VOLUME 17 ISSN 1531-4065 NUMBER 2 2018 AFRICAN JOURNAL

of DRUG and ALCOHOL STUDIES

p u b l i s h e d b y AFRICAN JOURNAL OF DRUG AND ALCOHOL STUDIES

PURPOSE AND SCOPE

The African Journal of Drug & Alcohol Studies is an international scientific peer-reviewed journal published by the African Centre for Research and Information on Substance Abuse (CRISA). The Journal publishes original research, evaluation studies, case reports, review articles and book reviews of high scholarly standards. Papers submitted for publication may address any aspect of alcohol and drug use and dependence in Africa and among people of African descent living anywhere in the world.

The term “drug” in the title of the journal refers to all psychoactive substances other than alcohol. These include tobacco, cannabis, inhalants, cocaine, heroin, prescription medicines, and traditional substances used in different parts of Africa (e.g., kola nuts and khat).

EDITORIAL AND MANAGEMENT TEAM

EDITOR-IN-CHIEF ASSOCIATE EDITORS Prof. Isidore Silas Obot Dr Neo Morojele Centre for Research and Information Medical Research Council on Substance Abuse (CRISA) Pretoria, South Africa E-mail: [email protected]; E-mail: [email protected] [email protected] Dr Nazarius Mbona Tumwesigye DEPUTY EDITORS Makerere University West Africa Kampala, Uganda Professor Hope Obianwu E-mail: [email protected] Niger Delta University Wilberforce Island, Nigeria Dr Andrew Zamani Psychiatric Hospital Southern & Central Africa Gwagwalada, Abuja, Nigeria Professor Charles J. Parry E-mail: [email protected] Medical Research Council Cape Town, South Africa MANAGING EDITOR E-mail: [email protected] Akanidomo J. Ibanga, CRISA E-mail: [email protected] Eastern Africa Prof. David M. Ndetei EDITORIAL ASSISTANTS University of Nairobi Okokon Umoh Nairobi, Kenya EDITORIAL ADVISORY BOARD E-mail: [email protected] Dr Reychad Abdool, Nairobi, Kenya Francophone countries Dr O.A. Ayo-Yusuf, Pretoria, South Africa Prof. Baba Koumare Prof. Moruf Adelekan, Blackburn, UK Hopital Point G Dr Yahyah Affinih, New York, USA Bamako, Mali Prof. E. E. O. Alemika, Jos, Nigeria E-mail: [email protected] Dr Pascal Bovet, Seychelles Prof. Layi Erinosho, Abuja, Nigeria Rest of the world Dr Axel Klein, London, UK Prof. James T. Gire Prof. Hope Obianwu, Benin, Nigeria Virginia Military Institute Lexington, VA, USA E-mail: [email protected] AFRICAN JOURNAL OF DRUG AND ALCOHOL STUDIES

Volume 17, Number 2, 2018

CONTENTS

Roles of Background Characteristics in HIV and Alcohol Use Prevention Among School Learners: The HAPS Project...... 79 Godswill N. Osuafor & Chinwe E. Okoli

Psychoactive Substance Use as a Predictor of Road Rage Behaviour in a Sample of Commercial Drivers in Enugu, South-Eastern Nigeria...... 93 Philip C. Mefoh, Joy I. Ugwu, & Timothy E. Eze

Commercial Tricycle Riders’ Perceptions of Psychoactive Drug Use and the Risk of Road Traffic Accidents in Uyo, Nigeria...... 105 Ediomo-Ubong E. Nelson, Okokon O. Umoh, Nsidibe F. Essien & Aniekan S. Brown

Some Neuropsychological Profiles of Cannabis Dependent Users on Long-Term Abstinence in a Rehabilitation Centre in Nigeria...... 119 Valentine A. Ucheagwu, Rita N. Ugwokwe-Ossai, Paul D. Okoli, & Jesse P. Ossai

Substance Use Among Youths: Roles Of Psychoticism, Social Alienation, Thriving and Religious Commitment...... 133 Steven K. Iorfa, Chinedu Ugwu, Chuka M. Ifeagwazi, & Johnbosco C. Chukwuorji

Community Perspectives on Cultural Practices and Belief Systems Influencing Alcohol and Drug Use: A Qualitative Study in Anaang Community, Nigeria...... 147 Nsidibe A. Usoro, Dorothy N. Ononokpono, Ursula Ette, & Nkereuwem N. James

Abstracting/Indexing services: The journal is indexed/abstracted by the following services: Addiction Abstracts, African Journals Online (AJOL), DrugScope, Applied Social Sciences Index, Social Services Abstracts, Sociological Abstracts, Scopus, Embasse, and PsycINFO.

African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications ROLES OF BACKGROUND CHARACTERISTICS IN HIV AND ALCOHOL USE PREVENTION AMONG SCHOOL LEARNERS: THE HAPS PROJECT

Godswill Nwabuisi Osuafor1, Chinwe Edith Okoli2

1Faculty of Humanities, North-West University, South Africa; 2Federal Medical Centre, Umuahia, Nigeria

ABSTRACT

HIV and alcohol prevention programmes to delay sexual initiation and alcohol use by learners have been shown to be effective interventions in high schools. However, the interplay of the interventions and the background characteristics of learners in preventing sexual initiation and alcohol use have not been examined. In this study, we examine the contribution of background characteristics of learners in HIV and alcohol prevention programme. Data were drawn at two time points from a cohort of 1259 and 1076 grade 9 learners. Generalized linear mixed models were used to predict the effects of background characteristics on alcohol consumption and sexual initiation. The results show that alcohol consumption increased from 34.6% to 39.9% between the two points among the learners. Between the two time points, prevalence of sexual intercourse rose from 31.1% to 37.7%. Background characteristics such as increasing age, being a male, absenteeism from school, importance of religion and average grade point predicted alcohol use. Sexual intercourse was significantly associated with increasing age, being a male, absenteeism from school and importance of religion. The study concludes that HIV and alcohol prevention strategy targeting learners should take serious consideration of their background characteristics for a more effective intervention programme.

Keywords: Alcohol, HIV, sexual risk behaviours, learners, South Africa

INTRODUCTION countries have initiated HIV prevention programmes among youth (Morojele & Sub-Saharan African has limited ex- Ranchod, 2011; Sani, Abraham, Denford, periences with alcohol and HIV preven- & Ball, 2016). The most important out- tion programmes among the youth. De- comes of intervention programmes were spite the fact that sub-Saharan African the needs to address a spectrum of in- is the most affected region by HIV, few terpersonal, cultural, structural factors

Corresponding Author: Godswill Nwabuisi Osuafor [email protected] OSUAFOR & OKOLI underlying adolescents alcohol use and learners. School environment is perceived HIV risk behaviour (Harrison, Newell, Im- as the most accessible venue for dissemi- rie, & Hoddinott, 2010; Morojele et al., nation of health information and ideal 2013). Of concern is the review of exist- for knowledge exchange network (Flisher ing alcohol and sexual risk prevention & Klepp, 2009). Review of school-based programmes were limited (Morojele & intervention programmes have docu- Ranchod, 2011), and characteristics of mented substantive success in plummet- successful interventions were not docu- ing early sexual initiation and alcohol use mented (Harrison et al., 2010). In addi- (Harrison et al., 2010; Sani et al., 2016). tion, evaluation of intervention content However, researchers have critiqued and characteristics of successful inter- school-based intervention programmes vention programmes on alcohol use and in South African societies on some of the sexual risk behaviour have shown mixed following grounds. South African high results (Scott-Sheldon, Walstrom, Harri- schools have fidelity challenges, high son, Kalichman, & Carey, 2013; Harrison level of staff and students absenteeism et al., 2010; Mukoma et al., 2009). (Karnell, Cupp, Zimmerman, Feist-Price, & Consumption of alcohol among South Bennie, 2006), violence and many school- African adolescents is characterised by level issues (Ahmed, Flisher, Mathews, binge and /or heavy episodic drinking Mukoma, & Jansen, 2009; Burton, 2008; (Morojele & Ramsoomar, 2016; Reddy Human-Vogel & Morkel, 2017) militating et al., 2013; Seggie, 2012), which has im- against learning and programme inter- plications for sexual risk behaviour and vention. In addition, most of the schools HIV infection amongst the youth (Scott- where the intervention programmes Sheldon et al., 2013). The scourge of HIV were rolled out do not have boarding fa- in South African society has necessitated cilities (Cupp et al., 2008). Thus, raising intervention and prevention strategy that a concern in achieving the objectives of targets school learners mainly because school-based interventions programme. alcohol and substance use are the main While the school based intervention pro- drivers of risky sexual behaviour among gramme have been effective to some -ex high school learners in South Africa. In tent, shortfalls due to after-school activi- this era of escalated knowledge of sexu- ties can be augmented through valuable ality, HIV prevention programme has information on background characteris- become the main intervention strategy tics of the learners (Patrick, Schulenberg, focussing on high school learners. Skilled- & O’Malley, 2016). based intervention has been rolled out UNISA Bureau Market Research, (2012) in schools to equip learners to deal with noted that intervention to adolescents’ challenges associated with indulging in alcohol, substance abuse and subsequent alcohol use and risky sexual behaviour. risky sexual behaviour in South Africa These programmes were multifaceted should be addressed through educational and well designed to address factors that programmes. They further emphasised expose learners to health risks. that this educational programme should Previous youth intervention pro- be a joint activity of the schools and the grammes have highlighted the need for homes of the adolescents. This is because school-based programmes for high school the local communities have influence on

80 HIV AND ALCOHOL USE PREVENTION substance abuse dynamics. They conclud- widespread in Southern African societies ed that substance use and risky behav- (Pascoe et al., 2015; Plüddemann, Flisher, iour may not be addressed properly and McKetin, Parry, & Lombard, 2012). Risk effectively if all spheres of society are not behaviours initiated as adolescents are involved. Since the existing intervention often perpetuated into adulthood with programme do not actively involve -par dependence problem (Mason et al., 2010; ticipation of the community in addressing McCambridge, McAlaney, & Rowe, 2011; alcohol and substance abuse, background Velleman, 2009). These demographic characteristics of the learners remain the factors are often neglected in school-ba- proxy for assessment. sed substance use and sexual risk beha- Effective school-oriented intervention viour intervention programmes. The aim programmes from the western world of the study was to clarify the effects of have been adopted by South Africa high socio-demographic variables in HIV and schools. However, given the socio-cultural alcohol prevention programmes in South differences between the west and Africa, Africa. The findings would improve school the importance of background character- intervention programmes and offer consi- istics of the learners may have expedit- derable variation in learners needs. ing effect on HIV and alcohol prevention intervention programmes (Cupp et al., 2008). Furthermore, school based skilled- METHOD oriented intervention can be effective on formative work that is built on back- HIV and Alcohol Prevention in Schools ground and cultural relevance of the re- (HAPS) is an integral prevention pro- cipients (Cupp et al., 2008). gramme to delay onset of sexual initia- Substance abuse and HIV prevalence tion (Kirby, Barth, Leland, & Fetro, 1991) among teenagers is a public health con- and Amazing alternative programme to cern which socio-demographic determi- prevent alcohol use in US (Perry et al., nants may account for a wide spectrum 2000). HAPS project was implemented of inhibitory variations in harm reduction at 8 high schools in Pietermaritzburg, the communications. Studies have shown that second largest city in Kwazulu-Natal Prov- socio-cultural factors play diverse roles in ince. The schools had similar character- preventing alcohol, substance use and risk istics in terms of language, comparable sexual behaviour in societies. For instan- school fees, no boarding facilities and ce, religion has an effect on socio-cultural co-educational system. The schools were factors that increase or decrease the risk randomly assigned to intervention and of sexually transmitted infection in the so- control groups comprising 4 schools each. ciety (Eriksson, Lindmark, Haddad, & Axe- The aim of the programme was to incul- mo, 2014; Ochillo, Van Teijlingen, & Hind, cate pertinent facts about consequences 2017). Eriksson et al., (2014) found that of alcohol and risky sexual behaviour religious programme accounted for over on the learners. The intervention pro- four-fifth of pre-marital sexual abstinen- gramme had 15-unit curriculum of which ce among young people of age 15 to 24 40% and 60% of the contents dealt with years old in KwaZulu-Natal. Poverty which alcohol related issues and reducing risky exposes youth to risky behaviours is still sexual activities respectively. Standard life

81 OSUAFOR & OKOLI orientation classes supplemented with RESULTS information on alcohol and HIV were of- fered to the control groups. Role plays Table 1 shows that distribution of the were used to develop techniques for re- individuals by the number of observa- sisting peer pressures to either drink alco- tions in the study sample. Of the 2638 hol or have sex. observation among the grade 9 learners, After the baseline data were collected, 47.2% received intervention programme. subsequent data were drawn from a co- Distribution by age shows an inverted hort of 1259 and 1076 grade 9 learners u-shaped. Slightly over half (55.1%) of age range 13 to 18 years old. Second of the learners were males. Over half and third data collection were assessed (52.0%) indicated that their education- at 6 months and 12 months respectively. al ambition was to have higher degree, Data collected on the background char- whereas less than a quarter (21.4%) as- acteristics of the learners were age, gen- pire to have at most matric certificate. der, socioeconomic status measured on Over two-thirds (77.4%) reported aver- the frequency of hunger in the family in age grade points of 50 or more in terms the last month before the survey, learn- of academic performance. Nearly half ers grade point average, future educa- (49.1%) have never been absent from tional aspirations, numbers of times ab- school in the past one month. About sent from school in the past one month 40.9% have experienced lack of food in and on importance of religion. The out- the homes several times in the past one come variables were measured on two month. As expected, two-thirds (67.2%) items: ever consumed alcohol and ever of the learners stated that their religion had sexual intercourse. Learners were is important in their lives. asked to answer either ‘’yes” or “no’’ to “have you ever consumed alcohol?’’. On Consumption of alcoholic and the question, “have you ever had sexual experience of sexual intercourse intercourse?’’ Learners were to answer Figures 1 and 2 show the patterns of either “yes” or “no”. At the baseline as- alcohol consumption and engaging in sex- sessment, there were no differences be- ual intercourse respectively among the tween the intervention and the control grade 9 learners. The results show that groups. at first wave 34.6% of the learners had Descriptive statistics were used to pro- consumed alcohol which then increased cess the independent and outcome vari- to 39.9% at the second wave. Similarly, ables. Generalized linear mixed models 31.1% of the learners had experienced (GENLIN) were used to adjust for longi- sexual intercourse at the first wave. The tudinal associations of the variables after proportion of learner that had experi- data were restructured. Binary logistic re- enced sexual intercourse increased to gressions were used to predict the effects 37.7% at the second wave. of the intervention and background char- Table 2 shows the association be- acteristics on ever had sex and alcohol tween alcohol consumption and back- consumption among the learners. Data ground characteristics of the learners. processing was carried out using IBM Based on the reported alcohol con- SPSS version 25. sumption, the intervention group did

82 HIV AND ALCOHOL USE PREVENTION

Table 1. Distribution of grade 9 learners by the number of observations

Characteristics Number of observations Percent

Treatment Intervention 1244 47.2 Control 1394 52.8 Current Agea 13 77 3.3 14 454 19.5 15 666 28.5 16 555 23.8 17 376 16.1 18+ 206 8.8 Gendera Male 1286 55.1 Female 1049 44.9 Educational aspirationa =

83 OSUAFOR & OKOLI

Ever drank alcohol

No Yes 65.4 60.1

39.9 34.6

Time1 Time2

Figure 1. Ever consumed alcohol among the grade 9 learners

Ever had sexual intercourse

No Yes

68.9 62.3

37.7 31.1

Time1 Time2

Figure 2. Ever had sexual intercourse among the grade 9 learners learners who had experienced hunger in difference between the intervention the family in the last month had higher group and the control group in report- percentage (42.2%) of reporting alco- ing engaging in sexual intercourse. Sig- hol consumption than those who never nificant associations were observed lacked food (34.4%). Compared to learn- between engaging in sexual intercourse ers who stated religion to be least im- and learners background characteristics. portant, learners who reported that re- As expected, reporting engaging in sexu- ligion is important in their life had lower al intercourse increase with age among levels of alcohol consumption. the learners. Compared to females, Table 3 presents the distribution males were more likely to report hav- of sexual experiences by background ing sexual intercourse. A third (30.1%) characteristics. There is no statistical of the learners whose educational

84 HIV AND ALCOHOL USE PREVENTION

Table 2. Distribution of learners on status of alcohol consumption by background characteristics

Variables N (Observation) No % (N) Yes %(N) X2; P value

Treatment 2.4; p=0.122 Intervention 1087 64.7(703) 35.3(384) Control 1244 61.6(766) 38.4(478) Current Age (years) 144.1; p= 0.000 13 77 77.9(60) 22.1(17) 14 454 75.6(343) 24.4(111) 15 662 71.9(476) 28.1(186) 16 555 58.0(322) 42.0(233) 17 375 49.3(185) 50.7(190) 18+ 206 39.8(82) 60.2(124) Gender 91.7; p= 0.000 Male 1284 54.4(698) 45.6(586) Female 1046 73.6(770) 26.4(276) Educational aspiration 18.4; p= 0.000 <= Matric 498 59.6(297) 40.4(201) Diploma/Degree 620 57.7(358) 42.3(262) Higher Degree 1212 67.1(813) 32.9(399) Average grade point 31.9; p= 0.000 < 50 529 52.9(280) 47.1(249) 50-69 1135 64.8(735) 35.2(400) 70+ 667 68.1(454) 31.9(213) Absenteeism 56.1; p=0.000 Never 1148 69.7(800) 30.3(348) Once 488 62.7(306) 37.3(182) 2+ 694 52.3(363) 47.7(331) No food at home Never 1559 65.6(1023) 34.4(536) 13.6; p= 0.009 Many 772 57.8(446) 42.2(326) Religion importance 28.2; p= 0.000 Least important 560 53.6(300) 46.4(260) Very important 1771 66.0(1169) 34.0(602) ambition was to have higher degree stated religion to be least important in had experienced sexual intercourse. their life, reporting religion to be very Also, a third (30.7%) of learners who important showed lower proportions of stated their average grade points to be engaging in sexual intercourse. 70 and above had engaged in sexual in- tercourse. Learners with records of ab- Modelling of alcohol consumption senteeism from school and experiences and sexual intercourse by learners’ of food shortage in the past month had background characteristics highest percentages of reporting sexual The results of GENLIN analysis, intercourse. Compare to learners who showing associations between alcohol

85 OSUAFOR & OKOLI

Table 3. Distribution of learners on ever had sexual intercourse by background characteristics

Variables N (Observation) No % (N) Yes %(N) X2; P value

Treatment 0.2; p=0.655 Intervention 1090 65.4(713) 34.6(377) control 1246 66.3(826) 33.7(420) Current Age (years) 268.5; p=0.000 13 77 85.7(66) 14.3(11) 14 454 83.3(378) 16.7(76) 15 666 75.7(504) 24.3(162) 16 555 63.4(352) 36.6(203) 17 376 44.1(166) 55.9(210) 18 206 35.4(73) 64.6(133) Gender 84.9; p= 0.000 Male 1286 57.7(742) 42.3(544) Female 1049 75.9(796) 24.1(253) Educational aspiration 18.6; p= 0.000 <= Matric 500 61.8(309) 38.2(191) Diploma/Degree 621 61.2(380) 38.8(241) Higher Degree 1214 69.9(849) 30.1(365) Average grade point 10.9; p= 0.004 < 50 529 60.3(319) 39.1(210) 50-69 1137 66.5(756) 33.5(381) 70+ 670 69.3(464) 30.7(206) Absenteeism 42.8; p=0.000 Never 1148 71.7(823) 28.3(325) Once 490 65.3(320) 34.7(170) 2+ 697 56.8(396) 43.2(301) No food at home 10.6; p= 0.001 Never 1560 68.1(1063) 31.9(497) Many 776 61.3(476) 38.7(300) Religion importance 9.5; p= 0.002 Least important 562 60.5(340) 39.5(222) Very important 1774 67.6(1199) 32.4(575) consumption and background variables learners who had an average grade point are presented in table 4. The control of below 50, those scoring 70 and above group were 1.3 times more likely than were less likely to have consumed al- the intervention group to have consume cohol. Learners who were absent from alcohol. Tendency to consume alcohol school were 78.6% more likely to have increased with learners age. The odds consume alcohol relative to those who of consuming alcohol were reduced by were never absent from school in the 49.0% for females compared to their past one month. Reporting religion to be male counterparts. Compared to the very important in their lives correlated

86 HIV AND ALCOHOL USE PREVENTION

Table 4. Background variables of learners explaining alcohol consumption and engaging in sexual intercourse

Variables Ever consumed alcohol Ever had sexual intercourse

Odds ratio 95% CI Odds ratio 95% CI

Treatment Control 1.295** 1.081-1.552 1.107 0.918-1.335 Intervention (ref) 1.000 1.000 Current Age 1.374*** 1.275-1.480 1.686*** 1.555-1.828 Gender Female 0.510*** 0.422-0.616 0.559*** 0.461-0.677 Male (ref) 1.000 1.000 Educational aspiration <= Matric (ref) 1.000 1.000 Diploma/Degree 1.104 0.854-1.426 1.059 0.809-1.385 Higher Degree 0.907 0.719-1.142 0.863 0.678-1.100 Average grade point < 50 (ref) 1.000 1.000 50-69 0.783 0.607-1.010 1.128 0.863-1.473 70+ 0.740** 0.590-0.928 1.002 0.792-1.267 Absenteeism Never (ref) 1.000 1.000 Once 1.254 0.995-1.582 1.243 0.977-1.582 2+ 1.786*** 1.443-2.210 1.571*** 1.263-1.955 No food at home Never (ref) 1.000 1.000 Many 1.143 0.943-1.384 1.054 0.865-1.283 Religion importance Least important (ref) 1.000 1.000 Very important 0.615*** 0.500-0.756 0.740** 0.597-0.918 Intercept 0.295*** 0.187-0.467 0.094*** 0.057-0.154

*p < 0.05; **p < 0.01; *** p < 0.001. ref= reference category, CI= confidence interval with 38.5% reduced odds of consuming sexual intercourse increased by 57.1% for alcohol. However, educational aspiration learners who were absent from school for and experiences of hunger in the fam- more than two times in the past month. ily did not significantly predict alcohol Compared to learners who stated that reli- consumption. gion had least importance in their lives, re- Table 4 further revealed association porting religion as very important showed between sexual intercourse and learners 26.0% reduction in the odds of engaging in background characteristics. As expected, sexual intercourse. However, the interven- engaging in sexual intercourse increase tion programme, educational aspiration, with age. Females were less likely than average grade points, experiences of hun- their male counterparts to have engaged in ger in the family were not significantly as- sexual intercourse. The odds of engaging in sociated with sexual intercourse.

