating marijuana use especially from students not residing at home [16].

Notwithstanding, another major finding in connection to the relationship between substance use and demographic variables is specifically attributable to age and gender [17]. Several studies [17-20] have proposed that males have been linked with an increased substance use consumption rate in comparison to females. Additionally, the world is at a unique and critical moment on issues around gender equality and this notion has gained a rapid climax of momentum in recent times [21]. Similarly, the UNI Global suggests that gender retains certain power relationships resulting from socially and culturally built hierarchy, which has consequently placed a higher social value on men than women. Nevertheless, it has been suggested that this increased uptake of substance use among males may be linked to a higher social acceptability of consumption by this group of the population [22].

Overall, this lack of attention to research on this subject matter has left pending answers to fundamental questions like the prevalence of university students that misuse substances, or the proportion of male to female students that often misuse drugs in the UK. In the absence of substantial studies, some of the most pivotal evidence on substance misuse among university students in the UK remains unknown. To conclude, this research area will help bridge a gap on an aspect of wider public health significance which has for too long, been left out. Hence, this study seeks to determine the prevalence of substance misuse among students at a post-92 institution in London.

Methods and methodology

Study setting

An institution‑based cross‑sectional study design was adopted for this work using a convenience sampling technique. This study was conducted at a post-92 institution located at the heart of London, this was of interest not only due to its convenience but its strategic finesse of encompassing a culturally diverse and social atmosphere of a total population of approximately 20,000 (41% male and 59% female) students representing 134 nationalities globally.

Data was collected from a sample size of 150 students and this was determined by using the sample size formula which has demonstrated its suitability for studies on prevalence. All currently enrolled students both full time and part time had equal opportunities to participate in the survey provided they were aged 18 years and above. The recruitment and participation of students was enhanced by the placement of an attractive and well-designed flyer, which was attached on notice boards and other strategic places on the different school campuses. The data collection was not exclusively online but incorporated students in classrooms and library to increase the participation of students, as limited number of students tend to respond to surveys. Ethical approval for the study was obtained in advance from the ethics committee and authorities of the University. Students were informed that the research will be anonymous explicitly excluding names, address or any personal information and assured of confidentiality.

Data collection procedure and tools

Considering the stipulated time available for this study and the suitability of effectively obtaining a data of great quality and calibre, the DAST-10 questionnaire was the most appropriate choice employed by this study [23]. The competence and authenticity of valid self-reported questionnaires to identify Drug Use Disorders (DUD) is a method that has shown its relevance during screening. This system is underpinned by the adoption of instruments that have been tested for its reliability and validity in early diagnosis of DUD (Tiet et al., 2008). The final survey of the collated questionnaire included measures of sociodemographic information relating only to age and gender, recreational drug types, drug use patterns (prevalence, drug use motivations and frequency), the use of multiple types of drugs at a time (multiple/polydrug use culture), consequences of drug usage and any circumstances that may have led to treatment resulting from drug use. However, before the survey was launched on the online platform, it was piloted with six (6) university students from the faculty of health sports and bioscience. Afterwards, necessary adjustments were made based on their feedback.

Data collection and analysis

After three weeks of free access to the online administered survey and the manually distributed questionnaire, the data was collated from the representative population of students and analysed and computed using a validated statistical package such as SPSS (previously Statistical Package for the Social Sciences) (IBM Corporation). As most of the questions in the questionnaire were marked as important to complete, no missing data was identified. The results for this research were illustrated using descriptive statistics of frequency tables and charts, which provided percentages for each variable. The study then estimated the prevalence of substance misuse among currently enrolled participants who satisfied the inclusion criteria of the study. A further step was then taken using inferences to draw certain conclusions about the population of students.

Results

This section presents the overall findings of this research work through data obtained from the set of questionnaires. For this analysis, the required sample size of 150 participants necessary for the survey was obtained completely, resulting in an 100percent response rate.

