Prevalence of substance abuse and its associated factors among medical students: a cross-sectional study

Study design and setting

A descriptive cross-sectional study was carried out among medical students (1^st to 5^th year) enrolled at Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC), Nepal from 1^st June 2020 to 1^st July, 2020. Whole sampling technique was used. Data was collected from the study participants through a questionnaire sent via Google form which was sent to their email through class representatives of each year. Students who were not available through email contact or did not consent for their participation in the digital consent form were not included in the study. The participation was completely voluntary and no incentives were offered to the study participants. Anonymity was maintained throughout.

Study sample

All the medical students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) program at GMCTHRC (n = 420) were included in the study. The study objectives and its implications were explained to the participants through the questionnaire sent via Google form on their email. The online method was preferred as physical classes had completely been cut down by the College administration in line with the COVID-19 protocols set up by the Government of Nepal.

Study instrument

Data was collected using a modified, online version of the Health Professional Questionnaire developed by Kenna and Wood.¹¹ Permission was taken from Elsevier for using the questionnaire in our research. This tool was preferred as it had already been used successfully in a similar study among other healthcare students in Nepal.¹² The final version of the survey did not require major changes and contained demographic information as well as the details and effects of substance abuse. We did not include the questions about university of study, faculty, course undertaken and religious beliefs that were originally present in the questionnaire.

Demographic characteristics

The study participants were asked about their age, gender, year of study, place of stay and if there was a problem of alcohol and drug abuse in their family.

Substance abuse related characteristics

We asked the study participants about alcohol, cigarette and illegal as well as prescription drug use. The questions “how many times, if ever, have you smoked cigarettes?” and “recognize yourself as: Nondrinker/infrequent drinker/light drinker/moderate drinker/heavy drinker” were used, respectively, for lifetime cigarette smoking and alcohol use. The participants were asked about their lifetime experience and tendency of use of both prescription as well as illegal drugs, e.g. “how many times, if ever, have you smoked marijuana or hashish?” Participants were asked to rate the frequency of their use, varying from “0” times to “>30 times”. The prescription drugs under consideration were major opiates, minor opiates, stimulants, sedative-hypnotics, tranquilizers, anxiolytics and other prescription pain medicines. Illegal drugs included marijuana, cocaine and designer drugs such as ecstasy, LSD, Meth and Ketamine.

The study participants were also asked about how often they were offered alcohol and drugs by friends and how often they worked with colleagues who were intoxicated by such substances. We also asked about the reasons for substance abuse and the dysfunction it had on their daily life using a series of questions. The list of dysfunctions included 1) falling behind in work; (2) calling in sick or being late; (3) having trouble getting along with people; (4) worrying that you might be using too much or too often; (5) seriously considered suicide; (6) having an automobile accident or other type of accident; (7) seeing a psychiatrist, psychologist, or a counselor.¹² The initial four effects were grouped as “minor dysfunction” and the remainder as “major dysfunction”. Subsequently, the minor and major dysfunction due to alcohol and drug abuse was calculated.

Statistical methods

The data collected through Google forms were extracted to Microsoft Excel-13. Any response with missing data was excluded from the study. After data cleaning, it was imported and analyzed by using SPSS (Statistical Package for Social Sciences) 25. Demographic variables and substance abuse were analyzed using descriptive statistics. The frequency of use was recorded as 0 = never used and 1 = any use. Chi square test was used to examine any differences in substance abuse by demographic characteristics. Fisher’s exact test was applied for cell count less than 5. P value for statistical significance was set as less than 0.05.

Ethical consideration

This study was approved by the Institutional Review Committee of GMCTHRC (Ref no: 023/2076/2077). All the participants were informed about the study through the online form attached in the questionnaire sent to them and informed consent was obtained. Anonymity of the study participants was maintained throughout.

General characteristics

Table 1 shows detailed demographic and general characteristics of study participants. Out of 420 medical students, 219 students participated in the study (response rate = 52.2%). There were considerably less participants from non-clinical years (n = 56, 35%) of medical school when compared to clinical years (n = 163, 63%). The mean age of study participants was 21.32 years, ranging from 18-30 years. Majority of respondents were females (n = 115, 52.5%) and most of them lived out of a rented property (n = 118, 53.9%).

Prevalence of substance abuse

Table 2 shows the detailed prevalence of various substances abused by medical students. Alcohol was the most commonly abused substance with overall lifetime prevalence of 58% (n = 127), followed by cigarette smoking and illegal drug abuse at 21.9% (n = 48) and 13.7% (n = 30), respectively.

Correlates of substance abuse

When analyzing the distribution of substance use with various demographic variables, it was shown that the abuse of substances was significantly higher (p < 0.05) in males, if substances were offered by friends and amongst study participants who worked with an intoxicated colleague (Table 3).

Reasons for substance abuse

Out of all the study participants, 78 respondents stated the reason for using substances. The most common reasons included: 1) for pleasure, curiosity or to go along with friends (n = 29, 37%); 2) supervising self for medical condition (n = 18, 23%); and 3) originally prescribed but now using on my own (n = 14, 18%). Table 4 shows the details regarding other reasons for substance abuse among the study participants.

Effect of alcohol and drug abuse

As stated earlier, we grouped the harmful effects of substance abuse into “major” and “minor” dysfunction. Details of these dysfunctions due to alcohol and drug abuse have been presented in Table 5. Alcohol caused dysfunction in 41 respondents while drugs caused dysfunction in 15 respondents respectively.

Inappropriate use of substances

In addition to all the other questions pertaining substance abuse, we also asked the study participants if they felt they used alcohol or drugs more than they would consider appropriate (Table 6). A total of 84% of the study participants (n = 184) responded that they didn’t feel they did, while 15.1% (n = 33) participants felt they used alcohol inappropriately. Only one participant each felt they used drugs and both substances inappropriately.

Underlying data

In this study, participant-level data were collected. No data are available publicly because consent for publication of raw data was not obtained and the dataset could in theory pose a threat to confidentiality. Researchers interested in accessing the data will need to submit an official letter of request for the data to Gandaki Medical College Institutional Review Committee, and will be asked to confirm that they will not violate the ethical standards of the ethical committee and protect the anonymity of the participants. Researchers can contact the corresponding author, who can facilitate this process.