87 OSUAFOR & OKOLI

DISCUSSION to the Zulu-speaking people which is of- ten interwoven in traditional appropriate- The aim of the study was to examine ness of casual and multiple sexual part- the bearing of background characteristics ners for men. It may be explained by the in HIV and alcohol prevention programme traditional norms on alcohol which pro- among high school learners. The results mote casual sex as a masculine behaviour. demonstrated that the intervention alone Taken together, male learners may be at did not portray a clear difference com- greater risk of developing alcohol-relat- pared to the control group at bivariate ed problems and susceptible to sexually analysis. However, at higher level analysis transmitted infection than female learn- the intervention programme prevented ers. This does not suggest that females alcohol use initiation. This suggest that are protected, as sexual activities in South the intervention programme operated African in educational institutions often through the background characteristics to takes concurrent patterns. mediate low alcohol use. The prevalence The results revealed that multiple ab- of alcohol use and sexual intercourse senteeism from school predicted both en- among the learners are worrisome given gaging in sex and alcohol use which is par- that abstinence is promoted for people allel to findings in Norway (Ingul, Klöckner, below the age of 18 years old in South Af- Silverman, & Nordahl, 2012). Absenteeism rica. In agreement with previous studies from school would mean that the learners in London (Mason et al., 2010; Bolland et were not in school to receive prevention al., 2016; MacArthur et al., 2012), alcohol and intervention messages designed for use and sexual initiation increase with schools. Thus, absenteeism from school age. Early alcohol use and sexual initiating may have partially jeopardized the chances are both risk behaviours that can trans- of delivering basic risk-reduction and risk late to alcohol disorder and contracting prevention instruction. Prevention and in- of sexually transmitted infections includ- tervention programme may be more effec- ing HIV. Learners who consistently en- tive if there is a strategy that offset truancy gage in behaviours that may reinforce the among the learners. This finding reiterates overburdened HIV scourge has multiple the need for Goal 25 of the South African negative effects on health, education and Department of Basic Education’s Action economy of South Africa. Plan for 2011 to 2014 which emphasises The findings that male learners were using the school as a location to promote more likely to engage in sex and consume children’s access to services including pub- alcohol than their female counterparts is lic health services and psycho-social sup- consistent with previous reports in Amer- port. Previous studies (Flisher, Townsend, ica (Woolf-King & Maisto, 2011). Rela- Chikobvu, Lombard, & King, 2010; Kear- tionship between alcohol use and sexual ney, 2008; Le Roux & Mokhele, 2011) have risk behaviour is fluid such that alcohol noted truancy as a serious issue in South enhances maleness, sexual encounters, African high schools. Absenteeism will in sexual experience and often a defence no doubt impact negatively on learner’s for irresponsible behaviour such as risky education and health matters. sex. Considering the cultural setting of the The findings echoed the importance study, risky sexual behaviour is common of religion as a veritable practice in

88 HIV AND ALCOHOL USE PREVENTION preventing sexual initiation and alcohol to play a crucial role in delaying alcohol use. This is in line with studies among use and early sexual initiation. Strategies adolescents in South Africa (Amoateng, that ensures regular school attendance, Kalule-Sabiti, & Arkaah, 2014; Eriksson will augur well for school-based HIV and et al., 2014) and USA (Dickens, Jackman, alcohol use intervention programmes in Stanley, Swaim, & Chavez, 2018; Patrick & South African society. Schulenberg, 2014; Salas-Wright, Vaughn, Maynard, Clark, & Snyder, 2017). Reli- gion advocates for sexual abstinence and REFERENCES frowns at alcohol use among teenagers. Religion being important in the life of the Ahmed, N., Flisher, A. J., Mathews, C., study population would mean that the Mukoma, W., & Jansen, S. (2009). HIV only strategy for HIV prevention is absti- education in South African schools: nence which parallels secular interven- The dilemma and conflicts of educa- tions. Given that religion is a belief that tors. Scandinavian Journal of Public operates at individual and societal levels, Health, 37(2_suppl), 48-54. https:// integrating it in intervention programme doi.org/10.1177/1403494808097190 may maximize desired effects. AJ Scott-Sheldon, L., Walstrom, P.,- Har rison, A., C Kalichman, S., & P Carey, M. (2013). Sexual risk reduction inter- CONCLUSION ventions for HIV prevention among South AfricanYouth: a meta-analytic Alcohol use and early sexual initiation review. Current HIV Research, 11(7), were not expected to be static in the study 549-558. population despite the intervention pro- Alex Mason, W., Hitch, J. E., Kosterman, gramme. Teenagers experimenting with R., McCarty, C. A., Herrenkohl, T. I., & alcohol and sex side by side with inter- David Hawkins, J. (2010). Growth in vention programme are both inevitable adolescent delinquency and alcohol developmental dimensions. However, the use in relation to young adult crime, findings of the study suggest the need for alcohol use disorders, and risky sex: a additional inhibitory factors to be consid- comparison of youth from low-versus ered in designing school-based interven- middle-income backgrounds. Journal tion programme. The results of the study of Child Psychology and Psychiatry, are drawing attention of programme 51(12), 1377-1385. managers and researchers to design pre- Amoateng, A. Y., Kalule-Sabiti, I., & ventive programmes that are inclusive Arkaah, Y. J. (2014). The effect of so- of the background characteristic of the cio-demographic factors on risky-sex- recipient. Interventionist need to think ual behaviours of adolescents in the critically on interventions that are tai- North West Province of South Africa. lored for males given their unprecedent- African Population Studies, 28(1), ed involvement in risky behaviour at very 487-498. tender age. Prevention and intervention Bolland, K. A., Bolland, J. M., Tomek, S., programmes should consider incorporat- Devereaux, R. S., Mrug, S., & Wim- ing religious components as it continues berly, J. C. (2016). Trajectories of

89 OSUAFOR & OKOLI

Adolescent Alcohol Use by Gender Research on Adolescence, 20(1), 237- and Early Initiation Status. Youth 255. & Society, 48(1), 3-32. https://doi. Harrison, A., Newell, M.-L., Imrie, J., & org/10.1177/0044118X13475639 Hoddinott, G. (2010). HIV preven- Burton, P. (2008). Dealing with school vio- tion for South African youth: which lence in South Africa. Centre for Jus- interventions work? A systematic re- tice and Crime Prevention (CJCP) Issue view of current evidence. BMC Public Paper, 4, 1-16. Health, 10(1), 102. Cupp, P. K., Zimmerman, R. S., Bhana, A., Human-Vogel, S., & Morkel, J. (2017). Feist-Price, S., Dekhtyar, O., Karnell, Teacher and learners’ belief in a just A., & Ramsoomar, L. (2008). Combin- world and perspectives of discipline ing and adapting American school- of Grade 4 - 8 learners in South Af- based alcohol and HIV prevention rican schools. Educational Studies, programmes in South Africa: The 43(3), 343-353. https://doi.org/10.10 HAPS project. Vulnerable Children 80/03055698.2016.1277136 and Youth Studies, 3(2), 134-142. Ingul, J. M., Klöckner, C. A., Silverman, W. Dickens, D. D., Jackman, D. M., Stanley, K., & Nordahl, H. M. (2012). Adoles- L. R., Swaim, R. C., & Chavez, E. L. cent school absenteeism: modelling (2018). Alcohol consumption among social and individual risk factors. Child rural African American and White and Adolescent Mental Health, 17(2), adolescents: The role of religion, par- 93-100. ents, and peers. Journal of Ethnicity Karnell, A. P., Cupp, P. K., Zimmerman, R. in Substance Abuse, 17(3), 273-290. S., Feist-Price, S., & Bennie, T. (2006). https://doi.org/10.1080/15332640.2 Efficacy of an American Alcohol and 016.1179155 HIV Prevention Curriculum Adapted Eriksson, E., Lindmark, G., Haddad, B., for Use in South Africa: Results of a & Axemo, P. (2014). Young People, Pilot Study in Five Township Schools. Sexuality, and HIV Prevention Within AIDS Education and Prevention, 18(4), Christian Faith Communities in South 295-310. https://doi.org/10.1521/ Africa: A Cross-Sectional Survey. Jour- aeap.2006.18.4.295 nal of Religion and Health, 53(6), Kearney, C. A. (2008). School absenteeism 1662-1675. https://doi.org/10.1007/ and school refusal behavior in youth: A s10943-013-9753-7 contemporary review. Clinical Psychol- Flisher, A. J., & Klepp, K.-I. (2009). ogy Review, 28(3), 451-471. https:// School-based HIV/AIDS preven- doi.org/10.1016/j.cpr.2007.07.012 tion in Sub-Saharan Africa. Scan- Kirby, D., Barth, R. P., Leland, N., & Fetro, dinavian Journal of Public Health, J. V. (1991). Reducing the risk: Impact 37(2_suppl), 4-6. https://doi. of a new curriculum on sexual risk- org/10.1177/1403494809105409 taking. Family Planning Perspectives, Flisher, A. J., Townsend, L., Chikobvu, P., 253-263. Lombard, C. F., & King, G. (2010). Le Roux, C. S., & Mokhele, P. R. (2011). The Substance use and psychosocial pre- persistence of violence in South Afri- dictors of high school dropout in ca’s schools: In search of solutions.Af - Cape Town, South Africa. Journal of rica Education Review, 8(2), 318-335.

90 HIV AND ALCOHOL USE PREVENTION

MacArthur, G. J., Smith, M. C., Melotti, R., organisations on HIV prevention Heron, J., Macleod, J., Hickman, M., … strategies in Africa: a systematic re- Lewis, G. (2012). Patterns of alcohol view. African Health Sciences, 17(3), use and multiple risk behaviour by 753-761. gender during early and late adoles- Pascoe, S. J. S., Langhaug, L. F., Mavhu, cence: the ALSPAC cohort. Journal of W., Hargreaves, J., Jaffar, S., Hayes, Public Health, 34(suppl_1), i20–i30. R., & Cowan, F. M. (2015). Poverty, https://doi.org/10.1093/pubmed/ Food Insufficiency and HIV Infection fds006 and Sexual Behaviour among Young McCambridge, J., McAlaney, J., & Rowe, Rural Zimbabwean Women. PLOS R. (2011). Adult consequences of late ONE, 10(1), e0115290. https://doi. adolescent alcohol consumption: a org/10.1371/journal.pone.0115290 systematic review of cohort studies. Patrick, M. E., & Schulenberg, J. E. (2014). PLoS Medicine, 8(2), e1000413. Prevalence and Predictors of Adoles- Morojele, N. K., & Ramsoomar, L. (2016). cent Alcohol Use and Binge Drinking Addressing adolescent alcohol use in the United States. Alcohol Research: in South Africa. SAMJ: South African Current Reviews, 35(2), 193-200. Medical Journal, 106(6), 551-553. Patrick, M. E., Schulenberg, J. E., & https://doi.org/10.7196/samj.2016. O’Malley, P. M. (2016). High School v106i6.10944 Substance Use as a Predictor of Col- Morojele, N. K., & Ranchod, C. (2011). lege Attendance, Completion, and Review of Interventions to Reduce Al- Dropout: A National Multicohort cohol Use-Related Sexual Risk Behav- Longitudinal Study. Youth & Soci- iour in Africa. African Journal of Drug ety, 48(3), 425-447. https://doi. and Alcohol Studies, 10(2). Retrieved org/10.1177/0044118X13508961 from https://www.ajol.info/index. Perry, C. L., Williams, C. L., Komro, K. A., php/ajdas/article/view/76890 Veblen-Mortenson, S., Forster, J. Morojele, N., Myers, B., Townsend, L., L., Bernstein-Lachter, R., … McGov- Lombard, C., Plüddemann, A., Car- ern, P. (2000). Project Northland ney, T., … Nkosi, S. (2013). Survey on High School Interventions: Commu- Substance Use, Risk Behaviour and nity Action to Reduce Adolescent Mental Health among Grade 8-10 Alcohol Use. Health Education & Learners in Western Cape Provincial Behavior, 27(1), 29-49. https://doi. Schools, 2011. Cape Town: South Af- org/10.1177/109019810002700105 rican Medical Research Council. Plüddemann, A., Flisher, A. J., McKetin, R., Mukoma, W., Flisher, A. J., Ahmed, N., Parry, C. D., & Lombard, C. J. (2012). Jansen, S., Mathews, C., Klepp, K.-I., & Methamphetamine use and sexual Schaalma, H. (2009). Process evalua- risk behavior among high school stu- tion of a school-based HIV/AIDS inter- dents in Cape Town, South Africa. vention in South Africa. Scandinavian Journal of Child & Adolescent Sub- Journal of Public Health, 37(2_suppl), stance Abuse, 21(2), 181-191. 37-47. Reddy, S. P., James, S., Sewpaul, R., Si- Ochillo, M. A., Van Teijlingen, E., & Hind, funda, S., Ellahebokus, A., Kamba- M. (2017). Influence of faith-based ran, N. S., & Omardien, R. G. (2013).

91 OSUAFOR & OKOLI

Umthente Uhlaba Usamila: the 3rd systematic review and meta-analysis. South African National Youth Risk BMC Public Health, 16(1), 1069. Behaviour Survey 2011. http://hdl. Seggie, J. (2012). Alcohol and South Afri- handle.net/20.500.11910/2487 ca’s youth. SAMJ: South African Medi- Salas-Wright, C. P., Vaughn, M. G., May- cal Journal, 102(7), 587-587. nard, B. R., Clark, T. T., & Snyder, S. Velleman, R. (2009). Influences on how (2017). Public or private religiosity: children and young people learn which is protective for adolescent about and behave towards alcohol, substance use and by what pathways? 64. Youth & Society, 49(2), 228-253. Woolf-King, S. E., & Maisto, S. A. (2011). Sani, A. S., Abraham, C., Denford, S., & Alcohol use and high-risk sexual be- Ball, S. (2016). School-based sexual havior in Sub-Saharan Africa: a narra- health education interventions to pre- tive review. Archives of Sexual Behav- vent STI/HIV in sub-Saharan Africa: a ior, 40(1), 17-42.

92 African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications PSYCHOACTIVE SUBSTANCE USE AS A PREDICTOR OF ROAD RAGE BEHAVIOUR IN A SAMPLE OF COMMERCIAL DRIVERS IN ENUGU, SOUTH-EASTERN NIGERIA

Philip Chukwuemeka Mefoh, Joy Ifeoma Ugwu, & Timothy Esomchi Eze

Department of Psychology, University of Nigeria, Nsukka, Nigeria

ABSTRACT

Two objectives were examined in the present study. The first described the prevalence of psychoactive substance use in a sample of 208 commercial drivers; while the second examined whether psychoactive substance would predict road rage behaviour in the same sample. Purposive sampling technique, which targeted only drivers who were willing to participate at no fee, was utilized to select commercial drivers from 4 motor parks in Enugu, South-Eastern Nigeria. All the drivers were male; there were 102 (49.04%) married and 106 (50.96%) single drivers. Their ages range from 27 years – 52 years (Mean age = 33.52years; SD = 6.04). The years of driving experience of the commercial drivers ranged from 4 years – 29 years. The Psychoactive Substance Use Questionnaire and the Driving Anger Scale (DAS) were instruments used for the collection of data. Data were analyzed with preliminary statistics and a simple hierarchical multiple regressions and correlation (MRC). Results showed that alcohol was the most prevalently used psychoactive substance in the sample, and that alcohol, cocaine, and amphetamine, predicted road rage behaviour (p < 0.001) in the sample. These findings were discussed and the limitations of the study and recommendations were highlighted.

Keywords: Commercial driver; Driving Anger Scale (DAS); Psychoactive substance use; Road rage behaviour; South-Eastern Nigeria.

INTRODUCTION transport system; road transportation is the major form of transportation in and Enugu is a town characterized by a out of Enugu. Road transportation ac- huge population of about 3.2 million resi- counts for more than 92% of freight and dents (National Population Commission, passenger movement in the town (Onah, 2007). Although the town has a function- 2008). With more and more commuters al airport and a completely moribund rail on the road, many drivers are driving less

Corresponding Author: Philip C. Mefoh, Department of Psychology, University of Nigeria, Nsukka, Nigeria. Email: [email protected] Phone: +2348066166656 MEFOH, UGWU & EZE courteously and even more recklessly that road to have a conversation with a -per other drivers seem to get angry at their son in another vehicle or with a pedes- driving. In general, when drivers become trian on the sidewalk is a good example annoyed and frustrated on the road, they of passive-aggressive road rage. Finally, respond with aggression. A driver’s un- road hostility refers to driving-related derlying predisposition for anger is what non-violent but hostile behaviour, such people describe as road rage behaviour. as, yelling or making rude gestures, weav- Coleman (2003) defines road rage behav- ing a fist, shouting verbal abuses, spitting iour as grossly disproportional outburst at another driver, or horning excessively, of aggression by a driver of a motor ve- that are specifically targeted at another hicle in response to perceived discourtesy driver. The active-aggressive and the road or transgression by another driver. Road hostility road rage behaviours are related rage has also been seen as a psychologi- in that both are actions deliberately tar- cal disorder. Ayer (2006) argues that road geted at another. However, in one case, rage is a psychological disorder where an the action is punitive, while in the other, individual experiences heightened levels it is simply hostile. of stress, anxiety, or hostility because of The frustration-aggression hypothesis their driving environment. (Berkowitz, 1989; Dollard, Doob, Miller, Road rage behaviour or aggressive driv- Mowrer & Scars, 1939) is the general ing manifest in a variety of ways; there are theory of human aggression that best at least three distinct forms of anti-social explains road rage behaviour. This hy- behaviour that is generally regarded as pothesis proposes that frustration leads road rage behaviour. These are active- to aggression – either against the source aggressive road rage behaviour, passive- of frustration or against an innocent but aggressive road rage behaviour, and road vulnerable substitute, or “scapegoat”. hostility (Butters, Smart, & Mann, 2006). The frustration-aggression framework is Active-aggressive road rage behaviour a general rule that aversive stimulation involves a grossly disproportional out- sparks aggression. Being trapped in a burst of aggression by a driver of a motor clogged traffic or being held up by a driver vehicle specifically targeted at another who obstinately observes the speed limit driver. It often involves extreme punitive in the fast lane, despite the signaling by measures, such as intentionally causing speeding drivers to go ahead, is likely to a collision between vehicles or assault- arouse anger and frustration. Because ing another motorist. When tempers rage substance use increases arousal level by out of control, the active aggressive road altering brain’s normal activity, there is rager can become very angry that the possibility that psychoactive substances individual can kill or injure somebody. use may predispose a driver to engage in Passive-aggressive road rage behaviour road rage behaviour. Psychoactive sub- involves ignoring other road users or stance use has been identified as pos- refusing to respond appropriately. The sible risk factors for road rage behaviours passive-aggressive road rage behaviour is (Butters, Mann, & Smart, 2006; Butters, not specifically targeted at any particular Smart, Mann, Asbridge, 2005). Research driver, the aggressing individual just want (e.g., Harrison, Erickson, Adlaf & Free- to cause obstruction. Stopping on the man, 2001; Mann, Smart, Stoduto, Adlaf,

94 PREDICTING ROAD RAGE BEHAVIOUR

& Lalomiteanu, 2004) has broadly shown 0.1%; and barbiturates 0.5%. Alcohol was that heavy drinkers and consumers of al- found in 5.9% of all substance cases. cohol and other psychoactive substances Several laboratory investigations on are often victims or perpetrators of ag- other psychoactive substances, such as gression, as well as being “at fault” in traf- cocaine, heroin and amphetamines reveal fic crashes. that these chemical substances tend to in- Alcohol is the most readily available crease the activity of the central nervous drug in Africa and it is by far the most system by replacing the blues with feeling widely used drug by all age group (Van of well-being, masking symptoms of fa- Heerden, Grimsrud, Seedat, Mayers, Wil- tigue, creating a sense of self confidence liams & Stein, 2009). Alcohol encourage and competence, and encouraging users users to take more risks on the road or to to go beyond normal levels of confidence. behave more aggressively, studies (Ejik- However, problematic ingestion of - psy eme, 2004;) show that even a moderate choactive substances carries potentially high in-take of alcohol inevitably lead to several hazards. Cannabis use constitute problems at home and at workplace ei- a risk to traffic safety, Walsh, Gier, Christo- ther from after-effects of drinking or from pher and Verstraete (2004) argue that the actual intoxication. There are evidence prevalence of cannabis among drivers in- that being a frequent drinker was strongly volved in accidents indicates a substantial associated with quarrelling, engaging in quantitative traffic safety. A study carried risky behaviours and experiencing physi- out in Ilorin, South-Western Nigeria found cal aggression (Tumwesigye & Kasirye, that cannabis use was positively associ- 2005), which are all veritable conditions ated with anti-social behaviours, such as for road rage behaviour to fester. Mann et risky sexual practices (Abiodun, Adelakan, al. (2004) found a significant relationship Ogunremi, Oni, & Obaga, 1994). Most between the problem drinking of alcohol drivers who consume cannabis do so be- – measured by the National Use Identifi- cause of its mild euphoric properties, but cation Test (AUDIT) – and the experience the substances can have some immediate of road rage victimization and perpetra- undesired side-effects such as, decrease tion. Fierro, Morales & Alverez (2011) in short-term memory, dry mouth, im- argue that driving under the influence of paired motor skills, reddening of the eyes, alcohol is associated with being a perpe- and feeling of paranoia or anxiety (Hall & trator of road rage behaviour. Although Pecula, 2003). Similarly, a meta-analytic alcohol has been recognized as hazard to study based on more than 120 experi- road traffic safety, the greatest increase in mental studies, including laboratory, driv- risk of being injured was for alcohol com- ing simulator, and on-road experiments, bined with any other substances. Das- showed that impaired performance was sault, Brault, Bouchard, and Lamire (2002) directly related to increasing cannabis examined the urine sample of 5931 driv- use (i.e., increased tetrahydrocannabi- ers and found substances other than al- nol, THC) in the blood levels (Berghaus, cohol in 11.8% of the urine sample, in Sheer, & Schmidt, 1995). The effects of the following proportion: cannabis 6.7%; amphetamine on driving as summarized cocaine 1.1%; benzodiazepines 3.6%; opi- by Logan (2002) concluded that meth- ates 1.2%; PCP 0.03%; amphetamines amphetamine increases the likelihood of

