Knowledge and Attitude Regarding Substance Abuse Among Fourth Year Nursing Student at a University

Introduction: Substance abuse is a pervasive problem across the world. The present study aimed to assess knowledge and attitudes regarding substance abuse among nursing student at the University of Namibia main campus. Substance abuse is a major public health problem globally and its prevalence is increasing rapidly amongst university students in many African countries. The target population were fourth years nursing student between the age of 20 and 35. A quantitative method approach was employed in this study.

Background: Drug and substance abuse is one of the most vexing and pervasive problems that most universities are grappling with in as far as administration is concerned. is a systematic review of literature describing the knowledge of substance abuse by university students and determines their attitude towards substance abuse. It compares university students in different countries.   

Aims: The present study aimed to assess knowledge and determined attitudes regarding substance abuse among nursing student at the University of Namibia main campus.

Method: A quantitative descriptive cross-sectional study was carried among 45, 4th year nursing degree students using simple random sampling. A questionnaire was used to collect the data. the researcher personally collected the data.  Data was analysed using google docs. Ethical principles were observed during the study.

Results: Finding show that students have adequate knowledge and appropriate attitudes towards substance abuse. 

Conclusion: The students had good knowledge of substance abuse yet engaged in substance abuse. The study students frequently used substances like alcohol, cocaine, codeine, cigarette and tramadol. Effective counselling programs is recommended specifically in universities and families to help tackle this problem.

Drugs and drug use are an integral part of human culture. Yet, we hardly know anything about drugs, at least not the kind of knowledge that would help us to understand how drugs affect people and how people become addicted to drugs. This is most surprising in light of the vast amount of knowledge that has been accumulated in the sciences [4].

Worldwide, according to the World Health Organization [21], alcohol is a commonly abused psychoactive chemical with dependence-inducing qualities. Alcohol and substance abuse are linked to serious medical and mental repercussions as well as significant social and economic problems for societies [7, 21], alcohol misuse is also responsible for about 3.3 million fatalities annually around the world [15]. contends, however, that alcohol use has some advantages over ailments including cardiovascular disorders (CVD).  Worldwide mortality in 2012 was linked to alcohol consumption by 5.9 percent (7.6 percent for men and 4.0 percent for women). The year 2011 had a 50% increase in these figures [21].  In Namibia, liquor use and smoking were associated with expanding dimensions of morbidity and mortality [5]. Numerous studies have observed alcohol to be the most utilized substance among Namibian youth and adults (normal use by 25% - 30%) [9] the author further indicated that tobacco, cannabis and Mandrax are the next substances that were being utilized by Namibia’s youth after alcohol.

Substance abuse is a major social problem with far-reaching implications. The World Health Organization (WHO) Global Status Report on Alcohol and Health (2015) identified alcohol as a major global contributing factor to disease, death (approximately 2.5 million deaths a year) and injury. Substance users suffer liver cirrhosis, cancer and injury, and non-users were affected through road traffic accidents and violence. In addiction fetal and child development were altered.

Substance misuse is a serious issue in Namibia that affects all demographic groups and, in some way, all members of our society. Namibia was classified as a country with medium alcohol consumption levels in the 2015 Global Report on Alcohol and Health by the World Health Organization (WHO) [22]. Namibia, though, had one of the highest rates of consumption in Southern Africa. 

One of the most difficult and prevalent issues facing most colleges in terms of administration and management of universities was drug and substance addiction. The effects on the students were terrible and life-changing. Rapid social and technological advancements that have a corrupting effect on university students have made this situation worse. Drug misuse posed a serious threat to children, parents, academic institutions, and economies. Countries all throughout the world rely on the valuable youth potential that drugs are robbing. The frequency of drug and substance misuse among young people has not decreased as a global issue [3].  Globally, the World Health Organization [21] states that alcohol is a widely abused psychoactive substance with reliance-producing properties [7] also added that alcohol and substance misuse is associated with severe physical and mental consequences, as well as massive social and financial problem on societies. WHO (2014) [21] reports further that the abuse of alcohol has resulted in around 3.3 million yearly deaths globally. Conversely, Piano (2017) [15] argues that alcohol use has some benefits on disease conditions like cardiovascular diseases (CVD). In the year 2012, 5.9% (7.6% for men, 4.0% for females) worldwide mortality was associated with liquor intake. These statistics increased by 50% in the year 2011 [21]. 