Data presentation and interpretation

Sociodemographic characteristics of respondents

Response for question 1

The pie chart below (Chart 1) clearly shows the dominance of female participants 58% (87) in comparison to male 48% (63) participants who took part in the survey. These differences in response rate may be explainable due to the total population of students studying at the University of East London which is approximately 20,000 (41%) male and (59%) female.

Response for question 2

One of the interesting findings in the classification of age as shown below (chart 2), is that the highest number (73) of respondents are between the age group of 18-24 years which is the youngest category of participants highlighted in the survey. Next in line, were 47 participants between ages of 25-34. Whereas, the least participatory age group was 55 and over with only one identifiable respondent.

Various types of recreational drugs and techniques associated with their use

Response for question 3

The infographics below (Chart 3) displays an illustration of the commonly abused drugs by students at UEL. Although there is variation in preference, it appears the choices include: Cannabis (25.2%) being at the peak, followed by Cocaine (3.3%), next in line was methamphetamines with about (2.6%), and then Tranquilizers (0.7%). Some students also claimed that they used other drug types not specified. However, out of the 150 respondents, only 52 students indicated the commonly used drug types, while the other 98 respondents were indifferent to the question.

Frequency of drug use

Response for question 4

The findings of this aspect of the question revealed that about 92 (61.3%) students stated they had never used drugs, 25 (16.7%) of them were categorised as rare users and ultimately the daily and weekly users were 8 (5.3%) and 15 (10%) individuals respectively.

Response for question 5 and research question (1)

In this aspect, the research questions are restated, and the corresponding answer is given to explain the findings obtained for this question. The data analysis carried out to respond to these questions is an expression in both percentages and frequencies.

(i) What is the prevalence of substance use among students at the University of East London?

The answer to this question has been clearly presented in Table 1 shown below.

Table 1: Shows the responses by students on substance abuse (N-150).

This table above (Table 1) points out that in a total of 150 students who participated in this study, 36(24%) of them stated they have taken drugs other than for medical purposes, 81 (54%) of them had specifically taken drugs for medical reasons while 33(22%) of them claimed that use of drugs for medical reasons was not applicable to them.

Response for research question (2)

Identifying and categorising into gender specifics (male or female) individuals who tend to be more involved in substance misuse uptake

An interesting finding in the representation above is its accordance with several other findings. The chart (Chart 3) demonstrates that a slightly higher number of males 19 (53%) conceded to using drugs for other reasons in comparison to females estimated as 17(47%), whereas majority of students indicated they used substances exclusively for medical reasons namely Male 34(41%) and Female 48(58%) respectively. A small number of respondents echoed that they were unaffected by use of drugs other than medical reasons with both genders approximately 32 students only.

Multiple drug use culture

Response for question 6

The chart below (Chart 6), notifies us that majority of individual 84(56%) students disagreed to using more than one drug at a time, about 16(10.7%) students acknowledged their multiple drug use act while those who maintained they neither used or not were about 50(33.3%) individuals in the study.

Ability of participants to control their drugs uptake

Response for question 7

The chart below (Chart 7) displays several student’s 72(48%) who stated that they are unaffected by inability to stop drug usage. Among this category of students at UEL, about 59(39.3%) of them had a contrary view of accepting their inability to control drug use while the remaining 19(12.7%) students felt confident to stop drug using substances whenever they felt like.

Possible complications linked to substance misuse

Response for question 7-11

A close inspection on one hand of the table (Table 2), shows that even though a great number of students have disagreed to items “1, and 5”. “Have you ever had blackouts or flashbacks as a result of drug use?” 75(50%), “Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs? 64 (42.7%). It is notable that on the other hand the greatest number of students who recognised the implications of drug use in (Table 2) item 1, 2 and 3, were those who expressed concerns in feeling guilty about drug use item 2. Have you ever had blackouts or flashbacks as resulting from drug use? (5.3%), “Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?” (7.3%) and Do you ever feel bad or guilty about your drug use? (13.3%) respectively. Commenting on the interpersonal relationships of drug use pattern in item “3 and 4,” Over half of the respondents are of the notion that ‘Does your spouse (or parents) ever complain about your involvement with drugs?’ (56.7%) and ‘Have you neglected your family because of your use of drugs?’ (54%) do not apply to them. Notwithstanding, on item 3 and 4 respectively, about (7.3%) and (4.0%) participants, suggested a relevance of their interpersonal relationships to drug use act.