95 MEFOH, UGWU & EZE performance deficit on complex psycho- given copies of the questionnaires to fill. motor tasks such as driving. Butters et al All the 208 drivers were commercial driv- (2006) maintain that the use of stimulants ers and all male. There were 102 (49.04%) (e.g., cocaine, heroin, amphetamine, etc) married and 106 (50.96%) single drivers. significantly increased the likelihood of The range of driving experience of the victimization and being classified as a se- commercial drivers was from 4 – 29 years. rious road rage perpetrator. Age of the drivers range from 27 – 52 So far, there seems to be limited knowl- years (Mean age = 33.52 years; SD = 6.04). edge on the prevalence of psychoactive substance use other than alcohol in road Instrument traffic studies in Nigeria. This study is an Two questionnaires were used in the early effort to bridge this lacuna in litera- present study. These were the Psychoac- ture. Secondly, the study examines the tive Substance Use Questionnaire (Eze, roles of psychoactive substances, namely: 2006) and the Driving Anger Scale (DAS) alcohol, cannabis, tobacco, cocaine, hero- (Daffenbacher, Oetting, & Lynch, 1994). in, and amphetamine, in predicting road The Psychoactive Substance Use Ques- rage behaviour. Thus, the study has two tionnaire assesses frequency of use of objectives: to describe the prevalence of psychoactive substance on a scale of four psychoactive substances use and to- ex degrees: never used it; have not used it amine whether those substances would more than two times; uses it less than predict road rage behavior. Two questions three times in one week, uses it more that guide the present study are: what is than three times in one week; and used the level of prevalence of those psychoac- it frequently in the past but has stopped. tive substances in the sample of commer- Specific substances included in the ques- cial drivers in Enugu, South-Eastern Nige- tionnaire were alcohol, cannabis, tobacco, ria? Would those psychoactive substanc- cocaine, heroin and amphetamine. These es predict road rage behaviour? Because were substances known to be abused in psychoactive substance causes significant Nigeria by many youths and adults, and modification of mood and behaviour, the which cause significant modification of study hypothesized that the six psychoac- mood, cognition or behaviour at the dos- tive substances would predict road rage age in which they are normally taken. In- behaviour. structions on the questionnaire require a participant to give a rating between 0 and 4 to each of the substances according to METHOD the degree of their use of each of them. The instrument has a content validity, and Participants test-retest reliability index of r = .61 (N = Participants for the study comprised of 55) (Eze, 2006). 208 commercial drivers who plied major The Driving Anger Scale (DAS) mea- roads linking Enugu and other towns or sures general driving anger. The DAS is states in Nigeria. The sampling technique a 33-item scale, which requires respon- used was purposive sampling technique, dents to imagine that incidents of unruly in which only the drivers who willingly behaviours on the road are happening to agree to participate in the study were them, and to indicate the extent to which

96 PREDICTING ROAD RAGE BEHAVIOUR that behaviour would provoke them to to explain any item the individual did not anger. Response options on the question- quite understand. This culminated in the naire range from 1 – 5 (i.e., “not at all proper completion of the questionnaire angry” to “very much angry”). Samples items and in 100% return rate. Apart from of items on the Driving Anger Scale were responding to items on the Psychoactive as follows: “Someone in front of you does Substance Use Questionnaire and the not move off straight away when the Driving Anger Scale (DAS), each respon- light turns green”; “Someone coming to- dent was required to supply demographic wards you does not dim their headlights information on age, driver experience, at night”; “Someone shouts at you about and marital status. The permission to ex- your driving”; “A cyclist is riding in the ecute this study was given by the Ethics middle of the lane and slowing traffic”. Board, Department of Psychology, Univer- Mefoh, Ugwu Ugwu, and Samuel (2013) sity of Nigeria, Nsukka. reported that DAS has a reliability coeffi- cient of 0.93 among Nigerian commercial Design/statistics drivers (N = 150). The design of the present study was cross-sectional design, in which data col- Procedure lection procedure was done once. A de- Data were collected from commercial scriptive statistics was used to describe drivers at four motor parks in Enugu. the prevalence of the various psychoac- The parks were: Enugu State Transport tive substances use among the sample. Company (ENTRACO) (51 commercial The major statically tool used in the anal- drivers), Peace Mass Transport Company ysis of data was a simple hierarchical mul- (65 commercial drivers), Ifesinach Trans- tiple regression and correlations (MRC). port Company (43 commercial drivers), and Onitsha-South Transport Company (49 commercial drivers). Permission RESULTS to conduct the study in the respective parks was given by the manager of each A preliminary analysis involving de- park. The managers gave the researcher scriptive statistics was used to assess the stern warning not to interview any driver prevalence of psychoactive substance use whose vehicle has started loading. This in the sample. Also, Pearson’s product- was a check to ensure that passengers moment correlation was used to specify are not kept waiting when the vehicle is the degree of relationships among the fully loaded. In administering the instru- studied variables. The results of the de- ments, the researchers gave the question- scriptive statistics in Table 1 indicated that naires only to drivers who freely agree to alcohol was the most widely used psycho- participate in the study at no cost and active substance in South-Eastern Nigeria. who also signed the researchers’ consent Of the 208 commercial drivers inter- form. Many drivers were unwilling to par- viewed, 73 (35.1%) of the drivers de- ticipate in the study when they realized clared that they had never used alcohol, that no payment would be made for par- implying that the rest 135 (64.9%) of the ticipation. The researchers were standby drivers have either used the substance to answer any participant’s question and more than three times a week, or use it

97 MEFOH, UGWU & EZE

Table 1. Prevalence of psychoactive substance use among commercial drivers

Psychoactive Substances Number of Users (%) Number of Non-Users (%)

Alcohol 135 (64.9) 73 (35.1) Cannabis 17 (08.2) 191 (91.8) Tobacco 10 (04.8) 198 (95.2) Cocaine 13 (06.2) 195 (93.8) Heroin 10 (04.8) 198 (95.2) Amphetamine 17 (08.2) 191 (91.8) less than three times in one week, or use declared if Pearson r is +/- 0.50 or be- it more than three times in one week. yond; a moderate relationship is depicted Similar investigations were made for oth- by a Pearson’s r value of approximately er psychoactive substances – cannabis, +/- 0.30 or above; and a weak relation- tobacco, cocaine, heroin, and amphet- ship is illustrated by an r value of less amine. These psychoactive substances than +/- 0.30. Following this classifica- were not so frequently used by the driv- tion, alcohol has a strong positive correla- ers as alcohol. However, all of them have tion with road rage (r = 0.52, p < 0.001). been used to some extent. The preva- The Pearson r for cannabis (r = 0.42, p lence of other psychoactive substances < 0.001), tobacco (r = 0.34, p < 0.001), co- – cannabis, tobacco, cocaine, heroin, and caine (r = 0.40, p< 0.001), heroin (r = 0.40, amphetamine, were 17, 10, 13, 10, and p < 0.001), and amphetamine (r = 0.43, p 17, respectively. < 0.001) showed that these were all posi- As mentioned, Pearson r was conduct- tive and moderately associated with road ed with the hope that given one variable, rage. Also, aside alcohol, all the other psy- the other can be predicted. The results choactive substances strongly and posi- of the Pearson r are presented on Table tively correlated with each other. Of all 2. Schwartz, Wilson, and Goff (2015) the demographic variables examined in proposed that a strong relationship is the study, only marital status showed a

Table 2. Pearson’s correlation matrix showing the correlation scores of the studied variables and the dependent measure

Variables 1 2 3 4 5 6 7 8 9 10

Road rage - Age -.06 - Driver experience .07 -.17* - Marital status -.28** -.01 -.40** - Alcohol .52** -.03 .05 -.13 - Cannabis .42** -.11 -.09 .01 .04 - Tobacco .34** -.09 -.01 .04 -.16* .74** - Cocaine .40** -.10 .02 -.02 -.10 .73** .95** - Heroin .35** -.09 .01 .03 -.15* .76* 1.0** .96** - Amphetamine .43* -.12 -.14* .09 .05 .94** .74** .71** .75** -

98 PREDICTING ROAD RAGE BEHAVIOUR

Table 3. A simple hierarchical multiple regression

Step 1 Step 2

Variables B β t B β t

Age of driver -2.86 -.07 -1.08 .31 .01 .16 Driver experience -.18 -.07 -.87 -.05 -.18 -.38 Marital status - 8.14 -.30 - 4.12** -6.32 -.24 -4.27** Alcohol 7.44 .48 9.69** Cannabis -4.08 -.11 -.73 Cocaine 7.01 .43 2.59* Heroin -2.48 -.15 -.81 Amphetamine 5.36 .34 2.22 R square .08 .54 R square change .08 .46 F change 6.18 39.30 F value 6.18 29.06

Keys: * = p < 0.05; ** = p < 0.01; *** = p < 0.001 negative weak relationship with road rage were found to be significant positive pre- (r = 0.28, p < 0.05). dictors of road rage behaviour. These psy- The result of the simple hierarchi- choactive substances predicted road rage cal multiple regressions and correlation behaviour as follow: alcohol significantly (MRC) showed that among the control (and positively) predicted road rage be- or demographic variables, namely: age, havior (t = 9.69, p < 0.001); similarly, driver experience, and marital status, cocaine (t = 2.59, p< 0.01) and amphet- that only marital status significantly and amine (t = 2.22, p < 0.05) significantly and negatively predicted road rage behaviour positively predicted road rage behaviour. (t = -4.27, p < 0.001). This finding implies The other three, namely: cannabis, tobac- that road rage behaviour increases if a co, and heroin, were not significant pre- driver of a vehicle is married rather than dictors (p > 0.05) of road rage behaviour. if is single. Marital status was coded ‘0’ for However, all the psychoactive substances single and ‘1’ for married in the analysis. combined to explain 52% of the variance Age (of driver) and drivers experience did on road rage behaviour. not significantly predict the dependent In summary, results show that alcohol measure. Overall, the control variables in is the most prevalent psychoactive sub- step 1 of the regression model explained stance that is frequently used by commer- an insignificant proportion of 7% of the cial drivers in South-Eastern Nigeria. Alco- variance in road rage behaviour. In step hol is closely followed by the use of can- 2, marital status continued to negatively nabis and amphetamine, then cocaine; predict road rage behaviour (t = -4.27, p tobacco and heroin were the least used < 0.001), while the other two control vari- psychoactive substances reported by the ables did not. With regards to the psycho- commercial drivers. On the specification active substances examined in this study, of the relationship between psychoac- only alcohol, cocaine, and amphetamine, tive substances use, alcohol showed a

99 MEFOH, UGWU & EZE strong positive association with road rage result on this objective indicated that alco- behaviour, while cannabis tobacco, co- hol, cocaine, and amphetamine predicted caine, heroin, and amphetamine were all road rage behaviour. In other words, driv- moderately correlated with road rage be- ing under the influence of these three sub- haviour. Finally, the results of the simple stances is related to road rage behaviour. hierarchical multiple regressions showed This finding partially supports the hypoth- that alcohol, cocaine and amphetamine esis that psychoactive substances would significantly and positively predicted road predict road rage behaviour. The finding is rage behaviour, but cannabis, tobacco somewhat consistent with previous relat- and heroin did not. ed studies (Butters, et al. 2005; Fierro, et al. 2010; Mann, et al. 2004), which consis- tently reported that substances and road DISCUSSION rage are associated. However, that canna- bis, tobacco, and heroin failed to predict This study examined two objectives. road rage behaviour in this study is diffi- First, was to describe the prevalence of cult to explain, because most psychoac- psychoactive substances, namely: alco- tive substances, including these three, are hol, cannabis, tobacco, cocaine, heroin, generally known to predisposes a driver and amphetamine, among a sample of to excessive speeding, reckless driving, commercial drivers in Enugu, South-East- and impatience, which are all associated ern Nigeria. Descriptive statistics revealed with perpetration of serious road rage be- that alcohol was the most prevalently haviour, as well as experiencing road rage used substance among commercial driv- victimization (Gjerde, Normann, Chris- ers in the region. This is consistent with tophersen, Samuelsen, Morland, 2011). the report by Van Heerden et al (2009) The moderately positive correlation that that alcohol is the mostly widely used cannabis, tobacco and heroin shared with drug in Africa. This is especially true for road rage behaviour in this study makes it people in Enugu; one of the biggest brew- more plausible to argue that driving under ery plants in Nigeria is located at 9th mile the influence of any of those psychoactive corner in Enugu and this makes availabil- substances would be associated with road ity and excessive use easy. Other psycho- rage behaviour. This conclusion can be active substances like cannabis, tobacco, explained on the grounds that since psy- cocaine, and so on, are not so widely choactive substances generally produce used as alcohol, but they have been used a change in conscious experience by al- to some extent. Converging evidence tering brain’s normal activity, they would in literature (e.g., Abiodun, et al., 1994; likely disrupt normal daily activity, such Walsh, et al., 2004) showed that commu- as driving. Commercial drivers do not use nities should be worried about the use of psychoactive substances for medical rea- psychoactive substances by vehicle - driv sons; rather they use them for increased ers, because the psychoactive substances alertness, to experience pleasure, and to pose safety risks to road users. mask symptoms of fatigue, which allow The second objective was to investigate them to go beyond normal level of per- whether those psychoactive substances formance. Drivers under the influence would predict road rage behaviour. The of psychoactive substance usually see

100 PREDICTING ROAD RAGE BEHAVIOUR driving as a contest or as a thrill, and driv- for the distribution and consumption of ers who view driving as an opportunity illicit and licit psychoactive substances, for thrill-seeking usually drive recklessly and these accounts for most of the road and in style. Such a behaviour has been rage incidents or its predictable conse- found to correlate with aggressive driv- quences – violence, injury, and traffic ac- ing (Krashe & Fenske, 2002). The thrill- cidents. There is urgent need therefore seeking drivers often engage in poten- to put up effective policies and strategies tially rapidly escalating conflict with other that would help clean up motor parks drivers; they drive aggressively, which pit of psychoactive substances. Road safety them with other drivers, and which in matters in Nigeria have often been treat- turn feeds a tendency to react in a more ed with disregard and a tendency to bear aggressive manner (Forward, 2004). the loss, instead of taking preventive measures. This need to change; psychol- Limitations and suggestion for future ogists and allied professionals should research join hands with government agencies, Although the explanatory power of such as the Federal Road Safety Corps correlational research is often enhanced (FRSC) to organize general driver edu- by using a complex correlational proce- cation to teach drivers the dangers or dure like the MRC, many of the assump- related harm in the use of psychoactive tions underlying such correlational study substances, especially without a doctor’s are questionable (Rogosa, 1980). This prescription. More importantly, it is the implies that casual statement made on responsibility of government to institute the basis of correlational evidence is sus- effective regulations to the extent that pect. The researchers therefore propose on no account should banned substanc- that future research in road traffic stud- es finds their way to the motor parks. ies in Nigeria should employ experimen- Also, substances not banned should at- tal design, which would present results tract more taxation in motor parks to dis- that researchers can accept with greater courage excessive use. confidence.

Conclusion and recommendations REFERENCES Identifying factors which are likely to engender unruly behaviours on the road Abiodun, O. A., Adelakan, M. L., Ogunre- is a major step towards reducing harm- mi, O. O., Oni, G. A., & Obayan, A. O. ful outcomes associated with road rage (1994A). Pattern of substance abuse behaviour. The present study was de- amongst secondary school students signed to meet this goal, its major re- in Ilorin, Northern Nigeria. West Af- search question is: would psychoactive rican Journal of Medicine, 13, 91-97. substances predict road rage behaviour? Ayar, A.A. (2006). Road rage: Recognizing Results showed the answer to be in the psychological disorder. Journal of Psy- affirmative, psychoactive substance use chiatry and Law, 34, 123-150. are indeed possible risk factors for road Berghaus, G., Sheer, N., & Schmidt, P. rage behaviour (Butters, et al. 2006). The (1995). Effects of cannabis on psycho- motor parks are frequently safe heavens motor skills and driving performance

101 MEFOH, UGWU & EZE

– A meta-analysis of experimental Ejikeme, G.G. (2004). The relevance of studies, In Proceeding – 13th Interna- social work practice in Nigeria. The tional Conference on Alcohol, Drugs Nigerian Social Scientist, 7(1), 26-29. and Traffic Safety, Eds. C.N. Kloe- Eze, J.E., (2006). Cult membership as a de- den, A.J. McLean, NHMRC Road Ac- terminant of psychoactive substance cident Research Unit. The University abuse among male undergraduates in of Adelaide, Adelaide, Australia, pp. Nigerian universities.Nigerian Journal 403-409. of Psychological Research, 5, 28-36. Berkowitz, l. (1989). Frustration-aggres- Fierro, I., Morales, C., & Alverez, F.J. sion hypothesis: Examination refor- (2011). Alcohol use, illicit drug use, mulation. Psychological Bulletin, 106, and road rage. Journal of Studies on 59-73. Alcohol and Drugs, 75, 185-193. Butters, J.E., Mann, R.E., & Smart, R.G. Forward, S. (2004). Effect of aggressive- (2006). Assessing road rage victimiza- ness on the road. Paper presented at tion and perpetration in the Ontario the International Seminar on Aggres- adult population: The impact of il- sive Behaviour on the Road. Geneva, licit drug use and psychiatric distress. Switzerland. Canadian Journal of Public Health, Harrison, L.D., Erickson, P.G., Adlaf, E., 97(2), 96-99. & Freeman, C. (2001). The drug-vio- Butters, J.E., Smart, R.G., Mann, R.E., As- lence nexus among American and Ca- bridge, M. (2005). Illicit drug use, al- nadian youth. Substance Use & Mis- cohol use problem drinking among use, 36, 2065-2086. infrequent and frequent road ragers. Hall, W. & Pacula, R. L. (2003). Cannabis Drug and Alcohol Dependence, 80, use and dependence: Public health and 169-15. public policy. Cambridge University Coleman, A.M. (2003). Oxford dictionary Press. p. 38. ISBN 978-0-521-80024-2. of psychology. New York: Oxford Uni- Krashe, B., & Fenske, I. (2002). Predict- versity Press. ing aggressive driving behaviour: The Dassault, C., Brault, M., Bouchard, J., role of macho personality, age, and Lemire, A.M. (2002). The contribution power of car, Aggressive Behaviour, of alcohol another drugs among fa- 28, 21-29. tally injured drivers in Quebec: Some Logan, B.K. (2002). Methamphetamine- preliminary results. In Proceedings of effects on human performance and 16th International Conference on Al- behaviour. Forensic Science Review. cohol, Drugs and Traffic Safety, Mon- 14, 131-151. treal, Canada, pp. 423-430. Mann, R.E., Smart, R.G., Stoduto, G., Ad- Deffenbacher, J.L., Oetting, E.R., & Lynch, laf, E.M., & Lalomiteanu, A. (2004). R.S. (1994). Development of a driving Alcohol consumption and problems anger scale. Psychological Reports, among road rage victims and perpe- 74, 83-91. trators. Journal of Studies on Alcohol, Dollard, J., Doob, L., Miller, N., Mowrer, 65, 161-168. O.H., & Scars, R.R. (1939). Frustration Mefoh, P.C., Ugwu, L.I., Ugwu, L.E., & and aggression. New Haven, CT: Yale Samuel, L.B. (2013). Psychosocial University Press. predictors of road rage among Nigerian

102 PREDICTING ROAD RAGE BEHAVIOUR

commercial drivers. European Journal Tumwesigye, N.M., & Kasirye, R. (2005). of Social Science, 40(2), 231-239. Gender and the major consequences National Population Commission (2007). of alcohol problems in Uganda. In Report of Nigeria’s National Popula- I.S. Obot & R. Room (eds.), Alcohol, tion Commission on the 2006 census. gender and drinking problems: Per- Population and Development Review, spective from low and middle income 33(1), 206-210. countries (pp. 189-208). Geneva: Onah, F.O. (2008). Road and exposed road WHO. users: The Nigerian experience. Com- Van Heerden, M.S., Grimsurd, A.T., Seed- missioned paper For Enugu Sector at, S., Myer, L., Williams, D.R., & Stein, Special Marshals, in partnership with D.J. (2009). Patterns of substance use Federal Road Safety Commission. Uni- in South Africa: Results from South versity of Nigeria, Nsukka, 21st August. African stress and health study. Regosa, D. (1980). A critique of the cross- South African Medical Journal, 99(5), lagged correlation. Psychological Bul- 358-366. letin, 88, 245-248. Walsh, J.M., Gier, J.J., Chritopherson, Schwartz, B.M., Wilson, J.H., & Goff, D.M. A.S., & Verstrate, A.G. (2004). Drugs (2015). An easy-guide to research and driving. Traffic Injury Preven- design & SPSS. Los Angeles: Sage tion, 5(3), 241-253. http://dx.doi. Publications. org/10.1080/1538958049065292

103

African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications COMMERCIAL TRICYCLE RIDERS’ PERCEPTIONS OF PSYCHOACTIVE DRUG USE AND THE RISK OF ROAD TRAFFIC ACCIDENTS IN UYO, NIGERIA

Ediomo-Ubong E. Nelson1, Okokon O. Umoh1,2, Nsidibe F. Essien1 & Aniekan S. Brown3

1Centre for Research and Information on Substance Abuse, Uyo, Nigeria;2 Department of Psychology, University of Uyo, Nigeria; 3Department of Sociology/Anthropology, University of Uyo, Nigeria

ABSTRACT

This article reports qualitative interview study on commercial tricycle riders’ perceptions of psychoactive drug use and the risk of road traffic accidents in Nigeria. A purposive sampling method was used to recruit ninety-four (n=94) commercial tricycle riders in Uyo, Nigeria. Data were collected through in-depth, individual interviews. Inductive and thematic analyses were undertaken on the interview transcripts. The tricycle riders reported frequently consuming significant quantities of licit and illicit drugs, including alcohol, cannabis, cocaine and heroin. They attributed drug use to occupational hazards such as stress, fatigue and exhaustion. They recognized the effects of psychoactive drug use on tricycle riding, including impairment of vision, coordination and navigational abilities, and how these increase the risk of traffic accidents. Education, routine screening for drug use, curbing bribery and corruption among road safety officials, and curtailing availability of psychoactive drugs were recommended as measures for preventing drug use and road traffic accidents. Findings indicate significant overlap between layand expert views on the risk factors for traffic accidents and counter-measures, highlighting the need to integrate lay perspectives into policy and action on road safety to improve outcomes.