In Namibia, drinking alcohol and smoking cigarettes were linked to rising levels of morbidity and death [16].  Numerous studies have shown that alcohol is the most often used drug among Namibian children and adults (normal consumption is between 25% and 30%), [4, 21]. cigarettes, cannabis, and Mandrax are the following drugs that Namibia's young use after alcohol. The purpose of this study was to ascertain university students' attitudes toward substance misuse [14], excessive alcohol consumption and drug use are linked to an increase in violence as well as other health disorders like HIV/AIDS and tuberculosis. Additionally, substance abuse affects mental health through depression and other mental problems. It also has detrimental social repercussions, such as academic challenges [19].  The WHO Executive Board discussed the global concern over substance abuse and its public health implications on February 9th, 2016 in preparation for the Special Session of the UN General Assembly in April 2016 [22]. 

Additionally, there is strong evidence that alcohol abuse is widespread among young people, with university students being the most concerning group [11]. Therefore, it is crucial to categorize psychological and behavioural protective factors that can lower the likelihood of substance use behaviours having negative effects on students' health and wellbeing [8].  Furthermore, improved comprehension of protective factors may alert actions to reduce morbidity and mortality linked to drug usage patterns found in young people. In order to understand the frequency and hazards of substance misuse among university students, the purpose of this study was to investigate views of substance abuse among university students at the University of Namibia. Additionally, as universities are full societies with their own laws and norms, it was important to understand the general viewpoint, current knowledge and attitude of substance usage among university students, and whether or not these opinions differed from those found in the literature.

The aims of the study were to assess knowledge and attitude regarding substance abuse among fourth year nursing student at a university, Khomas region, Namibia.

The study adopted a descriptive cross-sectional study where quantitative approach was used to collect the data from respondents in order to assess the knowledge and attitude of students regarding substance abuse at the University of Namibia [14]. It is preferred because it ensures complete description of the situation making sure that there is minimal bias in data collection. This design was justified as it captures all the information on the knowledge and attitude of students towards substance abuse.

Survey

The data was collected using questionnaire in English with open and close ended questions. The questionnaire consisted of the following sections Section A: consisted of Demographic data of the participants’ example: Age, and Sex Section B:  was assessing the knowledge regarding substance abuse among fourth year nursing student at the university, Khomas region, Namibia based on True and False. Section C: determined the attitude regarding substance abuse among fourth year nursing student at a university Khomas region Namibia based on Likert scale with disagree, neutral and agree.

Interview schedule

The researcher collected data on knowledge and attitude of 4th year students regarding knowledge, attitude on substance abuse from participants by responding to the questions on the questionnaire at a University, the researcher collected data by administering questionnaires to the participants.

Ethical approval

Ethical clearance was obtained through the structures of the University of Namibia. Therefore, the following ethical considerations were written, informed consent was obtained from each participant after the procedure was explained and risks were pointed out after adequate information were conveyed, possible risks were pointed out. Voluntary participation without penalty for withdrawal was pointed out.

The researcher approached students through class What’s App groups by sharing a message explaining the purpose and the nature of study. Students who needed clarifications and interested were requested to directly contact the researcher. Researcher was not directly involved when students were answering the questionnaire.

The analysis of the data was collected during a study enables an in-depth analysis and discussion paving way for the formulation of the recommendations. First, data was entered into a Microsoft excel spreadsheet. It was then being imported to the statistical package for social sciences (SPSS) version 26.0 for analysis. The descriptive analysis was presented as percentages, tables, frequencies, charts and graphs. Additionally, the Chi-Square tests (95% CI; 0.05 margin error) was used to calculate inferential statistics. This was used to show the association between dependent and independent variables.