Table 2: Sompares an overview of the possible detrimental effects/ complications linked to substance misuse (N-150).

Table 3: Provides a summary statistic for participants who have had any treatment or medical implications resulting from substance misuse (N-150).

Response for question 12

Additionally, from the chart represented below (Chart 8), it is apparent that only a minority of students (7%) have gotten involved in illegal activities for drug use, about (43%) of the respondents opposed this view while exactly half (50%) of all participants claimed it was not applicable to them.

Medical implications resulting from substance abuse

Response for question 13-17

As clearly presented in the table below (Table 3) only a negligible number of students ascertained a connection between substance use and treatment or medical conditions as stated in item “1 and 2”. Have you had medical problems resulting from your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?” (6%) and “Have you ever been in treatment for substance abuse?” (2%). Moreover, a sizeable number of respondents argued that their opinion differed in this regard with a response rate of (49. 3%) and (62%) to items 1 and 2 respectively. Even though the aspect of treatment in the survey has been giving little acknowledgement by respondents, it is worthwhile to mention that one student has been identified to have undergone treatment beyond the last 12months while another two are being treated within the last 12months.

Discussion

Currently, with reference to the various literature reviews encountered during this work, it can be ascertained that this study is the first identified work to specifically explore the prevalence of substance abuse among both undergraduate and postgraduate university students of various faculties in the UK). It is noteworthy to highlight that a major drawback in most studies (Babalola et al., 2013; Gebreslassie, 2013; Tesfaye et al., 2014; Gupta et al., 2013; Atwoli et al., 2011) revealed an inability to specify the faculty of various students who participated in the survey. Nevertheless, some studies (Makanjuola et al., 2014; Tseyl and Phillips, 2015; Deressa and Azazh, 2011) who further specified, restricted their findings specifically to students who are studying medicine or health related subjects. A further strategy for generalizability has been adopted by this study, which incorporates both medical and non-medical studies and has been earlier exemplary in the work of Osman et al. (2016).

The results of this study had a complete response rate of 100%. Similarly, these positive findings in terms of participation are similar to prior studies (Deressa and Azazh, 2011; Makanjuola et al., 2007) that have ranged from 68% to 98.7%. Nonetheless, this study shows an improved participation rate. Regarding the sociodemographic features, many respondents were young adults within the age group of 18-24 years, which correlates with the findings of Otiena, (2009) and Odejide (2000) who reported the mean ages of their respondents (drug abusers) to be 18 years old. However, the results of this particular study appear to be in contrast with the findings from Adeyemo et al. (2016) whose respondents were within the age range of 20-25years. Generally, both studies reflect the consumption of substances by young adults. Additionally, a view into gender differences in this study yielded an anticipated finding based on the total population of UEL students showing a slightly higher number of female respondents being (58%) in comparison to the male participants (48%). Although, this opinion is contrary to several reports which claimed higher number of male than female respondents (Matthias and Dada, 2012; Gebreslassie, 2013; Gupta et al., 2013; Atwoli et al., 2011). However, a possible explanation for this result may be accounted for by the higher number of female students present at UEL when compared to male students.

According to the data of this study, we can infer that the prevalence of substance use among students at UEL is of 36 (24%), accounted for by those who claimed the usage of drugs for non-medical purposes. This depiction is in line with the study of Maithya (2009) which showed 29.6% of prevalence among students. However, this view is a downward trend in relation to a study that was demonstrated by Adeyemo, (2016) showing 43.9% of students who misuse substances. Simultaneously, this study declared the fact that 81 (54%) of these students were taking drugs for strictly medical reasons, while 33 (22%) of them claimed it was not applicable to them. Furthermore, the commonly disclosed recreational drugs as approved by participants in relation to the past year include: Cannabis (25.2%) being at the peak, followed by Cocaine (3.3%), next in line was methamphetamines with about (2.6%), and then Tranquilizers (0.7%) respectively. This order agrees with the national evidence of statistics on drug misuse amongst youths in the UK (ONS, 2018) and several other reports (Tavolacci, 2013; Levinson, et al., 2007; Ashton and Kamali, 1995) that identified cannabis as the most commonly abused drug type. This high level of prevalence further emphasises the need to draw our attention to this category of drug users.