Keywords: Commercial tricycle riders, psychoactive drugs, road traffic accidents

INTRODUCTION a leading cause of death and disability, and contribute significantly to the global Globally, road traffic accidents con- burden of disease (Ameretunga, Hijar & stitute a major, though poorly recog- Norton, 2006; Hazen & Ehiri, 2006; Nan- nized, public health problem. They are tulya & Reich, 2002). The Global Status

Corresponding Author: Ediomo-Ubong E. Nelson, Centre for Research and Information on Substance Abuse, Uyo, Nigeria. Email: [email protected] NELSON, UMOH, ESSIEN & BROWN

Report on Road Safety states that about This article reports a qualitative study 1.3 million people die from road traffic of commercial tricycle riders’ views on crashes annually, and another 50 million psychoactive drug use and the risk of suffer severe injuries (World Health- Or road traffic accidents in Nigeria. Our focus ganization, 2015). Ninety percent (90%) aligns with current global emphasis on lo- of road traffic deaths occur in low and cal evidence for informing domestic poli- middle-income countries (WHO, 2015), cies and responses. The findings are signif- and the burden is fast increasing in these icant in the context of global and national countries due to urbanization and rapid efforts to reduce road traffic accidents and motorization (Jacobs, Aaron-Thomas & to promote road safety, notably the UN Astrop, 2000). Africa accounts for the Decade of Action for Road Safety (2011- highest rate of road traffic deaths in the 2020). In this article, we show that occu- world, estimated to be 26.6 per 100, 000 pational hazards are major determinants population (WHO, 2015). In 2000, the of psychoactive drug use among commer- economic cost of road traffic accidents cial tricycle riders. Drug use has negative in Africa was estimated to be US$3.7 bil- effects on riding and increase the risk of lion, translating to approximately 1-2% traffic accidents. Our findings highlight the of each country’s gross national product need to integrate lay views into policy and (Jacobs, Aaron-Thomas, & Astrop, 2000). programs to improve outcomes. Pedestrians, passengers and motorcy- clists bear a disproportionate burden of The Nigerian context road traffic deaths in Africa, estimated to Nigeria is the most populous country in be forty three percent (43%) of all road Africa, with a population of over 190 mil- traffic deaths (WHO, 2015). lion people. It is considered a ‘motorising’ The profile of road traffic deaths and country in terms of vehicle population injuries in developing countries should and ownership (Trinca et. al., 1988). The inform the development of domestic poli- WHO ranked road traffic accidents as the cies to improve prevention and control. 11th leading cause of death and the 6th Furthermore, policies should be based leading cause of disability adjusted life on local evidence and research, and tai- years (DALYs) in Nigeria in 2000 (WHO, lored to the peculiar social, political and 2004). Nigeria has the highest accident economic conditions of developing coun- fatality rate in Africa at 33.7 per 100, 000 tries (Nantulya & Multi-Musiime, 2001). population (WHO, 2013). There is paucity The importance of qualitative research of reliable data on accidents in Nigeria for deepening understanding of the lo- due to under-reporting and lack of effi- cal context of road traffic accidents have cient system of documentation and data been recognized (Ameretunga, Hijar, & retrieval (Asogwa, 1992). In 2016, the Norton, 2006). But there is a glaring pau- Federal Road Safety Commission (FRSC) city of qualitative research on road traf- reported 5, 053 fatalities, although the fic accidents in Africa, particularly those actual figures could be higher (ITF, 2017). that interrogate the direct perspectives of The WHO estimates that the actual num- transport workers on human risk factors ber of road fatalities could be up to 7 such as driving under the influence of al- times higher than the figures reported by cohol and other psychoactive drugs. FRSC (WHO, 2015).

106 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS

Adults and young adults account for a investigations of commercial transport disproportionately high percentage (93%) workers’ views on psychoactive drug use of fatal accident victims. The implications and the risk of road traffic accidents. As a of the loss of the productive segment of result, road safety policies scarcely inter- the population on a developing country sect with lay views on the determinants of like Nigeria are far reaching. Although road traffic accidents and how they may road traffic crashes have complex and be addressed. But in addition to expert multi-factorial aetiology, human factors, views, policies and interventions should either alone or in combination with other also integrate the views of the target pop- factors, contribute to about 95% of all ulation in order to improve outcomes. crashes (Ayinde et al., 2018). This indi- cates the importance of studying human factors in road traffic accidents. Psycho- METHODS AND MATERIALS active drug use is an important human factor contributing to road traffic acci- The study setting dents. In 2016, about 1% of fatal crashes The study was conducted in Uyo, which in Nigeria were due to drink-driving, while doubles as the largest city and admin- other psychoactive drugs accounted for istrative capital of Akwa Ibom State in an additional 0.5%. Together, they ac- Nigeria. The city lies between latitudes counted for more fatal crashes than other 5∙ 051 North and longitude 8∙ East, within human factors such as distraction (0.3%) the equatorial rain forest belt. The city and fatigue (1.3%) (ITF, 2017). Welcome has grown tremendously within the past and Pereverzev (2010) reported that ap- couple of decades, attracting people proximately 50% of accidents on Nigerian from different ethnic nationalities,- par roads are linked to alcohol consumption. ticularly the three major ethnic groups in Studies have investigated psychoactive the country (Igbo, Hausa and Yoruba). Ac- drug use among commercial transporters cording to figures from the 2006 national in Nigerian cities (Abikoye, 2012; Omo- census, Uyo has a population of 309, 573 lase et. al., 2012; Iribhogbe & Odai, 2009; inhabitants. The estimated annual growth Makanjuola, Oyeleke & Akande, 2007; rate of the population is 3.2%. Spatial -ex Abiona, Aloba & Fatoye, 2006). The bulk pansion is not matched by the develop- of these studies are social surveys, which ment of infrastructure and provision of provides data mostly on the prevalence of basic social amenities, including health- alcohol use among commercial transport- care, housing, electricity, sanitation, wa- ers. Omolase et al. (2012) reported that ter, telecommunication and transporta- 32.2% of their respondents admitted us- tion. Commerce, services and white collar ing alcohol before driving in the previous jobs, a variety of low-level office, adminis- year. Iribhogbe and Odai (2009) reported trative, or salaried positions mostly in the regular alcohol use by 39.8% of commer- civil service, are the mainstay of the local cial motorcycle riders in their study. Abio- economy. The city has a significant level na, Aloba & Fatoye (2006) reported alco- of poverty. Available figures indicate that hol use prevalence rate of 67.2% among over a third of the population live below commercial transport workers in south- the national poverty line (FERT, 2004). A western Nigeria. Lacking are qualitative large segment of the population earns a

107 NELSON, UMOH, ESSIEN & BROWN precarious living from various economic Nine (9) tricycle riders refused to partici- activities in a poorly regulated informal pate in the study, bringing the sample size sector where the boundary between le- to ninety-four (n=94). They were all male gal and illegal is blurred. In recent times, between 24 and 67 years of age. They there has been a proliferation of commer- were single (31%), married (57%) and di- cial tricycle riding. This means of public vorced or separated (11%). Majority had transportation was introduced under the only secondary education (49%). Only a National Poverty Eradication Programme small proportion had completed tertiary (NAPEP) of the Nigerian government to education (11%). The average duration create employment for a teeming popu- of engagement in commercial tricycle lation of youths; especially in urban cen- riding was three (3) years. Each partici- tres. Tricycles were introduced to replace pant gave verbal consent to participate motorcycle transportation because of the in the study. Interviews elicited the par- danger of head injury associated with ticipants’ views on psychoactive drug use the later. It is fast replacing automobiles among commercial tricycle riders, includ- as the major means of commercial trans- ing types, quantity and frequency of drug portation in cities, partly due to the high use, drug use initiation, determinants of cost of spare parts and maintenance of drug use, effects of drugs use on riding, automobile vehicles. A growing number the risk of traffic accidents and counter- of young men in Uyo are engaged in com- measures. Interviews were conducted in mercial transportation as a means of live- English and recorded with a digital device lihood, and most of them ride tricycles with the consent of each interviewee. (popularly known as ‘Keke’). The duration of interviews was between 45 minutes and 1 hour. Recorded inter- Participants and Interviews views were transcribed by paid research Qualitative data were collected through assistants and analyzed by the principal in-depth, individual interviews. Inter- researcher. views involved open-ended questions, which were revised in the course of data Data analysis collection and analysis (Glaser, 1978). Re- The transcripts were subjected to the- cruitment and data collection lasted for matic and inductive coding and analysis. four months (from April to August, 2016). Data coding was undertaken based on pri- A non-systematic survey was adopted or themes reflected in the interview guide since the study is qualitative by design and inductive codes generated through and did not involve a specific and speci- immersion in the transcripts (Braun & fied field location other than Uyo city. The Clarke, 2006; Borkan, 1999). Codes were participants were recruited from across based on key concepts and descriptions, the city through purposive sampling. The particularly those emerging from immer- researchers located one hundred and sion in the transcripts (O’Leary, 2014). three (103) commercial tricycle riders in The deductively and inductively devel- different parts of the city, explained the oped themes formed the basis of data purpose of the study to them, assured coding, which was done manually and them of confidentiality and requested involved assigning primary and second- their voluntary participation in the study. ary codes to relevant portions of each

108 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS interview transcript (Campbell et. al., use drugs. They use them a lot. It is 2013). The coding process was repeated not only tanker drivers and long dis- many times and some of the codes were tance drivers who take drugs. Keke revised while others were condensed or riders (tricycle riders) also use drugs. expanded (Braun & Clarke, 2006). To en- They use it every time they go out on hance inter-coder reliability and validity the road. of findings, two experts in qualitative -re search independently read samples of the Another participant opined: interview transcripts and assessed the coding scheme (Syed & Nelson, 2015). Many of us (tricycle riders) take The authors discussed the assessments, hard drugs. I will not tell you lie, I including discrepancies and confusions use drugs. Some people will tell you in the codes. As a result, unreliable codes they don’t use. It is not true. Most of were dropped or merged, while defini- the people you see driving Keke use tions of the codes were clarified. This pro- drugs. Only few Keke riders can truly cess continued until a good measure of say they don’t use drugs. reliability was achieved. Commercial tricycle operators con- sume a variety of licit and illicit psycho- RESULTS active drugs. The most commonly used drug was alcohol. The different bever- Psychoactive drug use among ages used include commercial beer, palm commercial tricycle riders wine, and imported and locally distilled Interview data shows that the use of gin (ogogoro). Participants also reported psychoactive drugs is common among the increasing popularity of caffeinated commercial tricycle riders in the city. The drinks, popularly known as ‘energy drinks’, bulk of participants said that many com- among transport workers. We learnt that mercial tricycle riders regularly consume commercial tricycle riders consume caf- psychoactive drugs while driving. Those feinated drinks to replenish energy and who said psychoactive drug use was un- stamina depleted in the course of tricycle common were in the minority (11.6%). riding. They also consume tobacco, canna- None of the participants out-rightly de- bis (Ikpo), crack cocaine (Charlie), heroin nied the use of psychoactive drugs among (Thailand) and pharmaceuticals, including commercial tricycle riders. Asked to pro- tramadol, rohypnol and codeine. Canna- vide a rough estimate of the proportion bis is either smoked or soaked in local gin of tricycle riders who take drugs while for drinking. Like the energy drinks, can- driving, the participants said it ranged nabis is said to provide needed strength from 60% to 85%. The bulk of participants and stamina for the energy-sapping work (82%) reported personal use of psycho- of tricycle riding. A participant said: active drugs while riding and most (67%) use regularly. A participant stated: Transport workers take all kinds of things: ikpo (cannabis), cigarette, co- If you know anything about transport caine and beer. There is no hard drug workers, you should know that they that transport workers do not use.

109 NELSON, UMOH, ESSIEN & BROWN

Some people will tell you they do not that drugs alter the normal functioning of use these drugs. The reason they tell the human body which in turn affects the such lie is fear. The truth is that most rider’s ability to ride well on the road. We of us take these drugs. were told:

Interview accounts reveal the deter- Drugs affect transport workers when minants of psychoactive drug use among they are on the road. What I mean commercial tricycle riders. Many partici- is that drugs affect how you ride on pants said that they were influenced by the road. When you take drugs and fellow tricycle riders to start using psycho- ride Keke on the road, you will not be active drugs. Occupational hazards such able to ride very well. It will be diffi- as fatigue, stress and exhaustion were the cult to ride because at that time you major reasons tricycle riders use psycho- are controlled by drugs. You are not active drugs. Participants reported that your normal self. they use drugs to counteract stress and replenish stamina. Stress and exhaustion Another participant added: are common problems among transport workers (Bekibele et al., 2007). Interview The issue is that drugs change the accounts also show that psychoactive way people act. The way you act nor- drugs are often recommended to new en- mally (i.e without drugs) is different trants into the occupation as remedies for from the way you act after you have stress and fatigue. A participant stated: taken drugs. It is the same thing with riding. You cannot ride normally. You When I entered this work (com- are not normal because of the drugs mercial tricycle riding) newly, I com- you took. plained to some friends about tired- ness. Many of them encouraged me The above comments capture partici- to take cannabis. They said that it will pants’ view of the physiological effects of give me strength. I started from us- psychoactive drugs. They further noted ing cannabis. Latter I moved to other that drugs, particularly alcohol, induce drugs like cocaine. various physiological changes, including weakness, shivering, trepidation and ner- Drug use, tricycle riding and the risk of vousness, which compromise the ability accident to ride. Participants told us that under The participants recognized that con- such conditions the likelihood of being sumption of psychoactive drugs is a risk involved in an accident on the road was factor for road traffic accident. They stat- very high since the rider will not be able ed that the use of psychoactive drugs con- to navigate traffic effectively. A partici- tributes to accidents because of the nega- pant stated: tive effect they have on driving behaviour. Asked what these effects were, most par- Drinking can make your body weak. ticipants pointed out that psychoactive You will notice that your hand will drug affect the tricycle rider’s ability to be shaking while you are holding navigate the road effectively. They stated the steering. If you ride when you

110 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS

are feeling like that, you are going compromised by the use of psychoactive to have accident. Nobody should drugs, the rider is at risk of being involved be allowed to ride Keke under that in traffic accident. A participant stated: condition. There is no way you take drugs and Accounts also highlight the effect of ride on the road and it will not af- drugs on vision. Participants opined that fect your riding. That is why they are psychoactive drugs affect a rider’s abil- called drugs. They affect human be- ity to visualize the road and to ride well. ings. When you take drugs and ride, They pointed out that accurate vision of you will not be able to think and the road is essential to successful riding; analyse things very well because of therefore, a rider whose vision is impaired the way the drugs affects your mind. is at grave risk of being involved in an ac- You may make wrong moves that can cident. Commenting from personal expe- lead to accident on the road. riences, some of the participants told us that when a rider is under the influence of Asked which drug had the strongest ef- psychoactive drugs he may not clearly see fect on a rider, the participants rated alco- road signs, pedestrians or on-coming ve- hol (68%) and cannabis (49%) as the most hicles. This was said to lead to accidents potent. They also observed that the effect since the rider will not be able to navigate of drugs depended on the quantity taken effectively under this condition. A partici- (‘if you take a little, it may not give you pant opined: trouble, but taking much is dangerous’). Consumption of significant quantities of If you take drugs and go out on the psychoactive drugs increases the risk of road, you will find it difficult to see traffic accident. A sizeable proportion of the road. When I take drugs and ride the participants (21%) reported that they out, I find it difficult to see bends had been involved in an accident in the on the road or see other vehicles past because of driving under the influ- that are coming towards me. When ence of psychoactive drugs, mostly alco- it happens like that you can collide hol. A participant narrated: with another vehicle or hit those who go on foot. Once I sat with some friends and took some bottles of beer. When I It was also pointed out that drugs affect stood up I felt the effect in my body the rider’s cognition and coordination. so I decided to ride home and rest. Participants told us that tricycle riding is a On the way I lost control and had ac- delicate activity that requires utmost con- cident. I thank God that it was not a centration. They said that the rider must serious one. constantly calculate his moves to ensure that he is involved in an accident. Psycho- Curtailing psychoactive drug use and active drugs compromise the rider’s abil- road traffic accidents ity to think and calculate his moves while Interviews also elicited participants’ riding. Participants opined that when views on ways of tackling drug use and the capacity to calculate and navigate is road accidents involving commercial

111 NELSON, UMOH, ESSIEN & BROWN transport workers. The participants were emphasis should be placed on the risk of verbose about the importance of taking traffic accidents. They further stated that measures to reduce psychoactive drug transport workers should be encouraged use among commercial transport work- to abstain from the use of drugs or to re- ers. They variously pointed out that this duce the quantity and frequency of drug was the most effective step towards pre- use, especially when they are on the road. venting traffic accidents. They were con- A participant stated: fident that consumption of psychoactive drugs is a major risk factor for traffic ac- Transport workers should be educat- cidents and that prevention of drug use ed on the dangers of drugs to their by transport workers, among other mea- health and the consequences of driv- sures, would result in reduction in the ing under the influence of drugs. rate of road traffic accidents. A partici- Most transport workers do not know pant commented: the dangers of using drugs. That is why they continue using them. Drug use by transport workers is one If they are told, some of them will of the reasons why we have many change their behaviour. accidents on the road. Something should be done about it. Transport Another participant expressed confi- workers, like those of us who ride dence in the power of increased knowl- Keke (tri-cycle), should not be al- edge to produce behavioural change. He lowed to take hard drugs and drive. If stated: that is done, accidents on our roads will reduce. The first thing is to let transport workers know that using drugs while Another participant stated: driving can result in accident on the road. There is a saying that ‘knowl- Government should stop the use of edge is power’. It means that when drugs by transport workers. They you know something, you can use should do something about it. The that knowledge for your benefit. use of hard drugs is a major problem. Transport workers should not be al- Participants also recommended that lowed to take hard drugs. That is one transport workers be screened regularly thing we should do to prevent acci- for drug use, and those found to be driv- dents. ing under the influence of drugs should be punished. They reported that officers Participants stated that ignorance of of the Federal Road Safety Commission the dangers of psychoactive drugs was (FRSC) do carry out random screening for a major reason transport workers use drug use on transport workers, but they them. They said that the use of drugs by felt it should be done more regularly since transport workers could be prevented by transport workers use drugs regularly. En- educating them on the negative conse- forcement of laws on driving under the quences of drug use on their health and influence of alcohol and other drugs was well-being and those of others, and that said to be compromised by bribery and

112 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS corruption. Participants intimated that riders. This resonates with the existing road safety officials habitually collect literature on road traffic accidents in Ni- bribes from offenders and allow them to geria. Previous studies reported the use go unpunished. They said that such prac- of alcohol among commercial transport tices encouraged violation of traffic laws. workers (Abikoye, 2012; Omolase et al., A participant narrated: 2012; Iribhogbe & Odai, 2009; Makanjuo- la, Oyeleke & Akande, 2007; Abiona, Alo- I have seen road safety people col- ba & Fatoye, 2006). A body of internation- lect money from drivers and they al literature identified psychoactive drug allowed them to go. Such practices use as a risk factor for fatal road traffic will encourage transport workers accidents, with emphasis on the possible to continue to take drugs and cause impairment of the driver (Barbone et al., accidents on the road. Road safety 1998; Lowenstein & Koziol-McLain, 2001; should do their work and keep peo- Drummer et al., 2004; Holmgren et al., ple who use drugs from driving on 2007; Woratanarat et al., 2009). Driving the road. under the influence of drugs elevates the risk of involvement in road crash, crash Many participants expressed the view severity and severity of crash injuries that the availability of psychoactive drugs (Pereden, Scurfield, Sleet et al., 2004). contributed to their consumption by Exploring psychoactive drug use and the transport workers. They said drugs are risk of road traffic accidents among com- widely available on the streets and that mercial tricycle riders is the contribution this was a contributory factor to wide- of our study to the existing literature, spread use. They suggested that the avail- which mostly report findings from mo- ability of psychoactive drugs should be torcyclists and bus drivers. Our findings controlled. They called on law enforce- suggest that drug use pervades all sectors ment agencies such as the Nigeria Police of road transport workers and should be Force (NPF) and the National Drug Law given priority in road safety policy. Enforcement (NDLEA) to adopt effective The tricycle riders in our study reported measures to curtail availability of psycho- frequent consumption of significant quan- active drugs on the streets. The expressed tities of different types of licit and illicit optimism that measures to reduce the psychoactive drugs, most of which have availability and consumption of psychoac- documented negative impacts on driving tive drugs will have a positive impact on behaviour. Alcohol is a well documented the prevalence of road traffic accidents. contributor to road traffic accidents. It is recognized as a principal risk factor for road crashes. Alcohol use is associated DISCUSSION with increased risk of accident involve- ment and increased risk of responsibility This study explored the views of com- for the accident (Robertson & Drummer, mercial tricycle riders on psychoactive 1994; Longo et. al., 2000). Other sub- drug use and the risk of road traffic acci- stances such as cannabis, caffeine and dents. Findings indicate a significant level opioids have negative impacts on driving of drug use among commercial tricycle ability, especially when vast quantities are