Demographic data

Table 1: Age

Majority of the participants were between 20-24 years of age with 68.9% followed by those with 25-29 of age with 17.8% and lastly 30-35 was 11.1%.36+ was only 2.2% among the participants table 1.

Table 2: Gender

Table 2 indicates that there were 45 participants who took part in this study with females making up 72.8% and males 17.8% of the participants.

Objectives: knowledge regarding substance abuse among fourth year nursing students

Figure 1 indicates response on the knowledge of drugs which causes addiction, The graph shows that majority of the respondents agreed that ecstasy causes addiction as n=37(82.2%) said true, while 8(18%) said false. On the other hand ,33(73.3%) said it is true sleeping pill causes addiction, while 9(20%) said false. All of the participants said true morphine causes addiction as n=45(100%).

Figure 1: response on the sign and symptoms of complications of addictive drugs

Figure 1 above indicates that all the participants n=45 (100%) agreed that dry mouth is one of the signs and symptoms of complications of addictive drugs. Most participants also agreed, that Myosis n=25 (55.5%) is also another sign and symptoms of complications of addictive drugs while n=20 (44.4%) was not in agreement with the statement. Lastly 18 (40%) were also in agreement that constipation is a sign of complication of addictive drugs, while most of them 27 (60%) were not in agreement.

Figure 2: the complications caused by stimulants

Figure 2 above illustrates that almost all participants agreed that dry mouth is one of the complications caused by stimulants n=35 (78%) while 10(22.3%) said it is not true. Most participants also agreed that mydriasis is another complication of taking stimulants n=30 (67%), while 15 (33.3%) said it is not a complication. Lastly, 25(55.5%) said diarrhoea is also another complication of taking stimulants, while 15 (33.3%) did not agree, on the other hand 27(60%) said that it is true that myosis is another complication of taking stimulants, while 18(40%) did not agree.

Attitude of Students Towards use of Drugs

Figure 3: reasons given by students for substance use

Figure 3 above indicate that all participants agreed n=45(100%) that stress and depression was the reasons for them to take drugs as an escape/copying mechanism, to add on most participants agreed that joy seeking was the reason for use of drugs n=40 (89%), 4(9%) were neutral, while 1(2.2%) disagreed. Some of the respondents were also in agreement that somatic disorders were the reason for using drugs n=15(33.3%), 17(38%) were neutral, while 12(27%). Lastly, Psychiatric disorders were some of the reasons why students took drugs, n=38(84.4%) agreed, while 5(11.1%) were neutral and 2 (4.4%) disagreed.

The knowledge of 4th year nursing students on substance abuse

Teenagers and young adults need to be especially concerned about the impacts of substance addiction [12].  In research studies carried out over the world, several consequences regarding the frequency of alcohol and drug use among university students have been mentioned [12]. However, research has revealed that alcohol is currently the most overused substance in Namibian institutions.

Exploring the knowledge of Students on Substance Abuse

The study aimed to investigate how students perceived substance usage. The research results showed that students frequently abuse drugs like morphine, alcohol, sleeping pills and marijuana. These results indicate that substance use among students has becoming more common, despite the fact that they knew that using drugs causes addiction as 100% of the students agreed that morphine causes addiction. The majority of the students concurred that drug use in Namibia is no longer a humiliating or illegal activity; rather, those who abstain are seen by communities as being less civilized than those who do. Substance misuse is no longer seen as a bad thing, especially among young people who see it as stylish and a normal part of being a student. The results support the social learning theory's claims that behaviour is taught and eventually normalized. 

The study's findings match those found in earlier works of literature. This current data is supported by a study done by Sorel [18], which also notes that Namibia, among the African countries, is one of the leading countries second to South Africa in the illicit drug abuse, with the prevalence rising from 0.5 to 0.8 percent in 2006 to 0.7 to 14 percent in 2012. The numbers are really rising in Namibia year after year, and one factor contributing to this is the country's acceptance of substance misuse as a norm. The results suggest that most students knew the signs and symptoms and complications of substance abuse, therefore if proper actions are not taken to curb the trend, if not totally eradicate it, it may occasionally worsen rather than improve.