The findings of this study in relation to gender are in accordance with both historical and recent studies (Tsvetkova and Antonova, 2013; Baba et al., 2013; Gupta et al., 2013; Altindag et al., 2005; EMCDDA, 2009; Mccabe et al., 2007) that have indicated a higher number of prevalence of drug use among males than females. Although the observational difference in this result may be minimal due to the earlier explanation of overall respondents, its confirmation of similar results points towards the agreement that males are more involved in acts of substance misuse than females. This study revealed an estimate of 19 males (53%) and 17 females (47%) who declared the usage of illicit drugs, while about 34 (41%) males and 48 (58%) females stated they do not use other drug types except for medical purposes. Diversely, it is worth mentioning that a few studies (Yi et al., 2017; El Ansari et al., 2015) have had a contrary opinion by claiming females have higher prevalence of drug use in comparison to males. Moreover, Tsvetkova and Antonova (2013) offered an explanation by proposing that these findings may be due to higher social status of males than females in most countries of the world. Therefore, there is a need to interpret this gender reflection of male dominance with caution as it cannot be extrapolated in all places.

From the perspective of McCabe and Teter (2007), epidemiological studies have contributed to understanding concerns about substance abuse liability among students. This study supports evidence from previous observations on the cultural trend of multiple drug use among young adults. However, the current finding estimated only 16 students (10.7%) as active poly drug users which portrays a lower trend in comparison to other studies. This study also recorded the disagreement of about 84 (56%) students who claimed their abstinence from this trend. Though, our findings may be minimal, this result correlates with those of earlier studies (Webb et al., 1996, Hall et al., 1994) who recognised a significant association between cannabis and other illicit drugs among UK university students (Steyl and Phillips, 2011; Baba et al., 2013; Tesfaye et al, 2014; Yi et al European). Undeniably, these findings pointed out the health and social hazards associated with substance misuse in recent times and ultimately suggested that there is a need to implore an integrated approach to preventing substance abuse, specifically among university students.

Taking into consideration the idea that most respondents 92 (61.3%) have declared that they had never used drugs in the past 12 months, it is necessary to highlight that there are variations in methods by which drugs are consumed. A major criticism of some literature (Harrel, 1997; Krumpal, 2013) on this finding is the idea that most participants may feel uncomfortable to discuss their usage of substance use for several reasons. They include avoidance of concerns around social threat, feelings of shame or embarrassment linked with violation of social traditions. Another possible explanation of reduced reporting of substance misuse cases are on the rise due to its perceived stigmatization and this concurs with studies by Robbins and Clayton (1989) who claimed that the respondents view reporting substance use as a sign of weakness and therefore they may not have a desire to speak up on this aspect (O’Malley et al., 1983; Mieczkowski, 1989; Hser, 1997). In classifying the users of these drugs in order of their frequency, 25 (16%) of them identified themselves as rare users, 15 (10%) of them weekly users, while the daily users were 8 (5.3%) of individuals respectively. The stratification of our findings may demonstrate a broader classification which may be slightly different from other studies (Yi et al., 2017), but still mirrors the overall reflection of prevalence rates (frequent and infrequent drug users) worldwide (Bajwa et al., 2013, Mohammadpoorasl, et al., 2014; El Ansari et al., 2015). These results provide further support for the hypothesis that wider concerns of illicit drug use among university students is a matter of public health significance that draws our global attention (Degenhardt, 2013).