113 NELSON, UMOH, ESSIEN & BROWN consumed or when they are used in com- workers is essential for the development bination (e.g cannabis and alcohol) as re- and implementation of effective programs ported by the tricycle riders in this study. for prevention and control. They highlight The pharmacological effects of these sub- the importance of peer-based education stances impair cognitive and psychomo- and behavioural change programs which tor skills necessary for driving and elevate seek to address the problem of psychoac- the risk of accidents (EMCDDA, 2014). The tive drug use among commercial trans- pattern of psychoactive drug use reported port workers. by the tricycle riders in this study has criti- The key insight emerging from the study cal implications for road safety, especially is tricycle riders’ views on the physiologi- in view of the reported prevalence of fre- cal and psychological effects of psychoac- quent and poly-drug use. tive drugs and how these elevate the risk The findings also show that common of road traffic accidents. They mentioned occupational hazards such as stress,- ex weakness, shivering, nervousness, and haustion and fatigue are risk factors for impairment of vision and coordination psychoactive drug use among commer- as the effects of drugs. These compro- cial tricycle riders. Driving (and riding) is mise the individual’s ability to navigate a strenuous and rugged physical activity traffic effectively and increase the risk of which is associated with stress and fa- road traffic accident. Lay accounts of the tigue (Taylor & Dorn, 2005). Commercial impact of psychoactive drugs on driving/ transportation in Nigerian cities involves riding behaviour resonate with existing commuting a vast and unremitting num- literature, especially in relation to visual ber of people (Fasakin, 2001; Ogunbod- and mental impairments. Psychoactive ede, 2008). Since profit mostly depends drugs such as alcohol, cannabis, cocaine on the number of passengers commuted and heroin impair driving performance and distance covered (Fasakin, 2001), by altering mood, perception, concen- commercial transporters make incessant tration, coordination and responses to and energy-sapping journeys in order to external stimuli, especially when high maximize profit. They use psychoactive doses are taken and when they are used drugs to medicate the conditions associ- in combination (Kelly, Darke & Ross, 2004; ated with their arduous work. Drug use EMCDDA, 2014). There is a convergence is therefore a form of self-medication, between scientific and lay understand- where drugs are used intentionally to ing of the effects of drugs on driving and treat the conditions which commercial how these increase the risk of road traffic tricycle riders suffer (West, 2006). accidents. This finding has important im- Initiation of psychoactive drug use plications for road safety policy. Lay views among commercial tricycle riders is me- on the effects of psychoactive drugs on diated by peer influence. Psychoactive driving provide an entry point for behav- drug use plays an important function in ioural change interventions. Integrating the occupational sub-culture, serving as lay views into the development of inter- a mechanism of social and psychological ventions has the potential to foster ac- functioning for tricycle riders. Such con- ceptance and improve outcomes. textual understanding of psychoactive The tricycle riders recommended edu- drug use among commercial transport cation, routine drug use screening of

114 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS transport workers, curbing bribery and corruption among road safety officials corruption among road safety officials, and curtailing the supply of psychoactive and controlling the availability of psycho- drugs. Bribery and corruption is a con- active drugs as measures for reducing drug tributory factor to ineffectiveness in the use and preventing road traffic accidents. enforcement of traffic laws by enforce- Their recommendations resonate with ment agents (Asogwa, 1992). It is there- internationally recognized measures for fore necessary to adopt measures to re- the prevention and control of traffic acci- duce the level of corruption among road dents. In Nigeria, educational campaigns safety officials. Relevant measures in- should be implemented. These campaigns clude training and provision of adequate should build on lay understanding of the incentives. Measures should also be tak- link between psychoactive drug use and en to control the supply of psychoactive road traffic accidents. They should en- drugs, including enacting and enforcing gage tricycle riders as peer educators to laws on alcohol advertising and market- maximize effectiveness. They should also ing. But supply reduction strategies have provide accurate information, discourage not been very successful in reducing drug driving under the influence of alcohol and use. Although these measures should not other psychoactive drugs and promote be abandoned, their complement should adoption of safe driving behaviours. It is be developed: policies and interventions also important to enact and enforce ap- to reduce demand for drugs and alcohol. propriate legislations on driving under Primary prevention programs on drugs the influence of alcohol/drugs. These in- and alcohol, including public education clude routine blood alcohol screening and campaigns incorporating culturally-mean- drug use screening, which is recognized ingful and factual information on the dan- as an effective measure for reducing road gers of alcohol and drug abuse should be traffic accidents (WHO, 2015). There is no mounted. Treatment services should also maximum blood-alcohol concentration be provided for people with alcohol and (BAC) in Nigeria (Welcome & Pereverzev, drug use disorders. 2010). This makes the implementation of the Federal Traffic code on drink-driving problematic. A legal blood alcohol con- CONCLUSIONS centration should be established to make it possible to prosecute drivers involved in The majority of Nigerian people rely on impaired driving. commercial transportation for their daily The tricycle riders’ recommendations activities. The safety of commercial trans- support the need for a multi-level, com- portation is affected by human factors, bination strategy for promoting road particularly impaired driving owing to the safety. They highlight the importance of consumption of alcohol and other psycho- complementing individual-behavioural active drugs. Driving under the influence interventions (educational programs and (DUI) of alcohol and other drugs increases routine drug use testing) with structural- the risk of road traffic accidents. But policy environmental interventions. The latter and interventions addressing road traffic include enactment and enforcement of violations such as DUI are mostly based on relevant road safety legislations, curbing expert views. Little consideration is given

115 NELSON, UMOH, ESSIEN & BROWN to the views of the transport workers Arneratunga, S., Hijar, M. & Norton, R. themselves. Lay views could enrich and (2006). Road-traffic injuries: confront- optimize the effectiveness of policies and ing disparities to address a global- programs. The views reported in this ar- health problem. The Lancet, 367, ticle indicates that psychoactive drug use 1533-1540. among commercial tricycle riders is linked Ayinde, O. O., Adejumo, O. A., Olukolade, to occupational hazards such as stress, O. & Lasebikan, V. A. (2018). Should fatigue and exhaustion, and affects riding traffic offenders undergo compul- through impairment of vision, judgement sory “mental test”: A study of mental and coordination. These elevate the risk health and crash involvement among of road traffic accidents. The views also commercial motorcyclists in Ibadan highlight the importance of education, Nigeria? Community Mental Health law enforcement and routine drug use Journal, Doi: 10.1007/s10597-018- screening, curbing corruption among en- 0302-4. forcement officials and controlling avail- Barbone, F., McMahon, A. D., Davey, P. G., ability of psychoactive drugs as measures Morris, A. D., Reid, I. C., McDevitt, D. for stemming drug-impaired driving and G., & MacDonald, T. M. (1998). As- preventing road traffic accidents. These sociation of road-traffic accidents views overlap with scientific evidence with benzodiazepine use. The Lancet, on risk factors for traffic accidents and 352(9137), 1331-1336. counter-measures. It is important to inte- Bekibele, C. O., Fawole, O. I., Bamgboye, grate lay views into road safety policy and A. E., Adekunle, L. V., Ajav, R. And Bai- interventions to bolster acceptance and yeroju, A. M. (2007). Risk factors for improve outcomes. road traffic accidents among drivers of public institutions in Ibadan, Nige- REFERENCES ria. African Journal of Health Sciences, 14(3-4), 137-142. Abiona, T. C., Aloba, O. O., & Fatoye, F. O. Borkan, J. (1999). Immersion/crystalliza- (2006). Pattern of alcohol consump- tion. Doing Qualitative Research, 2, tion among commercial road trans- 179-194. port workers in a semi-urban com- Braun, V. and Clarke, V. (2006). Using the- munity in south western Nigeria. East matic analysis in psychology. Quali- African Medical Journal, 83(9), page tative Research in Psychology, 3(2), numbers. 77-101 Abikoye, G. E. (2012). Psycho-spatial pre- Campbell, J., Quincy, C., Osserman, J and dictors of hazardous drinking among Pedersen, O. (2013). Coding in-depth motor drivers in Ibadan, Nigeria: Im- semi-structured interviews: problems plications for preventing vehicular ac- of unitization and inter-coder reliabil- cidents. International Journal of Alco- ity. Sociological Methods & Research, hol and Drug Research, 1(1), 17-26 42(3), 294-320. Asogwa, S. E. (1992). Road traffic acci- Drummer, O.H., Gerostamoulos, J., dents in Nigeria: A review and a reap- Batziris, H., Chu, M., Caplehorn, J., praisal. Accident Analysis and Preven- Robertson, M.D., Swann, P. (2004). tion,24(2), 149-155. The involvement of drugs in drivers

116 PERCEPTIONS OF DRUG USE AND RISK OF ACCIDENTS

of motor vehicles killed in Australian epidemiology, impairment, risk road traffic crashes. Accident Analysis factors and risk perceptions. and Prevention, 36: 239-248. Drug and Alcohol Review, DOI: European Monitoring Centre for Drugs 10.1080/09595230412331289482. and Drug Addiction (2014). Drug use, Longo, M. C., Hunter, C. E., Lokan, R. J., impaired driving and traffic accidents. White, J. M., & White, M. A. (2000). 2nd Edition. Lisbon: EMCDDA. The prevalence of alcohol, cannabi- Fasakin, J. O. (2001). Some factors affect- noids, benzodiazepines and stimu- ing daily profits of commercial mo- lants amongst injured drivers and torcycles in Akure, Nigeria. Transport their role in driver culpability: part ii: Policy, 8(1), 63-69. the relationship between drug preva- Foundation for Economic Research and lence and drug concentration, and Training (2004). Socio-economic pro- driver culpability. Accident Analysis & file of Akwa Ibom State. Uyo: FERT. Prevention, 32(5), 623-632. Glaser, B. G. (1978). Theoretical sensitiv- Lowenstein, S. R. and Koziol-Mclain, J. ity: advances in the methodology of (2001). Drugs and traffic crash re- grounded theory. Mill Varley, Califor- sponsibility: A study og injured mo- nia: Sociology Press. torists in Colorodo. The Journal of Hazen, A. & Ehiri, J. E. (2006). Road traf- Trauma, Injury, Infection and Critical fic injuries: Hidden epidemic in less Care, 50(2), 313-320. developed countries. Journal of the Makanjuola, B. A., Oyeleke, S. A. & Akan- National Medical Association, 98(1), de, T. M. (2007). Psychoactive sub- 73-82. stance use among long distance ve- Holmgren, A., Holmgren, P., Kugelberg, F. hicle drivers in Ilorin, Nigeria. Nigeria C., Jones, A. W., & Ahlner, J. (2007). Journal of Psychiatry, 5(1), 14-18. Predominance of illicit drugs and Nantulya, V. M. & Reich, M. R. (2002). poly-drug use among drug-impaired The neglected epidemic: road traffic drivers in Sweden. Traffic injury pre- injuries in developing countries. Brit- vention, 8(4), 361-367. ish Medical Journal, 324(11), 1136- International Transport Forum (2017). 1141. Road safety annual report. Paris: Nantulya, V. M., Muli-Musiime, F. (2001). OECD Publishing (http://dx.doi. Kenya. Uncovering the social deter- org/10.1787/irtad-2017-en). minants road traffic accidents. In: Iribhogbe, P. E. & Odai, E. D. (2009). Driv- Whitehead, E. T., Diderichsen, F., er-related risk factors in commercial Bhuiya, A. & Wirth, M (eds.) Challeng- motorcyclists (Okada) crashes in Be- ing inequities: from ethics to action. nin City, Nigeria. Pre-hospital & Disas- Oxford: Oxford University Press. ter Medicine, 24(4), 356-359. O’ Leary, Z. (2004). The essential guide to Jacob, G., Aaron-Thomas, A. & Astrop, doing your research project. Los An- A. (2000). Estimating global road fa- geles: Sage Publishers. talities. London: Transport Research Ogunbodede, E.F. (2008). Urban road Laboratory. transportation in Nigeria from 1960 Kelly, E., Darke, S. and Ross, J. (2004). to 2006: problems, prospects and A review of drug use and driving: challenges. Ethiopian Journal of

117 NELSON, UMOH, ESSIEN & BROWN

Environmental Studies and Manage- G. M. Et. al. (1988). Reducing traffic ment, 1(1), 7-18. injury – A global challenge. Royal Aus- Omolase, C. O., Afolabi, O. T., Omolase, B. tralian College of Surgeons. O. & Ihemedu, C. O. (2011). Drink-driv- Welcome, M. O. & Pereverzev, V. A. (2010). ing among commercial drivers in a Ni- Limit of blood-alcohol concentration: gerian city. Middle East African Journal A major problem to solve in Nigeria. of Psychiatry and Alzheimer, 2, 15-19 European Psychiatry, 25(Supplement Pereden, M., Scurfield, R., Sleet, D., Mo- 1), 544. han, D., Hyder, A.A., et al. (2004). West, R. (2006). Theory of addiction. Ox- World report on road traffic injury ford: Blackwell Press. prevention. Geneva: World Health Or- World Health Organization (2004). Sum- ganization. mary tables for mortality and disabil- Robertson, M. D., & Drummer, O. H. ity adjusted life years for all member (1994). Responsibility analysis: a countries in 2002. Switzerland, Ge- methodology to study the effects of neva: WHO. drugs in driving. Accident Analysis & World Health Organization (2013). Road Prevention, 26(2), 243-247. safety in the WHO African region – Syed, M. & Nelson, S. (2015). Guidelines the facts 2013. Switzerland, Geneva: for establishing reliability when cod- WHO. ing narrative data. Emerging Adult- World Health Organization (2015). Global hood, Volume/issue number, 1-13. status report on road safety 2015. Taylor, A. H., & Dorn, L. (2006). Stress, fa- Switzerland, Geneva: WHO. tigue, health, and risk of road traffic Woratanarat, P., Ingsathit, A., Suriya- accidents among professional drivers: wongpaisal, P. et. al. (2009). Alco- the contribution of physical inactivity. hol, illicit and non-illicit psychoactive Annual Review of Public Health, 27, drug use and road traffic injury in 371-391. Thailand: A case-control study. Ac- Trinca, G. W., Johnson, I. R., Campbell, B. cident Analysis and Prevention, 41, J., Haight, F. A., Knight, P. R., Mackary, 651-657.

118 African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications SOME NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS ON LONG-TERM ABSTINENCE IN A REHABILITATION CENTRE IN NIGERIA

Valentine A. Ucheagwu1, Rita N. Ugwokwe-Ossai2, Paul D. Okoli2, & Jesse P. Ossai2

1Department of Psychology, Madonna University Okija Campus, Anambra, Nigeria Laboratory of Human and Animal Psychology, Chukwuemeka Odumegwu Ojukwu University Igbariam Campus, Anambra, Nigeria 2Department of Psychology, Nnamdi Azikiwe University, Awka, Nigeria

ABSTRACT

The present study examined some neuropsychological profiles of cannabis dependent users on long abstinence in Nigeria. Ninety participants were recruited for the study. Their ages ranged from 27 – 35 years with a mean age of 30.78. Five neuropsychological instruments were used for the study: Symbol Digit Modality Test (SDMT), Digit Symbol Modality Test (DSMT), Trail Making Tests A & B (TMT – A/B), Rey Auditory Verbal Learning Test (RAVLT) and Rivermead Post Concussion Syndrome questionnaire (RPC). The findings of the study showed significant differences on verbal learning; RAVLT Trial 5: F(2,81) = 15.20, RAVLT Total Trial: F(2,81) = 11.06, Delayed verbal memory, F(2,81) = 10.94 all at P ≤ 0.05 level of testing with cannabis users performing worse than the psychiatric and healthy controls. Significant differences were also seen on processing speed: DSMT: F(2,81) = 3.53 with cannabis users performing worse than the healthy control but better than the psychiatric group. Drug users had significant less performance than the healthy control on TMT A; F(2,81) = 8.04 and TMT B; F(2,81) = 7.41 as measures of executive function. Also, drug users had significant worse complaints of somatic, cognitive and emotional symptoms following brain injury as measured by RPC; F(2,81) = 7.11 all at P ≤ 0.05 level of testing. Discussions of the study was based upon long term effects of cannabis use on neuro-cognition even after prolonged abstinence and reasons for the mixed findings surrounding this area of study. Implications of the study were also examined.

Keywords: Neuro-cognition, Cannabis Users, Abstinence, Processing Speed, Memory

Corresponding Author: Valentine, A. Ucheagwu, Department of Psychology, Madonna University Okija Campus, Anambra, Nigeria. E-mail: [email protected]; Phone: +234-8066640319 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI

INTRODUCTION Colleagues, 2004; Jovanovski, Erb & Zak- zanis, 2005; Vonmoos, Hulka, Preller, Jen- Addiction is generally defined as com- ni, Baumgaitner, Stohler et al, 2013; Soar, pulsive and persistent use of drugs despite Mason, Potton & Dawkins, 2012). negative consequences (Pascoli, Terrier, Vonmoos, Hulka, Preller, Mander, Hiver & Cuscher, 2015). Ideally depen- Baungartner and Quednow (2014) stud- dent drug users will continue drug con- ied cognitive impairment in cocaine users sumption despite negative consequences and its possible reversibility. Their findings typically related to social and psychologi- showed that increased cocaine use within cal defects that are often delayed in time 1 year was associated with reduced cogni- (Pascoli et al., 2015). Neurobiological ex- tive performance primarily in the working planations of addiction have shown vari- memory. By contrast, decreased cocaine ous areas of the brain to be involved in use was linked to small cognitive improve- compulsive drug seeking. Pascoli et al. ments in all domains studied (attention, (2015) using optogenetic self stimulation working memory, declarative memory show that the Dopamine (DA) neurons of and executive functions). Importantly, us- the ventral tegmental area (VTA) are im- ers who ceased taking cocaine seemed plicated in drug addiction. Consequently to recover completely, attaining a cogni- their study implicated the D1 receptor ex- tive performance level similar to that of pressing neurons of the nucleus acubems control group. In addition, recovery of (NAc) as involved in cue induced relapse working memory showed correlation after weeks of abstinence while resistant with the age of onset with early onset us- to punishment was associated with en- ers showing hampered recovery. Studies hanced neural activity in the orbitofrontal have shown deficits in attention, - work context (OFC) of mice addicted to drugs. ing memory and declarative memory in In humans similar neural areas have been chronic cocaine users whereas the het- identified as addictive brain areas. Everitt erogeneous concept of executive func- and Robbins (2016) described the transi- tions have yielded mixed results (Java- tion from ventral to dorsal striatum involv- novski, et al. 2005; Vonmoos et al. 2013). ing the DA neurons as major pathways of Other studies have equally demonstrated drug use to drug compulsion. Taken to- that cocaine users additionally display in- gether all the evidences on drug addiction ferior social cognition including prosodic based on neurobiology, it becomes clear and cross modal emotion recognition, that neural plasticity occurs during addic- emotional empathy, mental perspective tion and such plasticity accounts for drug taking and social decision making (Hulker, addiction. Eisenegger, Preller, Vonmoos, Jenni, Ben- Aside the neural plasticity leading to drick and Colleagues, 2014; Hulker, Prel- addiction, drug users also show relative ler, Vonmoos, Broicher & Quednow, 2013; cognitive impairments (Cadet & Bisagno, Preller, Hulka, Vonmoos, Jenni, Baungart- 2016). Accumulating evidence suggests ner, Oziobek and Colleagues, 2014). that dependent and recreational cocaine Becker, Collins, Schultz, Urosevic, use is associated with broad neuropsy- Schmaling and Luciana (2018) stud- chological impairments (Goldstein, Les- ied longitudinal changes in cognition in kovjan, Hoff, Hitzeman, Bashen, Khalsa & young adult cannabis users. Their study

120 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS examined associations between chronic effects of cannabis use in executive func- use (CU) and cognition over time in chron- tions. In seven studies reviewed by Crean ic daily adolescent onset chronic users et al. (2011), five found no attention or (CUs) as compared to normal controls. concentration impairments in partici- Both groups completed a neuropsycho- pants who had remained abstinent from logical battery at study intake and again 28 days to one year (Lyons, Bar, Paniz- 2 years later. Their baseline group differ- zon, Toomey, Eisen, Xian & Tsuang, 2004; ences indicated deficits in verbal learning Pope, Gniber, Hudson, Huestis, Yurgelun– and memory, motivated decision making, Toos, 2001, 2002, 2003, Verdejo-Garcia, planning and working memory in CUs. At Lopez–Torrecillas, Aguillar de Arcos, Per- the longitudinal follow-up, the majority of ez-Garcia, 2005). Other areas of neuro- Cus continued to report regular and heavy psychological abilities have equally been cannabis use. Relative impairments in the examined among abstinent cannabis us- domains of working memory, planning ers including working memory, verbal flu- and verbal memory remained stable sug- ency, inhibition and impulsivity, decision gesting that these are enduring vulnerabil- making and risk taking (see Crean et al ities associated with continued CU during 2011 for exhaustive discussion). Overall young adulthood. However impairments cannabis appears to continue to exert in motivated decision making were evi- impairing effects in executive functions dent in both groups. In addition, CUs dem- even after 3 weeks of abstinence and be- onstrated relatively better performance yond. While basic attentional and -work in short duration speeded tasks, while an ing memory abilities are largely restored, earlier age of CU onset was associated with the most enduring and detectable deficits poorer verbal learning and memory and are seen in decision making, concept for- planning performance over time. Other mation and planning (Crean et al 2011). studies have equally supported the effects The present study was on examina- of cannabis on neurocognitive functions tion of some neuropsychological abilities both the acute (Grady, 1999; Morrison, among cannabis users in a rehabilitation 2015; Mckeown, Lee, Holt, Powell, Kapur centre in Anambra State. The neurocogni- & Murray, 2009) and residual effects of tive abilities examined were verbal learn- cannabis (Herman, Sartorius, Welzel, Wal- ing/memory, processing speed and exec- ter, Skopp, Ende & Mani, 2007; Solowji, utive functions of the participants. To the Stephens, Roffman, Bator, Kadden, Miller, researchers best of knowledge, no studies Christiaonsen, McRee, Vendetts, 2002). have been carried out in Nigeria on neu- Crean, Crane and Mason (2011) re- ropsychological profiles of cannabis users viewed some evidence of long term ef- particularly those on abstinence for over fects of cannabis use on executive cogni- 3 months. The problems of paucity of lit- tive functions. According to the authors erature on this area of long term cognitive this area of research has been fraught effects of cannabis following abstinence with inconsistencies in findings and is may affect post detoxification manage- complicated by discrepant definition of ment. Crean et al (2011) had earlier stat- what constitutes long term effects.- Cre ed the benefits of neurocognitive assess- an et al asserted that only a handful of ment on rehabilitation of drug addicts. researchers have examined the long term The gap in knowledge and treatment

121 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI created by such lack of studies on neuro- the participants were on newer forms of cognition of cannabis dependents is what antipsychotic medications as at the time the present study seeks to fill. of the study and have stayed in the hos- Thus the following hypotheses were pital for at least 3 months. On the other proposed to guide the research: hand, the drug users were recruited from the inpatient rehabilitation facility owned i. Cannabis users on abstinence will dif- by the Nigeria Drug Law Enforcement fer significantly on verbal learning and Agency in Anambra State. They included memory from healthy controls and 30 participants identified to be cannabis psychiatric patients. users. Twenty five (25) of the participants ii. Cannabis users on abstinence will dif- reported that they also take codeine and fer significantly from the healthy con- alcohol and sparingly cocaine. However trols and psychiatric patients on test the predominant drug of usage was can- of processing speed. nabis. All the cannabis participants re- iii. Cannabis drug users will differ signifi- ported that they had had used cannabis cantly from health control and psy- for over 5 years and had for the past one chiatric patients on test of executive year been using cannabis on a near daily functioning as well as post concussive basis. The reason for choosing the Drug symptom reports. Rehabilitation centre was its strict rules on inpatient admission. Patients are not allowed to assess drugs neither were METHOD there rooms for drug smuggling into the patients’ wards. This to a large extent as- Participants sures abstinence as soon the drug user Ninety participants took part in the is still in admission. The normal controls study. They were recruited from the were recruited from the population of population of psychiatric patients, drug undergraduate students and secondary users and healthy controls. The psychi- school leavers who reported no use of atric samples were thirty (30) inpatients drugs (cannabis, cocaine, codeine, trama- recruited from the government neuropsy- dol, etc.) and no symptoms of psychotic chiatric hospital in Anambra State Nige- disorder based on Symptom Checklist 90 ria. They included 22 males and 8 females R self report. They were matched on age diagnosed with psychotic disorders by and education with the addiction group. the attending psychiatrists. The psychiat- Table 1 shows no significant differences ric group was receiving treatment in the among the groups on age and length of mental health facility during the study. All education respectively.