Exploring the Risk Factors of Substance Abuse among University Students

Finding the risk factors of substance addiction among university students was one of the study's goals. According to the study, curiosity, stress and depression, peer pressure, somatic and psychiatric disorders, and "seeking enjoyment" all raise students' risks of substance misuse. Peer pressure and socialization, however, are significant risk factors. The urge for each student to "fit in" with a particular group of friends raises the danger of substance usage. Socialization from the family is significantly more important because behaviour is ingrained from an early age. The majority of students experience drug misuse as a part of their upbringing, coming to accept it as the usual. The study's findings are consistent with those made [20] in the United States. The authors claim that because of familial and social influences, young adults are particularly prone to engaging in substance misuse. Peer pressure, curiosity and socialization were mentioned as causes of substance abuse. They differ from this study, though, in that they refer to the idea that poor child upbringing including domestic neglect and emotional abuse increases the likelihood that young people would take drugs.

Attitude on the Effects of Substance Abuse among Students

Understanding the effects of student abuse among university students was the third goal of the study. According to the participants who were selected for the study, the study's findings support the notion that the harmful consequences of substance usage led to risk factors. It was shown that students who abuse drugs and alcohol struggle to control their emotions and moods since they tend to be violent, especially male students. As the males force themselves on the ladies while intoxicated or high on drugs, this may subsequently result in sexual assaults and rape. Additionally, the students admitted that fighting always occurs more frequently when people are highly intoxicated or high. These results are consistent with the literature [2]. The youth are engaging in illegal behaviour that will land them in trouble as a result of substance misuse. 

According to the findings of this study, the majority of students are aware that abusing anything will always have a bad effect. The students also highlighted how substance addiction has a detrimental impact on their time management and financial situation. Additionally, it was found that a student's academic performance will suffer if their time management and financial situation are poor. The idea of planned behaviour, which holds that an individual primarily considers the outcomes that may occur, the good and the bad, and then takes a decision, could be used to explain these findings better [1]. 

Namibian teenagers make the decision to abuse substances despite being aware of the risks or complications that can arise from doing so. Additionally, the students admitted that they knew that when the term "abuse" is used, it no longer refers to anything positive but rather something terrible. They acknowledged that substance usage could result in health concerns and problems, but they continued to use substances excessively despite this knowledge. Depression and addiction were among the most common health concerns addressed. These two diseases rank among the top health concerns for university students. Other students spoke of having sexually transmitted illnesses and diseases (STD/STI). According to the research, the biggest health risk brought on by student drug consumption is the Human Immunodeficiency Virus (HIV/AIDS). Another terrible consequence of drug addiction among Namibians students' is isolation, according to the study.

The study was limited to the fourth-year bachelors nursing students only.

It appears that students believe alcohol to be the chemical that is most commonly abused in general. According to the participant's narratives, marijuana consumption has been normalized and occasionally rationalized by users. Together, these findings point to a concoction of risk variables that predispose schoolchildren and young people to drug usage. Although certain risk factors are more prominent than others, they all work together as "pushes" to encourage increased substance uses.

We would like to thank the fourth-year degree students for partaking in our study.

Authors contribution Funding

No funding was received for this study.

Availability of data and materials

The data sets generated during the current study are available from the corresponding author on reasonable request. Joseph Galukeni Kadhila

Authors contributions

1.Fransine Tulonga Petrus was responsible for manuscript preparation, data collection and analysis, Joseph Galukeni Kadhila* was responsible for supervision and editing of the manuscript.

Ethics approval and consent to participate

Written informed consent was obtained from the participants prior to data collection to partake in this study. Ethical clearance was obtained from the School of Nursing and Public Health at the University of Namibia Health Research Ethical Committee to conduct the study. The following ethical principles, respect for a person, justice, maleficence and beneficence where adhered and respected throughout the study according to guidelines.

Consent for publication

Not applicable

Competing interest

The authors declared no conflict of interest.