The critical impact of substance misuse amongst youths in association with the threat these substances pose to health and wellbeing have been clearly pointed out by several studies (Arnett, 2005; Khayyati, et al., 2016; Stone et al., 2012; Taremian et al., 2018). The present study records the number of respondents who have had blackouts or flashbacks resulting from drug use being only 8 (5.3%) and the majority who did not experience these 75 (50%). This almost equals the same response for participants who have stated medical problems resulting from drug use (e.g. memory loss, hepatitis, convulsions, bleeding) of 9 (6.0%) and 74 who have not (49.3%) respectively. Similarly, the attribution of substance misuse to long term consequences of psychological health issues like flashbacks, depression and anxiety has been cited by numerous authors (McCabe, 2008; McCabe and Teter, 2007; Zullig and Divin, 2012, Taremian et al., 2018). These findings also relate to the widely held views (Dehghani et al., 2010; Yi et al., 2017) of medical problems associated with substance abuse, for example, risky sexual activity, which may enhance susceptibility to diseases. |Even though the number of students who experience these ill health issues are a few at UEL, it is still worth looking into at this crucial stage of development. Hence, there is a need for understanding both the risk and protective factors of substance use, which is a research necessity among students in the university.

Even though consequences of substance misuse have been ascertained to be associated with various negative effects, the engagement of students in this activity remains an issue of concern. Some findings (Makanjuola et al., 2014; Tseyl and Phillips, 2015; Gebreslaisse, et al., 2013; Atwoli, et al., 2011; Tsvetkova and Antonova, 2013) have raised intriguing questions regarding the nature and extent of students’ involvement in illegal activities and their impacts. Nevertheless, the number of respondents who positively acknowledged their participation in this act were only 7%, while a higher number of them had a negative view of being involved, which was estimated to be 43%. Also, in terms of relationship disruption which has also earned a minimal acknowledgement rate both towards spouse or in connection with family members, this number was estimated as 11 (7.3%) and 6 (4.0%) respectively. On the contrary, over half of the students held an opinion of substance misuse not having influence in their homes 54 (36%) and 63 (42%). Moreover, these results provide further support for the hypothesis of other studies (Makanjuola et al., 2014; Tseyl and Phillips, 2015; Gebreslaisse, et al., 2013; Atwoli, et al., 2011; Antonova, 2013; Baba et al., 2013; Naimi, et al., 2003; Ekpenyong, 2012) that have agreed that substance use impacts on family or other interpersonal relationships. A possible explanation of the continuity of this trend by Babalola et al. (2013) was that young adults remain unaware of the harmful effects of this lifestyle pattern. There is an urgent emphasises on the need to enhance and increase their education on this topic, especially when consideration is given to the pernicious effect it poses everywhere and to everyone (Gupta et al., 2013).

Generally, these findings contribute in several ways to the understanding of substance misuse and its associated trends especially among students in the university setting. The results from this study confirm the prevalence of substance misuse trends among university students which corresponds to prior findings. This same study has also ascertained the dominance of male students as predominant users of illicit drugs in comparison to their female counterparts. Moreover, this study highlighted the age group of young adult students (18-24) at UEL who are mostly involved in the non-medical use of drugs. Although, circumstances may differ from one university to the other, there is need for continuous research within the university environment to monitor trends and formulate adequate strategies for control.

Conclusion

It can be argued that the drug policies in university environment has been rather overlooked with concentration being diverted to the young generation. This lack of attention is believed to be inexcusable as university students should be equally as deserving of attention as the young school children. Considering the overall findings on the prevalence of substance abuse among students in university settings, preventive measures should be taken through quality enhanced health education in schools to raise awareness of risks involved in substance abuse. The concepts in this research shows a need for investigation into more detailed aspects of risk and protective factors on university students. Finally, continuous research to buttress government and school polices to enforce laws in regulating production and consumption of these substances among youths.

Acknowledgements: My sincere appreciation goes to the Dean of the faculty of Health sports and Bioscience who has been a very supportive pillar from the onset of this study, public health lecturer and most importantly all university students that participated in the survey.

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