Table 1. Summary Table of Education and Age of the Participants

Group Mean Age Mean Length of Education F (age) F (edu)

Drug users 30.52 7.65 Psychiatric patients 31.68 7.08 0.85a 1.34a Normal Controls 30.75 8.03 a = No Significant difference at P ≤ 0.05.

122 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS

Instrument test. The present study included the num- Five neuropsychological tests were ber of errors made on the task. The TMT used in the study. The Symbol Digits provides information regarding atten- Modalities Test (SDMT, Smith, 1991) is a tion, visual scanning, speed of eye-hand speeded task that has been used exten- coordination and information processing sively with diverse clinical groups for the (Miltrushina, Boone & D’Etia, 1999). The assessment of processing speed (Martin & Rey Auditory Verbal Learning Test (RAVLT) Bush, 2008). This requires an examinee to affords an analysis of learning and reten- look at a series of nine geometric figures tion. It involves a five-trial presentation of that have each been paired with a num- a 15 – word list (List A), a single presen- ber. The test items present the geometric tation of an interference list (List B), two figures that have each been paired with a post interference recall trials (one imme- number. Test items present the geometric diate, one delayed) and recognition of the figure only and the examinee must quickly target words presented with distracters write in the target number that goes with (RWL) (Lezak, Howieson, Bigler & Tranel each figure (Martin & Bush, 2008). The (2012). RAVLT has been shown to be re- score is the number of correct substitu- liable and valid in neuropsychological as- tion completed within 90 seconds. How- sessment of memory in various disorders ever the present study allowed the par- including multiple sclerosis (Brown, Kin- ticipants to work as fast as they could and sella, Ong & Volvels, 2000) and Alzheimer the score was the time it took the partici- type dementia (Bigger, Rosa, Schultz et al, pants to complete the task. Similar to the 1989, Ferman, Smith, Boone et al, 2006). SDMT was the Digit Symbol Modality Test RAVLT has been shown to have adequate (DSMT). The DSMT (WAIS III: Psychologi- reliability and divergent validation using cal Corporation, 1957) shares the same Nigeria samples (Ucheagwu, Ugokwe-Os- features with the SDMT other than the ex- sai, Okpaleke & Ugokwe, 2017). The Riv- aminee looks at a series of nine numbers ermead Post Concussion Symptoms ques- that have each been paired with a geo- tionnaire (King, Crawford, Wenden, Moss metric figure. In DSMT, test items present & Wade, 1995) is designed to assess the the numbers only and the examinee must presence and severity of post concussion quickly write in the target figures that go syndrome (PCS) which is a set of somatic, with each number (Lezak, et al 2012). The cognitive and emotional symptoms fol- Trial Making Test (TMT; Army Individual lowing traumatic brain injury. The authors Test Battery, 1944) is a commonly used show that RPQ had good reliability both neuropsychological assessment instru- for test – retest and inter-rater reliability. ment (Arbuthnott & France, 2000; Reitan & Wolfson, 1983) that consists of two Procedure subtests. TMT – A involves drawing a line The psychiatric sample were tested in that connects consecutive numbers from the psychiatric hospital where they were 1 to 25 while TMT – B involves drawing a inpatients receiving treatment. All the line connecting alternating numbers and psychiatric participants were taking new- letters in sequence (1 – A – 2 – B etc). er forms of antipsychotic medication. Be- Traditional scoring is the time in seconds cause of their medication, they were all required to complete each part of the tested in the afternoon. This was to allow

123 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI for sometime after taking the medication participants because only eight partici- the previous night. Because of antipsy- pants were involved and they were from chotic side effects, some patients eligible the psychiatric group only. for the study did not participate. Only The findings of the study showed signif- patients that reported no or fewer signs icant differences on the Rivermead Post of motor retardation and dizziness were Concussion Questionnaire (RPQ) F(2, 81) recruited for the study. They were tested = 7.11 at P ≤ 0.001, RAVLT Trial 5: F(2, 81) individually after adequate rapport and = 15. 20 at P ≤ 0.001; RAVLT Total Trial: written consent were obtained from the F(2, 81) = 11.06 at P ≤ 0.001; RAVLT In- patients and care-givers respectively. Con- terference: F(2, 81) = 7.89 at P ≤ 0.001; versely the drug users were equally test- RAVLT Delayed Trial: F(2, 81) =10.94 at P ed at the drug rehabilitation centre where ≤ 0.001; TMT A (TIME) F(2, 81) = 8.04 at P they were admitted for rehabilitation. As ≤ 0.001; TMT B (TIME) F(2,81) = 7.41 at P at the time of the study, none of the par- ≤ 0.001; TMT A (ERROR) F(2, 81) = 25.21 ticipants were on antipsychotics. The only at P ≤ 0.001; TMT B (ERROR) F(2, 81) = medication known to be administered 7.46 at P ≤ 0.01; SDMT: F(2, 81) = 10.68; was multivitamins. The drug addicts were DSMT: F(2, 81) = 3.53 at P ≤ 0.03. How- tested individually after adequate con- ever no significant differences were seen sent was obtained from the participants on RAVLT Trial 1 and RAVLT Recognition at and authorities of the rehabilitation cen- P ≤ 0.005 respectively. tre. The normal controls were invited to Table 2 shows the mean scores of the the psychology laboratory of the univer- groups as they reflect the neuropsycho- sity (Lead Author’s University) where they logical behaviours. Equally Table 3 shows were equally tested individually after ob- the pair wise comparisons of the 3 groups taining written consent from the partici- on neuropsychological behaviours that pants. The research ethical committee of show significant differences. the Madonna University Department of Psychology approved the study which fol- lows the Helsinki declaration on involve- DISCUSSION ment of human participants in research. The findings of the study showed sig- Design and Statistics nificant differences among the groups The between group design was used studied on verbal memory and learn- for the study while the multivariate analy- ing using the Rey Auditory verbal learn- sis of variance was used for data analysis. ing test (RAVLT). Trial 5 of the RAVLT has been shown to identify the number of words learnt during the verbal learning RESULTS tasks (Lezak et al, 2012). The analysis of the present data showed that cannabis The statistical estimations were to es- users on abstinence had the least score tablish neuropsychological differences on verbal learning and pair wise com- among cannabis drug dependents, psy- parisons of the three groups showed sig- chiatric patients and healthy controls. nificant learning differences between the The analysis did not include the female cannabis addicts on one hand and health

124 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS

Table 2. Mean Scores of Neuropsychological Profiles of the Participants

Dependent Variable Mean Std Error

Psychiatric patients 17.15 2.06 RPQ Drug Users 26.04 1.96 Normal 16.87 1.10 Psychiatric patients 6.62 0.51 RAVLT Trial 1 Drug Users 5.77 0.49 Normal 6.95 0.47 Psychiatric Patients 9.08 0.54 RAVLT Trial 5 Drug Users 5.62 0.51 Normal 9.07 0.50 Psychiatric Patients 39.63 2.13 RAVLT Total Trial Drug Users 28.07 2.02 Normal 39.77 1.95 Psychiatric Patients 7.75 0.59 RAVLT Interference Drug Users 5.40 0.56 Normal 8.35 0.54 Psychiatric Patients 7.84 0.57 RAVLT Delayed Trial Drug Users 4.83 0.54 Normal 7.96 0.52 Psychiatric Patients 14.08 0.66 RAVLT Recognition Trial Drug Users 12.67 0.63 Normal 12.62 0.61 Psychiatric Patients 112.27 9.07 TMT A (TIME) Drug Users 109.19 8.61 Normal 68.87 8.33 Psychiatric Patients 168.68 13.35 TMT B (TIME) Drug Users 156.51 12.67 Normal 103.91 12.26 Psychiatric Patients 0.15 0.91 TMT A (ERROR) Drug Users 0.82 0.08 Normal 0.14 0.08 Psychiatric Patients 3.34 0.66 TMT B (ERROR) Drug Users 2.50 0.62 Normal 0.06 0.60 Psychiatric Patients 371.29 22.45 SDMT Drug Users 255.35 21.31 Normal 238.17 20.63 Psychiatric Patients 326.37 51.55 DSMT Drug Users 300.32 48.92 Normal 156.43 47.35 controls and psychiatric patients on the of the RAVLT) showed that cannabis ad- other hand. Equally the RAVLT total trial dicts performed significantly worse than score (ie: scores total scores of trials 1-5 the other 2 groups.

125 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI

Table 3. Summary Table of Pair Wise Comparison

Defendant Variable Group Group Diff Sig.

Normal Psychiatric Patients -0.28 0.92 RPQ Drug Users -9.17 0.001 Normal Psychiatric Patients -.013 0.97 RAVLT Trial 5 Drug Users 3.45 0.001 Normal Psychiatric Patients 0.14 0.96 RAVLT Total Trial Drug Users 11.70 0.001 Normal Psychiatric Patients 0.61 0.45 RAVLT Interference Drug Users 2.96 0.001 Normal Psychiatric Patients 0.12 0.86 RAVLT Delayed Trial Drug Users 3.13 0.001 Normal Psychiatric Patients -43.40 0.001 TMT A (TIME) Drug Users -40.32 0.001 Normal Psychiatric Patients -64.77 0.001 TMT B (TIME) Drug Users -52.64 0.004 Normal Psychiatric Patients 0.15 0.24 TMT A (ERROR) Drug Users -0.67 0.001 Normal Psychiatric Patients -3.28 0.001 TMT B (ERROR) Drug Users -2.43 0.005 Normal Psychiatric Patients -133.12 0.001 SDMT Drug Users -17.19 0.56 Normal Psychiatric Patients -169.94 0.02 DSMT Drug Users -143.89 0.04

This finding show that cannabis us- be as a result of diverse neuropsycho- ers on abstinence for over 3 months still logical tests used by various researchers. show impairments on verbal learning The present study used the RAVLT while performance. Previous studies show ver- Pope et al study used measures dealing bal impairment in cannabis chronic us- more on verbal fluency. Equally previous ers when compared with health control studies recruited cannabis users (light (Becker et al 2018) both at acute intoxica- users) as control group while our con- tion and long term chronic use. However trol groups were persons that were can- studies relating to abstinence of heavy nabis naive. This may have contributed chronic users show that at 28 days, no to differences in our findings. Thus our difference is seen between chronic users findings showed relative lasting residu- on abstinence and control group (non al effect of cannabis on verbal learning heavy users) on verbal fluency and ver- even after 3 months of abstinence. Con- bal information (Pope et al, 2001, Crean versely, the same significant difference et al., 2011). These findings were in con- was observed on delayed task of RAVLT trast with our present finding that chron- which measures verbal memory. Can- ic heavy users on abstinence for over 3 nabis users on abstinence still showed months still showed impairment on ver- significant poor performance than other bal learning. However differences may groups on delayed verbal memory task

126 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS of RAVLT. Our finding was in line with as well be attributed to the nature of those of Solowji et al. (2002) and Solowji neuropsychological tests used to assess and Battisti, (2008), who showed that executive functioning, the nature of par- long term cannabis users performed sig- ticipants recruited for the study as well nificantly less well than the short term the length of abstinence. users and controls on tests of memory and attention using the RAVLT and time Implication for Treatment estimation tasks. According to them long Cognitive impairments have been term users show impairments in memo- generally associated with poorer drug ry and attention with increasing years of abuse treatment outcome (Aharonovich, regular cannabis use. However our study Brooks, Nunes & Hasin, 2008; Abboth & was little different from theirs because Gregson, 1981) and those impairments our cannabis participants were abstinent have been found to impede acquisition for over 3 months but still showed de- of new coping behaviours (McCrady & creased verbal memory when compared Smith 1986), learning and retention of with healthy controls. new material (Alternman & Hall, 1989) On the other hand, significant differ- and also increases the likelihood of ences were only seen on the process- treatment dropouts (Teichner, Horner, ing speed performance using the digit Routzch, Herron & Theros, 2002). This symbol modality test (DSMT) between suggests that incorporating the standard the healthy controls and cannabis par- cognitive remediation into the rehabilita- ticipants. Importantly cannabis users tion of cannabis users will optimize treat- performed better than the psychiatric ment outcome. It is therefore important participants on DSMT and also onan- to equally include standard neuropsycho- other task of processing speed the sym- logical assessment in the protocols for bol digit modality test (SDMT). Similarly assessment and treatment of cannabis cannabis users show significantly less dependent users. performance than the healthy controls Since the present study suggests long on measures of executive functions us- term effects of cannabis use on neuro- ing the TMT A and B. Mixed findings have cognition, intermediate neuropsychologi- trailed the residual effects of cannabis on cal assessment of cannabis users under executive function following some days rehabilitation will help determine can- (maximum 20 days) of abstinence. Pope nabis users still affected with cannabis et al (2001, 2002) as well as Jager, Kahn, neuro-cognitive effects over long term re- Ven Den Broken Van Reea and Ramsey habilitation and abstinence and possibly (2006) on all five studies found no signifi- improve on their neuro remediation. cant differences on executive functions Our present study has certain limita- of heavy cannabis users, former heavy tions. We were not able to divide the cannabis users and control subjects on 28 cannabis users into months of abstinence days abstinence. Contrary to this, Solowy like 3 months, 5 months, 1 year, although et al (2002) and Herman et al (2007) re- all our participants have had at least 3 ported positive significant differences on months of abstinence and were still in abstinence between chronic users and the rehabilitation centre. Future studies healthy controls. These differences may including different abstinence time may

127 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI further tell us more about abstinence they showed significant impairment in and neuro-cognition. Although our pres- processing speed and executive functions ent study to the author’s best of knowl- when compared with the healthy control edge was the first to assess the neuro- but performed better than the psychiatric cognitive status of cannabis users on 3 participants. months of abstinence in a rehabilitation centre, we believe that neuro-plasticity following cannabis use may still improve REFERENCES based upon time. Equally our study failed to categorize the users under duration Abbott, M.W., & Gregson, R.A. (1981). of exposure and quantity of cannabis Cognitive dysfuntion on the predic- abused. However, we reported that all tion of relapse in alcoholics. Journal participants had used cannabis for over Studies of Alcohol, 42(3), 230-243. 5 years prior to admission and based Aharonorich, E., Brooks, A.C, Nunes, E.V & upon self report have been using canna- Hasin, D.S. (2008). Cognitive deficits bis on everyday basis at least 1 year be- in marijuana users: Effects on moti- fore admission into rehabilitation. These vational enhancement therapy plus description criteria have ideally covered cognitive behavioural therapy treat- bases for dependence and heavy use, but ment outcome. Drug and Alcohol De- further categorization could have given pendence, 95 (3), 279-283. more credence to the study. Equally we Alterman, A.I., & Hall, J.G (1989). Effects did not involve any biological test to en- of social drinking and familial alcohol- sure total abstinence among the drug ad- ism risk on cognitive functioning: Null dicts. We had simply relied on the nature findings. Alcohol Clinical Experimen- and security of the centre for abstinence. tal Research, 1-3, (6), 799-803. Future studies involving such measures Arbuthnott, K. & Frank, J. (2000). Trail will give better credence to the results Making Test, Part B as a measure of obtained. executive control: Validation using Psychiatric patients were included into a set switching paradigm. Journal of the study also as a form of control to the Clinical and Experimental Neuropsy- cannabis participants. Some cannabis us- chology, 22, 518-522. ers from clinical experience show some Army Individual Test Battery (1994).Man - signs of psychotic features when first ad- ual of directions and scoring. Wash- mitted in a rehabilitation centre. This was ington, DC. War Department, Adju- also reported in 25 participants from our tant General’s office. study. Thus to cushion the effect of psy- Becker, M.P., Collins, P.F., Schultz, A., Nro- chotic features on the findings, we decid- seric, S., Schmahy, B. & Luciana, M. ed to recruit the psychiatric participants (2018). Longitudinal changes in cog- with psychotic features under remission nition in young adult cannabis users. undergoing psychiatric rehabilitation. Journal of Clinical and Experimental Overall, our study shows that cannabis Neuropsychology, 40(6), 529-543. users have impairments in verbal learn- Bigler, E.D., Rosa, L., Schultz, F. et al (1989). ing and memory when compared to Rey auditory verbal learning and Rey- healthy and psychiatric controls. Equally Osterriech complex figure design

128 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS

performance in Alzheimer’s disease et al (2014). Altered social and non and closed head injury. Journal of social decision making in recreational Clinical Psychology, 45, 277-280. and dependent cocaine users. Psy- Cadet, J.C. & Bisagno, V. (2016). Neuro- chological Medicine, 44, 1015-1028. psychological consequences of chron- Hulka, L.M., Preller, K.H., Vonmoos, M., ic drug use: Relevance to treatment Breicher, S.D, Queduaw, B.B. (2013). approaches. Frontiers in Psychiatry, 6, Cocaine users manifest impaired pro- 189. Doi: 10.3389/-/psyt.2015.00189. sodic and cross modal emotion pro- Crean, R.D., Crane, N.A., & Mason, B.J. cessing. Frontiers of Psychiatry, 4, (2011). An evidence based review of 1-12. acute and long term effects of can- Jager, G., Kahn, R.S. Van den Brink, W., Van nabis use in executive cognitive func- Ree, J.M. & Ramsey, W.F. (2006). Long tions. Journal of Addiction Medicine, term effects of frequent cannabis use 5, 1, 1-8. on working memory and attention: Ferman, T.J., Smith, G.T., Boone, B.F. et al an FMRI study. Psychopharmacology, (2006). Neuropsychological differen- 185 (3), 358-368. tiation of dementia with lewy body Jovanovski, O., Erb, S. & Zakzanij, K.K. from normal ageing and Alzheimer’s (2005). Neuro-cognitive deficits in disease. The Clinical Neuropsycholo- cocaine users: a quantitative review gist, 20, 623-636. of the evidence. Journal of Clinical Goldstein, R.Z., Leskorjan, A.C., Hoff, A.L., Experimental Neuropsychology, 27, Hitzemann, R., Bashan, F., Khalsa, S.S. 189-204. et al (2004). Neuropsychological im- King, N., Crawford, S., Wenden, F., Moss, pairment in cocaine and alcohol ad- N. & Wade, D. (1995). The Rivermead diction: Association with metabolism post concussion symptoms ques- in the prefrontal cortex. Neuropsy- tionnaire. Journal of Neurology, 242, chologia, 42, 1447-1458. 587-592. Grady, C.L. (1999). Neuroimaging and ac- Lezak, M.O., Howieson, D.B., Bigler, E.D. & tivation of the frontal .lobes In B.C. Tranel, D. (2012). Neuropsychological Mather, J.C. Cummings (eds.), the hu- Assessement (5ed). Oxford: Oxford man frontal lobes: function and disor- University press. ders. New York: Guilford Press. Lyons, M.J., Bar, J.C., Panizzon, M.S., Smith, A. (1991). Symbol digit modalities Toomey, R., Esen, S., Xian, H. & Tsu- Test. Los Angeles: Western Psycho- ang, M.T. (2004). Neuropsychological logical Services. consequences of marijuana use: a Hermann, D., Sartorius, A., Welzel, H., twin study. Psychological Medicine, Waltor, S. Skoff, G., Ende, G & Mann. 34 (7), 1239-1250. K. (2007). Dorsolateral Prefrontal Cor- Marton, T.A & Bush, S.S. (2008). Assess- tex N-acetyl aspartate/total Creatine ment tools and research methods for (NAA/ter) loss in male recreational human information processing speed. cannabis users. Biological Psychiatry, In J. Deluca and J. H. Kalmar (eds.), 61 (11), 1281-1291. information processing speed in clini- Hulka, L.M., Eisenegger, C., Preller, K.H., cal populations. New York: Routledge Vonmoos, M., Jenni, D., Bendrick, K. Taylor & Francis Group.

129 UCHEAGWU, UGWOKWE-OSSAI, OKOLI, & OSSAI

McCrady, B.S. & Smith, D. E. (1986). Im- Psychological Corporation (1997). WAIS plications of cognitive impairment for – III WMS – III technical manual. San the treatment of alcoholism. Alcohol Antonio, TX: Author. Clinical Experimental Research, 10 Reitan, R. M. & Wolfson, D. (1993). The (2), 145-149. Halstead- Reitan neuropsychological Mitrushina, M. N., Boone, K.B., & O’Elita, L.F. test battery (2nd ed). Tucson, A2: Neu- (1999). Handbook of normative data ropsychology Press. for neuropsychological assessment. Soar, K., Mason, C., Potton, A., Dawkins K. New York: Oxford University press. (2012). Neuropsychological effects as- Morrison, P.D., Zois, V., Mckeown, D.A., sociated with recreational cocaine use. Lee, T.D., Holt, D.W., Powell, J.F., Ka- Psychopharmacology, 222, 633-643. pur, S. & Murray, R. M. (2009). The Solowji, N., Stephens, R.S., Roffman, acute effects of synthetic intravenous R.A., Babor, T., Kadden, R., Miller, M., Delta-Tetrahydro cannabinol in psy- Christiansen, K., McRee, B., Vendeth, chosis, mood and cognitive function- J., Marynana, P. & Treatment Project ing. Psychological Medicine, 39 (10), Research Group (2002). Cognitive 1607-1616. functioning of long term heavy can- Pascoli, V., Terrier, J., Hiver, A & Luscher, nabis users seeking treatment. JAMA, C. (2015). Sufficiency of mesolimbic 6 (287), 1123-1131. dopamine neuron stimulation for the Solowy, W. & Battisti, R. (2008). The progression to addiction. Neuron, 88, chronic effects of cannabis on mem- 1054-1066 ory in humans: a review. Drug Abuse Pope, H.G, Gruber, A.J., Hudson, J.I., Co- Review, 1 (1), 81-98. hane, G; Heytis, M.A, & Yurferlun- Teichner G, Horner M.D., Roltzeh, J., Her- Toud, D. (2003). Early onset cannabis ron, J. & Theros, A (2002). Substance use and cognitive deficits: what is the abuse treatment outcome for cogni- nature of association? Drug Alcohol tively impaired and intact outpatients. Dependence, 69 (3), 303-310. Addictive Behaviours, 27 (5),751-763. Pope, H.G., Gruber, A.J., Hudson, J.I., Hes- Ucheagwu, V.A., Ugokwe-Ossai, R.N., tis, M.A., Yurgelun Todd, D. (2007). Okpaleke, U & Ugokwe J. (2017). Neuropsychological performance in Inter-trial reliability, cardio and de- long term cannabis users. Archives of mographic markers of Rey Auditory General Psychiatry, 58 (10), 909-915. Verbal learning test performance in Pope, H.G., Gruber, A.J., Hudson, J.I, Hues- young adult sample from Nigeria. tis, M.A., Yurgelun Todd, D. (2002). American Journal of Psychiatry and Cognitive measures in long term can- Neuroscience, Vol. 5 (6), 70-77. nabis users. Journal of Clinical Phar- Verdejo-Garcia, A.J., Lopes- Torrecillas, F., macology, 42 (11) (suppl), 415-475. Agular decross, F., Perez-Garcia, M. Preller, K., Hulka, L., Vonmoos, M., Jenni, (2005). Differential effects of MDMA, D., Baumgartner, M., Ozuebek, C.A. et cocaine and cannabis use severity in al (2014). Impaired emotional empa- distinctive components of the execu- thy and related social network deficits tive functions in Poly substance users: in cocaine users. Addiction Biology 19 a multiple regression analysis. Addic- (e-pub ahead of print). tive Behaviour 30 (1), 89-101.

130 NEUROPSYCHOLOGICAL PROFILES OF CANNABIS DEPENDENT USERS

Vonmoos, M., Hulka, L.M., Preller, K.H., Vonmos, M., Hulka, L. M., Preller, K.H., Jenni, D., Baumgartner, M.R., Stohler, Minder, F., Baumgartner, M.R. & R. et al (2013). Cognitive dysfunc- Quediow, B.B (2014). Cognitive im- tions in recreational and dependent pairment in cocaine users is drug cocaine users: role of attention defi- induced but partially reversible: Evi- cit hyperactivity disorder, craving and dence from a longitudinal study. Neu- early age at onset. British Journal of ropsychopharmacology, 39, 2200- Psychiatry, 203, 35-43. 2210.

131

African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications SUBSTANCE USE AMONG YOUTHS: ROLES OF PSYCHOTICISM, SOCIAL ALIENATION, THRIVING AND RELIGIOUS COMMITMENT

Steven Kator Iorfa, Chinedu Ugwu, Chuka Mike Ifeagwazi, & Johnbosco Chika Chukwuorji

Department of Psychology, University of Nigeria Nsukka, Enugu State, Nigeria

ABSTRACT

The rising levels of drug abuse among youths in the world require evidence-based, cost effective and research-informed intervention strategies. These strategies will need to be formulated around observed socio-demographic and psychosocial characteristics of youths who abuse drugs. This paper presents reports of two studies which investigated the roles of psychoticism, social alienation, religious commitment, and thriving in drug abuse among secondary school students (n = 293, 53% males) and undergraduates (n = 300, 76% males) students in southeastern Nigeria. The emerging psychoactive substances of abuse among the students were also explored. Participants completed measures of the relevant variables and provided their demographic information. Psychoticism and social alienation were positively significant predictors of substance abuse among secondary school students, while thriving and religious commitment were negatively significant predictors of substance abuse among university undergraduates. Itwas suggested that psychological factors such as psychoticism, social alienation, thriving and religious commitment be considered in drug use policies and intervention programmes for young persons in Nigeria.

Keywords: adolescents, drug abuse, intervention, prevention, psychoticism, thriving

INTRODUCTION cognition, behavior, or motor functions (The American Psychiatric Association, Substance abuse is the improper, ex- APA, 2000). Substance abuse has become cessive, irresponsible or self-damaging one of the most serious challenges and use of addictive substances (Reber & Re- threats to the life and wellbeing of young ber, 2001). Such substances when taken persons in several parts of the world, in- by a person modify perception, mood, cluding Nigeria (UNODC, 2018; Uwakwe

Corresponding Author: Steven Kator Iorfa, Department of Psychology, University of Nigeria Nsukka, Enugu State, Nigeria. Email: [email protected]; Phone: +2348130843373 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI

& Gureje, 2011). Williams (2016) posited young persons, we believe that the unify- that over 6 million bottles of codeine are ing factor for these studies is the investi- sold and available on a daily basis in the gation of psychosocial factors that predict North-West part of Nigeria. Even as the substance abuse among young people. government has placed sanctions on the Psychoticism is a personality pattern importation or production and sale of typified by aggressiveness and hostil- some of these commonly abused drugs ity towards others (Eysenck, 1993). More (e.g. codeine), the long term effects of ex- common traits that may be characteristic posure to and abuse of these drugs are still of psychoticism include impulsivity, sen- evident in the Nigerian society. Moreover, sation seeking, risk taking, and liveliness. imposing sanctions and making some Previous research (e.g., Farren, Hameedi, drugs illegal and medically unauthorized & Rosen, 2000; Johns et al., 2004; Ver- may not be the immediate solution to the doux, Sorbara, Gindre, Swendsen & Vans menace. Drug abusers have shifted from Os, 2002) established that psychoticism the abuse of conventional drugs such as is implicated as a predisposing factor to codeine, tramadol, cannabis, cocaine, drug abuse among addicts in experimen- nicotine and phencyclidine, to a mixture tal populations. of volatile solvents and a wide range of Social alienation is a social condition pharmaceutical preparations which go by characterized by distance and isolation varying names across different regions of between an individual and other mem- the country. bers of a society or group. Socially alien- Research has shown that abuse of ated persons perceive meaninglessness if drugs is influenced by several underlying they do not have fulfilling social encoun- psychosocial factors: peer pressure, per- ters or lack group ties and social roles that ceived recreational value of drug abuse, reflect such ties (Ifeagwazi, Chukwuorji, & neglect, depression, curiosity and force Zacchaeus, 2015). When looked at sub- (Khan & Shah, 2014). It is therefore impor- jectively, social alienation refers to a psy- tant that the underlying predispositions chological state where alongside feeling to drug abuse among young persons be isolated and detached from society, an investigated. These will not only help curb individual feels powerless and meaning- the abuse of drugs, but may help inform less. An alienated individual is only weak- better intervention strategies for addicts. ly attached to the goals of belonging to a This paper reports results from two stud- given society and may not be particularly ies examining the relationships between motivated to follow generally accepted psychoticism, social alienation, religious norms (Israel, 1994). Social alienation has commitment, thriving and drug abuse. been implicated to be another predispos- The first study examined psychoticism ing factor to drug abuse (e.g. Shedier & and social alienation among college stu- Block, 1990; Murray, 2014; Johnson, Pa- dents as predictors of substance abuse. gano, Lee, & Post, 2015). Nevertheless, The second study examined religious there is paucity of literature on psychoti- commitment and thriving as predictors of cism and social alienation in relation to substance abuse among university under- drug abuse in the sub-Saharan African graduates. Although the two studies were setting. To fill this gap in knowledge, the conducted using different samples of present study examines the role of social

134 SUBSTANCE USE AMONG YOUTHS alienation in substance abuse among stu- (2007) found that adolescents who abused dents in Nigeria. substances had significantly lower levels of Religious commitment sometimes re- psychological wellbeing and life satisfac- ferred to as religiosity is conceptualized tion. In the second study, we aim to inves- as a reflection of a social entity entailing tigate whether religious commitment and particular beliefs, customs and boundar- thriving predict substance use in a Nige- ies (Miller & Thoresen, 2003). It is the ex- rian sample of undergraduate students. tent to which an individual adheres to his Research in this part of the world on the or her religious values, beliefs and practic- issues of interest in the present study are es and uses them in his or her daily living relatively scarce. Hence the need for this (Worthington et al., 2003). Religious com- study. It was hypothesized that psychoti- mitment may also include the amount cism and social alienation will positively of time an individual spends in private predict substance abuse, while religious religious involvement and religious af- commitment and thriving will negatively filiation. It is important to note that re- predict substance abuse. ligious commitment (beliefs, practices and behaviors associated with organized Study 1 religious groups) is distinguishable from spirituality (a more personal and abstract METHOD beliefs and practices such as a sense of the divine in daily life or communication Participants and procedure with a transcendent power which may or Two hundred and ninety three partici- may not be associated with organized reli- pants (53% (155) males, Mage= 15 years, gious practices). Alaedein-Zawawi (2015) SD = 1.2) were drawn from a secondary reported that religious commitment may school in Enugu State. The first author influence all areas of an individual’s life visited the school and obtained the ap- either positively or negatively depend- proval of the school principal in order to ing on the level to which the individual conduct the study. With the permission is committed. Research has consistently of the principal, the researcher moved identified religious commitment as a pro- to the classes to recruit the participants tective influence against youth substance for the study. Two teachers in the school abuse (e.g., Bahr, Hawks & Wang, 1993; served as research assistants who accom- Nonnemaker, McNeely, & Blum, 2003; panied the researcher to the classrooms. Ritt-Olson, et al., 2004). After the introduction of the purpose of Thriving as a psychological construct re- the visit, students were requested to take fers to the integrative perspective of posi- part in a study on wellbeing of students. tive psychological health which cuts across Those who agreed to participate in the subjective wellbeing, happiness, purpose study were given the questionnaire packs and meaning in life. Research has estab- and asked to indicate their informed lished a link between substance abuse and consent by signing on the front page of various aspects of thriving. For instance, the questionnaire form. A total of three Khan and Shah (2014) reported an effect hundred copies of questionnaire forms of substance abuse on subjective wellbe- were administered at three different ing of young persons. Visser and Routledge classrooms. Participants took an average

135 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI of 13 minutes to respond to all the items are; “how often do you take alcoholic on the questionnaire form. All question- drink”, and “how often do you smoke can- naire forms were collected by the first nabis”. High scores on the questionnaire author and the research assistants on the represent high substance abuse. As re- spot. The first author and research assis- ported by Eze (2006), the instrument has tants examined each questionnaire be- content validity and test – retest reliabil- fore collecting and urged those that had ity index (r = .61). Reliability analysis and incompletely filled theirs to complete it confirmatory factor analysis yielded good before returning. However, seven copies fit for the present study (see Table 3). of the questionnaire forms were discard- ed due to incomplete filling. A return rate The psychoticism subscale of Eysenck of 97.6% was therefore observed. Personality Questionnaire Revised-Short Form (EPQR-S): The psychoticism subscale Measures of the EPQR-S (developed by Eysenck, Ey- Data for the first study were gathered via senck & Barrett, 1985) consisting of 12 self-report inventories. Respondents com- items was used to assess participants’ pleted a questionnaire form containing levels of psychoticism. Each question has the Psychoactive Substance Abuse Scale a binary response of ‘yes’ or ‘no’ and is (PSAS, Eze, 2006), The psychoticism sub- scored 1 or 0 for each dichotomous item. scale of Eysenck Personality Questionnaire Sample items on the psychoticism sub Revised-Short Form (EPQR-S) (Eysenck, Ey- scale include, ‘do you take much notice of senck & Barrett, 1985), Social Alienation what people think?’, ‘Would being in debt Scale (SAS) (Jessor & Jessor, 1977) and a worry you?’ ‘Would you like other people demographic section requesting them to to be afraid of you?’ etc. An earlier version indicate their age, gender, and list number of the scale had yielded acceptable reli- of substances they abuse and those they ability and validity in Nigeria (see Eysenck, knew friends and others abused. Adelaja, and Eysenck, 1977). Abiola, Udo- fia and Yunusa (2012) reported that the Psychoactive Substance Use Question- EPQ psychoticism domain correlated neg- naire (PSUQ): PSUQ, developed by Eze atively with agreeableness and consci- (2006), is a 6-item measure of the fre- entiousness as evidence of its construct quency of substance use. The items are validity. Eysenck, Eysenck and Barrett, scaled on a 4-point Likert format as fol- (1985) reported an internal consistency lows: never used it = 0, used it not more of .68 for males and .51 for females. In in- than twice in a week = 1, used it less than terpreting the test, higher scores indicate thrice in a week = 2, used it more than a manifestation of the typical personality thrice in a week = 3, used it frequently in characteristic of psychoticism. Reliability the past but stopped = 4. Substances in- analysis and confirmatory factor analysis cluded in the instrument were alcohol, to- yielded good fit for the present study (see bacco, heroine, cannabis, cigarette, kola- Table 3). nut and amphetamine. Provision was also made for participants to specify other Social Alienation Scale (SAS): The Social substances they used that are not among Alienation Scale was developed by Jessor the listed ones. Sample items in the scale and Jessor (1977). The scale measures

136 SUBSTANCE USE AMONG YOUTHS generalized alienation with respect to positive correlations were observed be- uncertainty about the meaningfulness of tween psychoticism, social alienation and daily roles, activities and the belief that substance abuse. As evident from Table 1 one is isolated from others. It is made above, there are significant associations up of 15 items that have a Likert-type re- between the study variables. The posi- sponse format of ‘strongly agree’, ‘agree’, tive correlations suggest that higher lev- ‘disagree’ and ‘strongly disagree’. Scores els of psychoticism and social alienation range from 15 to 60 with higher scores in- in respondents are associated with higher dicating higher alienation. Sample items substance abuse. include, ‘I sometimes feel that children Result of the hierarchical multiple re- I know are not too friendly’, ‘I often feel gression in Table 2 in which substance alone when I am with other people’, and abuse was entered as the criterion variable ‘Hardly anyone I know is interested in indicates that the demographic variables how I really feel inside’. Safipour, Tessma, entered in the equation as controls collec- Higginbottom & Emami (2010) reported tively accounted for a 2% variance in sub- an internal consistency using Chronbach’s stance abuse. However, only age (β =.16, alpha of .81. Reliability analysis and con- t = 3.72, p<.05) significantly and positively firmatory factor analysis yielded good fit predicted substance abuse. This means for the present study (see Table 3). that for every one unit increase in age of respondents, substance abuse increased Statistical Analysis by .16 units. Thus, older students reported Confirmatory factor analysis and item abusing drugs more often than younger analysis were first conducted to validate students. When psychoticism was entered the measures. Thereafter, Pearson’s cor- in step 2 of the equation, it contributed a relation (r) analysis was conducted among significant 12% variance observed in sub- the study variables while hierarchical mul- stance abuse. Psychoticism positively and tiple regressions was employed to statisti- significantly predicted substance abuse (β cally test the hypotheses for the study. = .21, t = 6.23, p<.01). This means that for every one unit increase in psychoticism, substance abuse increases by .21 units. RESULTS Social alienation entered in the last step of the equation raised the variance ob- Table 1 showed the intercorrela- served in substance abuse to 17%. Social tions among study variables. Significant alienation also significantly and positively

Table 1. Intercorrelations between variables in Study One

Variables 1 2 3 4

1. Age 1 2. Gender .01 1 3. Psychoticism .16 .04 1 4. Social Alienation -.13* -.06 .28* 1 5. Substance Abuse .37** .08 .54** .33** Note. N = 293, * = p < .05 (two-tailed), ** = p < .01 (two-tailed), *** = p < .001 (two-tailed). Gender was coded 0 = female, 1 =male.

137 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI

Table 2. Hierarchical multiple regression predicting substance abuse by psychoticism and social alienation

Variable Step 1 Step 2 Step 3 Β β Β

Controls Age .16* .15* -.15* Gender .04 .03 .02 Predictors Psychoticism .21** .21** Social Alienation .29** Adjusted R2 .02 .12** .17** ∆R2 .03 .10** .15 ∆F 7.09 32.46** 26.6**

* = p < .05, ** = p < .01, *** = p < .001.

Table 3. Goodness of Fit indicators for the measures used in studies 1 & 2

Scale α χ2 Df χ2/Df CFI TLI RMR GFI RMSEA(90% CI)

EPQ-R (P) .67 491 170 2.8 .83 .88 .05 .95 .06(.07-.08) SAS .82 491 169 2.9 .88 .87 .05 .91 .04(.03-.05) RCS-10 .80 133.5 35 3.8 .85 .72 .04 .92 .07(.08-.09) BIT .93 256 143 1.8 .90 .89 .04 .96 .04(.03-.05) PSAS .78(.71) 247.8 20 12.3 .70(.76) .60(.80) .10(.06) .81(.87) .19(.17-.22)

Note: α=Cronbach’s alpha (>0.6 suggests adequate internal reliability, <0.6 suggests poor internal reliability) CFI: comparative fit index (>0.95 suggests good fit, >0.9 suggests adequate fit, <0.9 suggests poor fit); TLI: tucker Lewis Index (> 0.95 indicates good fit, >0.9 suggests adequate fit, <0.9 suggests poor fit); RMR: root mean residual (<0.05 suggests good fit, <0.08 suggests adequate fit, >0.08 suggests poor fit); GFI: Goodness of fit Index (> 0.95 indicates good fit, >0.9 suggests adequate fit, <0.9 suggests poor fit) RMSEA: root mean square error of approximation (< 0.05 is good fit, <0.08 is adequate fit, >0.08 is poor fit) CI: confidence interval. Values for PSAS in bracket represent indices obtained from study 2; RMSEA for study 1 and 2 were the same. predicted substance abuse (β = .29, t = of the University of Nigeria, Nsukka par- 4.18, p<.01). This means that for every unit ticipated in this study. Respondents were increase in social alienation, substance majorly Igbo (82.3%) while others were abuse or proneness to substance abuse Yoruba (4.3%), Hausa (6%) and other increases by .29 units. It was therefore ob- ethnic groups (7.3%). With respect to served that age, psychoticism and social al- religious affiliation, 90.7% of the respon- ienation are predictors of substance abuse dents reported being Christians while among secondary school students. 5% reported being Muslims and 4.3% belonged to the African Traditional Reli- Study 2 gion. Forty-two percent had stayed in the boarding houses during their secondary Participants and Procedures school education while 58% attended sec- Three hundred (76% (228) males, ondary schools from homes. As regards

Mage=17, SD=2.3) undergraduate students to accommodation in the University, 49%

138 SUBSTANCE USE AMONG YOUTHS of the participants were living off cam- they abuse and those they knew friends pus, 26% in the University hostels, 12.7% and others abused. were living either with their parents or grandparents and 12.3% lived within the Religious Commitment Inventory, RCI-1O: University Staff quarters. They were con- RCI-1O (Worthington, et al., 2003) assess- veniently sampled by the first author and es one’s level of religious adherence in some research assistants at three differ- daily life and the extent to which an indi- ent times; during a sports event at the vidual interprets life events based on his/ Stadium, University of Nigeria Nsukka, her religious views. It was designed for re- during a social psychology class and at search and clinical use. The 10 items of the their apartments. Informed consent was inventory are arranged on a 5-point Likert got by asking respondents to indicate type scale: not at all true of me (1), some- willingness to participate in the study. what true of me (2), moderately true of Those who indicated by signing were ad- me (3), mostly true of me (4) and totally ministered the questionnaire individually. true of me (5). Sample items of the scale They were informed that they were free include: ‘my religious beliefs lie behind to withdraw from the study at any point my whole approach to life’ (intraperson- without facing any consequences. A total al), and ‘I enjoy working in the activities of of three hundred copies of questionnaire my religious organization’ (interpersonal). forms were administered and retrieved Worthington et al. (2003) reported 6 dif- at the different occasions giving a- re ferent studies for the development and turn rate of 100%. Response time varied refinement of RCI - 10, in large heteroge- from 7-14 minutes for the different occa- neous samples, including college students sions. All questionnaire forms were col- and university undergraduates. Scores on lected on the spot. The first author and the RCI-1O had strong estimated internal some research assistants examined each consistency with Cronbach’s alpha rang- questionnaire form before collecting and ing from .93 - .96 (Worthington et al., urged those that had incompletely filled 2003). A previous study in Nigeria had theirs to complete it before returning. replicated the two factor structure of RCI- 10 (See Ifeagwazi & Chukwuorji, 2014). Measures Another study by Chukwuorji, Ituma and Data for the second study were gath- Ugwu (2017) obtained Cronbach’s alpha ered via self-report inventories. Re- values of .85 (full scale), .79 (intraperson- spondents completed a questionnaire al religious commitment) and .74 (inter- form containing the Psychoactive Sub- personal religious commitment). Higher stance Abuse Scale (PSAS, Eze, 2006), scores on the inventory indicate higher Religious Commitment Inventory, RCI-10 religious commitment. Reliability analysis (Worthington et al., 2003), the Brief In- and confirmatory factor analysis yielded ventory of Thriving (BIT, Su, Tay, & Diener, good fit for study 2 (see Table 3). 2013) and a demographic section request- ing them to indicate their age, gender, Brief Inventory of Thriving (BIT): The BIT religion, ethnic group, type of secondary (Su, Tay & Diener, 2014) was used to as- school attended, type of accommodation sess participants’ perceived levels of sub- in school and list number of substances jective wellbeing. It is a 5-point Likert-type

139 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI scale, consisting of 10 items, responded to the measures (results are given in Table on a response format ranging from strong- 3). Thereafter, Pearson’s correlation (r) ly disagree (1) to strongly agree (5). It con- analysis was conducted among the study sists of items such as “There are people variables while hierarchical multiple re- who appreciate me as a person”, “I feel a gressions was employed to statistically sense of belonging to my community”, “I test the hypotheses for the study. feel good most of the time”. All items are directly scored. Possible range of scores Results was from 10-50. High scores indicate the Table 4 shows the intercorrelations presence of subjective wellbeing while among study variables. There were nega- low scores reflect a negative evaluation of tive correlations between thriving and one’s life and consequently low levels or substance abuse, as well as religious com- possible absence of wellbeing. The validity mitment and substance abuse. and reliability of the BIT has been demon- The results of the hierarchical multiple strated in various studies. For example, Su, regression in Table. 5 in which substance Tay, and Diener (2014) reported a reliabil- abuse was entered as the criterion vari- ity coefficient of α = .90. The convergent able indicate that the demographic vari- validity for the BIT was established using ables entered in the equation as controls the Satisfaction with Life Scale (Diener et collectively accounted for a 10% variance al., 1985) (r = .29, p < .001), and a Cron- in substance abuse. However, only type bach’s α of .87 was obtained. (Chukwuorji, of secondary school attended (β = .06, Iorfa, Nzeadibe, & Ifeagwazi, in press). Re- t = 1.72, p<.05) and type of accommo- liability analysis and confirmatory factor dation in school (β =.02, t =1.07, p<.05) analysis yielded good fit for the present significantly and positively predicted study (see Table 3). substance abuse. This means that re- spondents who had attended day sec- Statistical Analyses ondary schools abused drugs more than Confirmatory factor analysis and item those who had attended boarding sec- analysis were first conducted to validate ondary schools. Also, students who stay

Table 4. Pearson’s correlations of demographic factors and study variables

Variables 1 2 3 4 5 6 7

1. Gender - 2. Ethnic group .19 - 3. Religion -.11 .16** - 4. Type of sec school -.04 -.13* .00 - 5. Accommodation in school -.04 -.01 .03 .27** - 6. Substance Abuse -.21** .10 .16** .08* .11* - 7. Thriving -.09 .03 .11 -.05 .01 -.75** - 8. Religious Commitment .01 -.03 -.04 .02 .11 ­-.63** .83**

Note. N = 300, * = p < .05 (two-tailed), ** = p < .01 (two-tailed), Gender was coded 1 = male, 2 =female. Ethnic group, 1= Igbo, 2= Yoruba, 3= Hausa, 4= Others; Religion, 1= Christianity, 2= Islam, 3= African Traditional Religion; Type of Secondary School, 1= Boarding house, 2= Day school; Accommodation in school, 1= living with parents, 2= School hostel, 3= Staff quarters, 4= off campus

140 SUBSTANCE USE AMONG YOUTHS

Table 5. Hierarchical multiple regression predicting substance abuse by thriving and religious commitment Variable Step 1 Step 2 Step 3 Β Β Β Controls Gender -.07 -.10 -.10 Ethnic Group .02 .03 .03 Religion .10 .11 .11 Type of Secondary School .06* .07* .07* Accommodation in School .02* .04* .05* Predictors Thriving -.13* -.12* Religious Commitment -.37** Adjusted R2 .10 .12* .32** ∆R2 .12 .11* .21** ∆F 1.2 4.40* 7.61** * = p < .05, ** = p < .01, *** = p < .001. outside the school campus either with Data on emerging psychoactive sub- their parents or by themselves reported stances abused were also gathered from higher substance abuse than those who studies 1 & 2. The results is presented in stayed in school hostels. When thriving Table 6 below. It was observed that apart was entered in step 2 of the equation, it from the common psychoactive substanc- contributed a significant 12% variance es abused by youths, new and emerging observed in substance abuse. Thriving substances which most times are a com- negatively and significantly predicted bination of two or more other drugs have substance abuse (β= -.13, t = -3.25, surfaced and are known by varying names p<.05). This means that for every one in different locations across the country. unit increase in thriving, substance abuse Table 6 presents alongside the name of decreases by .13 units. Religious com- the drug, the percentage of participants mitment entered in the last step of the in the study who had either used it, seen equation raised the variance observed in someone use it or have heard of it. substance abuse to 32%. Religious com- mitment also significantly and negatively predicted substance abuse (β = -.37, t = DISCUSSION -7.18, p<.01). This means that for every unit increase in religious commitment, The aim of this study was to examine substance abuse or proneness to sub- the roles of psychoticism, social alien- stance abuse decreases by .37 units. It ation, thriving and religious commitment was therefore observed that age, type in substance abuse. The present study es- of secondary school, type of accommo- tablished strong association between sub- dation in school, thriving and religious stance abuse and psychoticism, social alien- commitment are predictors of substance ation, thriving and religious commitment. abuse among university undergraduates. While the first study looked at predisposing

141 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI

Table 6. Emerging psychoactive substances abused by young persons in Nigeria

Substance Reason for intake Mode of intake % of awareness % of awareness in Study 1 in Study 2

Marijuana (Kpoli, Igbo, ganja) Euphoria Smoking, chewing 53% 89.6% Black Mamba (spice, Colorado,) Euphoria Smoking 7% 85% Codeine (blunts) Euphoria Injestion 32% 77% Tramadol Euphoria, delay Ingestion (singly/mixed 34% 98% ejaculation, with alcohol/coca-cola) Rohypnol (Roko, roofies, renfol, Euphoria, Crushed/snorted, smoked 6% 68% etc.) with Marijuana, dissolved in drinks Alabukun Treat hangover Sniffing/mixed with alcohol 3% 47% Dexacoitin Gain weight Ingestion 0% 34% Aspirin Euphoria Ingestion (singly/mixed 3% 57% with alcohol/coca-cola, Valium Relaxation Injestion, Injection 7% 33% Gum Euphoria Sniffing 79% 54% Soakaway Euphoria Sniffing 12% 34% Monkey tail (local gin brewed Increase libido Ingestion 8% 67% in marijuana leaves, stems, roots, seeds) Gutter water (a combination Euphoria Ingestion 0% 3% of codeine, refnol, tramadol, cannabis, and water/juice Dongoyaro Euphoria Ingestion 43% 78% Molly Euphoria Swallowed 0% 6% Storm Increase libido Swallowed 0% 20% Cloud 9 (ZB, bath salt) Euphoria Swallowed 0% 1% Ecstasy (Rolls) Euphoria Swallowed, snorted, 0% 13% smoked, injected factors to substance abuse, the second ing substance abuse at the secondary study looked at positive concepts that may school level, we found that the menace buffer substance abuse in youths. has become common among adolescents It was found in this study that the more in secondary schools. Type of secondary psychoticism traits reported by the- par school (whether boarding or day) attend- ticipants, the more the level of substance ed also had influences on drug abuse later abuse as well. Therefore the hypoth- in the university. As observed from the re- esis which stated that psychoticism will sults, secondary school students who had positively predict substance abuse was attended day schools during their second- supported. The implications of this in in- ary education, abused drugs more than tervention and therapy is that anti-drug those who stayed in the boarding house. campaigns, intervention strategies and Also, undergraduate students who were therapeutic approaches ought to include not living in campus hostels abused more efforts at reducing the manifestation of drugs than their counterparts who stayed psychotic traits in individuals. Investigat- in the university hostels.

142 SUBSTANCE USE AMONG YOUTHS

This study also found significant and In the second study, it was found that positive prediction of substance abuse by religious commitment was a negative social alienation. Therefore the hypothe- predictor of substance abuse. In other sis which stated that social alienation will words, those who were more religiously positively predict substance abuse was committed reported less use of psychoac- supported. Integrating social inclusion as tive substances. Therefore the hypothesis an intervention strategy and creating a which stated that religious commitment sense of belonging among drug addicts will negatively predict substance abuse may prove instrumental in psychosocial was supported. The finding is consistent interventions for substance abuse. Earlier with finding by some authors (e.g., Bahr, studies had also touched on social inclu- Hawks & Wang, 1993; Nonnemaker, Mc- sion as a therapeutic approach to drug Neely, & Blum, 2003; Ritt-Olson, et al., addiction. For instance, Alexander (2010) 2004) that have consistently identified re- reported experiments in which rats in sol- ligious commitment as a protective influ- itary confinement consumed more drugs ence against youth substance abuse. By than rats which were allowed to social- implication, fostering stronger religious ize. Addiction may create a cage for the beliefs and adherence to the tenets of addicted and therefore the need to bring one’s religion may make the students less them out of that cage for social inclusion likely to engage in abuse of substances. into the society. Social inclusion thera- Thriving was also found to be a nega- pies may need to be client oriented with tive predictor of substance abuse. Previ- self-directed goals. In emphasizing social ous research has established a link be- inclusion for the addict, therapists and tween substance abuse and various as- clinicians must have in mind that addicts pects of thriving (e.g., Khan & Shah, 2014; are more prone to developing networks Visser & Routledge, 2007). Therefore the based on their problems rather than the hypothesis which stated that thriving will presenting solutions. Therefore, group negatively predict substance abuse was therapies and good social networks may supported. Efforts and psychosocial in- be suggested to the addict. terventions to enhance the psychological The society must also strive for col- well-being and functional mental health lectivism- a more collective attitude that of youths must be given priority in the so- broods a sense of belonging to every ciety. By so doing, the abuse of substanc- member of the community. Social exclu- es may be reduced. However, it should sion also may result from other socioeco- also be noted that the use of substances nomic factors such as unemployment, also impacts negatively on mental health poor housing, family breakdown and status. disputes. This calls for government and Our study has some noteworthy limita- other agencies involved to work on im- tions. As a crosssectional research, it has plementing policies that revolve around all the inherent weaknesses of this type poverty reduction and crime eradication of research design. Although we consid- in the society. These and many other fac- ered the four independent variables fac- tors may be indirectly responsible for the tors in substance abuse, it is possible that high rate of substance abuse observed in substance abuse also influences one’s the country. perceived alienation, psychotic traits,

143 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI religious commitment and thriving. We REFERENCES suggest the adoption of longitudinal de- signs in future research to clarify the caus- Abiola, T., Udofia, O., & Yunusa, S. (2012). al mechanisms of effect among the vari- Reliability and concurrent validity of ables. We used self-rated substance abuse the International Personality item and the predictor variables by students Pool (IPIP) Big-five Factor Markers in in a secondary school university located Nigeria. Nigerian Journal of Psychia- in South eastern Nigeria. The sample was try, 10(2), 1-8. not religiously diverse because of the pre- Alaedein-Zawawi, J. (2015). Religious com- dominance of Christians in the student mitment and psychological wellbeing: population. Therefore, the generalizabil- Forgiveness as a mediator. European ity of the findings is limited. Researchers Scientific Journal, 11 (5), 117-141. should in future consider a more religious- Alexander, B. (2010). Globalization of ad- ly and ethnically heterogeneous group in diction: A study in poverty of the spir- order to make better generalisations. it. London: Oxford University Press. American Psychiatric Association (APA). (2000). Diagnostic and statistical CONCLUSION manual of mental disorders. Wash- ington, DC: American Psychiatric As- Youth addiction has become a major sociation. public health concern, not only in Nige- Bahr, S. J., Hawks, R. D., & Wang, G. (1993). ria, but all over the world. This is partly Family and religious influences on ad- due to the over availability of prescription olescent substance abuse. Youth and medication/over the counter drugs and Society, 24, 443-465. the ease in procuring street drugs (mari- Chukwuorji, J. C., Iorfa, S. K., Nzeadibe, juana, cocaine, nicotine, etc.). While the T. C., & & Ifeagwazi, C. M. (In press). government and other regulatory agen- Role of climate change awareness cies fight this menace from the top, it is and pro-environmental behaviour in essential that a grass root approach that subjective wellbeing. Nigerian Jour- integrates evidence-based, cost effective nal of Social Sciences, 14(1&2). and research-informed intervention strat- Chukwuorji, J. C., Ituma, E. A., & Ugwu, L. egies be adopted to fight the menace at E. (2017). Locus of control and aca- individual levels. The findings from this demic engagement: Mediating role of study will help inform proper therapeu- religious commitment. Current Psy- tic approaches and intervention strate- chology. First online. doi: 10.1007/ gies for tackling substance abuse among s12144-016-9546-8. young persons. Taken together, these re- D’Souza, D. C., Perry, E., MacDougall, L., sults have implications for clinical practice Ammerman, Y., Cooper, T., Wu, Y. T… and counselling among youths. Clients Krystal, J., H. (2004). The psychoto- who are inclined to religious commitment mimetic effects of intravenous del- may respond better to therapies that in- ta-9-tetrahydrocannabinol in healty corporate religious teachings and create individuals: implications for psycho- room for clients (who are willing) to dis- sis. Neuropsychopharmacology, 29, cuss religious themes with therapists. 1558-1572.

144 SUBSTANCE USE AMONG YOUTHS

Diener, E. D., Emmons, R. A., Larsen, R. J., Israel, J. (1994). Alienation: fran Marx till & Griffin, S. (1985). The Satisfaction modern sociologi. Helsinki: Tammi. With Life Scale. Journal of Personality Jessor, R., & Jessor, S. (1977). Problem Assessment, 49(1), 71-75. behavior and psychosocial develop- Eysenck, H. J. (1993). Creativity and per- ment. New York: Academic Press. sonality: Suggestions for a theory. Johns, L. C., Cannon, M., Singleton, N., Psychological Inquiry, 4(3), 147-178. Murray, R. M., Farrell, M., Brugha, T… Eysenck, S. B. G., Adelaja, O., & Eysenck, Meltzer, H. (2004). Prevalence and H. J. (1978). A comparative study of correlates of self-reported psychotic personality in Nigerian and English symptoms in British populations. subjects. Journal of Social Psychology, British Journal of Psychiatry,, 185 102, 172-178. 298-305. Eysenck, S. B. G., Eysenck, S. J., & Barret, Johnson, B. R., Pagano, M. E., Lee, M. T., P. (1975). A revised version of the psy- & Post, S. G. (2015). Alone on the in- choticism scale. Personality and Indi- side: The impact of social isolation vidual Differences, 6, 21-29. and helping others on AOD use and Eysenck, S. J., & Eysenck, S. B. G. (1975). criminal activity. Youth and Society, 1, Manual of the Eysenck Personality 1-22. Questionnaire (adult and junior). Lon- Khan, I., & Shah, S. A. (2014). Subjec- don: Hodder and Stoughton. tive wellbeing and substance depen- Eze, J. E. (2006). Cult membership as a de- dence: A comparative study. Indian terminant of psychoactive substance Journal of Positive Psychology, 5 (3), abuse among male undergraduates in 280-285. Nigerian Universities.Nigerian Journal Murray, D. (2014). Hard to study: The diffi- of Psychological Research, 5, 28-36. culty in measuring Marijuana’s value. Farren, C. K., Hameedi, F. A., & Rosen, Washington, DC: Hudson Institute. M. A. (2000). Significant interactions Available at http://www.hudson.org/ between clozapine and cocaine in co- research/10604-hard-to-study-the- caine addicts. Drug and Alcohol De- difficulty-in-measuring-marijuan-s- pendence, 59, 153-163. value Hari, J. (2015). Chasing the scream: The Nonnemaker, J. M., McNeely, C. A., & first and last days of the war on drugs. Blum, R. W. Public and private do- United Kingdom: Bloomsbury. mains of religiousity and adolescent Ifeagwazi, C. M., & Chukwuorji, J. C. health risk behaviors: Evidence from (2014). Relationship of religious com- the National Longitudinal Study of mitment and posttraumatic growth: Adolescent Health, Social Science and Moderating role of gender. Nigerian Medicine, 57, 2049-2050. Journal of Psychological Research, 10, Peters, D. (2015). Social exclusion and 20-35. addiction: Creating a sense ofbe- Ifeagwazi, C. M., Chukwuorji, J. C. & Zac- longing. Paper presented at the chaeus, E. A. (2015). Alienation and Australian and New Zealand Addic- psychological wellbeing: Moderation tion conference, Gold Coast, 20- by resilience. Social Indicators Re- 22 May. Available at http://www. search, 120(2), 525-544. mentalhealthcarersnsw.org

145 IORFA, UGWU, IFEAGWAZI, & CHUKWUORJI

Reber, A. S., & Reber, E. S. (2001). The wdr2018/prelaunch/Pre-briefingAM- Penguin dictionary of psychology (3rd fixed.pdf ed.). London: Penguin. Uwakwe, R., & Gureje, O. (2011). The re- Ritt-Olson, A., Milam, J., Unger, J. B., Trini- lationship of comorbidity of mental dad, D., Teran L., Dent, C. W., & Suss- and substance use disorders with sui- man, S. (2004). The protective influ- cidal behaviors in the Nigerian survey ence of spirituality and “Health-as-a- of mental health and wellbeing. So- value” against monthly substance use cial Psychiatry & Psychiatric Epidemi- among adolescents varying in risk. ology, 46, 173-180. Journal of Adolescent Health, 34 (3), Verdoux H., Sorbara, F., Gindre, C., Swend- 192-199. sen, J. D., & vans Os, J. (2002). Canna- Safipour, J., Tessma, M. K., Higginbot- bis use and dimensions of psychosis tom, G., & Emami, A. (2010). Measur- in a nonclinical population of female ing social alienation in adolescence: subjects. Schizophrenia Research, 59, Translation and validation of the Jes- 77-84. sor and Jessor Social Alienation Scale. Visser, M., & Routledge, L., (2007). Sub- Scandinavian Journal of Psychology, stance abuse and psychological well- 51, 517-524. being of South African adolescents. Shedier, J. & Block, J. (1990). Adolescent South African Journal of Psychology, drug use and psychological health: A 37 (3), 595-615. longitudinal inquiry. American Psy- Worthington, E. L., Jr., Wade, N. G., Hight, chologist, 45 (5), 612-630. T. L., Ripley, J. S., McCullough, M. E., Su, R., Tay, L., & Diener, E. (2014) The de- Berry, J. W., Schmitt, M. M., Berry, velopment and validation of Compre- J. T., Bursley, K. H., & O’Conner, L. hensive Inventory of Thriving (CIT) (2003). The religious commitment and Brief Inventory of Thriving (BIT). inventory-10: Development, refine- Applied Psychology: Health and Well- ment, and validation of a brief scale being, 6 (3), 251-279. for research and counselling. Jour- United Nations Office on Drugs and nal of Counselling Psychology, 50, Crime, UNODC (2018, June 20). World 84-96. Drug Report 2018. Pre-briefing to the Wylie, A. S., Scott, R. T., & Burnett, S. J. member states. Vienna: Author. Re- (1995). Psychosis due to Skunk. Brit- trieved from https://www.unodc.org/ ish Medical Journal, 311 (6997), 125.

146 African Journal of Drug & Alcohol Studies, 17(2), 2018 Copyright © 2018, CRISA Publications COMMUNITY PERSPECTIVES ON CULTURAL PRACTICES AND BELIEF SYSTEMS INFLUENCING ALCOHOL AND DRUG USE: A QUALITATIVE STUDY IN ANAANG COMMUNITY, NIGERIA

Nsidibe A. Usoro1, Dorothy N. Ononokpono2, Ursula Ette3, & Nkereuwem N. James4

1,2Department of Sociology and Anthropology, University of Uyo, Uyo, Nigeria; 3Ministry of Health, Akwa Ibom State, Uyo, Nigeria; 4Department of Establishments, Akwa Ibom State, Uyo, Nigeria

ABSTRACT

Alcohol and drug use are socially sewn into cultural practices and belief systems in societies. This has been the case with Anaang community. This qualitative study examined narratives in a natural setting to gain insights on cultural practices relating to alcohol and drug use in Anaang society. The methods of study were participant observation and in-depth interview with 80 participants. The study found that some cultural activities harbour causal factors to alcohol use. Majority of participants reported using alcohol in conformity with societal norms and values. Participants differed in opinion concerning drug use. Some confessed using drugs out of personal conviction. Conversely, a good proportion of participants believed that cultural practices and belief system have either overtly or covertly lured them into drug use. Participants unanimously identified low literacy rates, ignorance and lack of effective regulatory mechanism as precursors to alcohol and drug use in local communities. This study mediated through Anaang cultural practices and belief system to derive informed insights that are needful for designing culture-sensitive-programme of preventive intervention for alcohol and drug use in local communities in Nigeria.

INTRODUCTION for medical and scientific use, while- re ducing the elicit use of narcotic drugs and The world drug problem remains a psychotropic substances(Common Afri- common and shared responsibility that can Position [CAP] for the UN General As- requires effective and increased -inter sembly Special Session on the World Drug national cooperation and demands an Problem, 2016). integrated, multidisciplinary, mutually Globally, alcohol use and misuse ac- reinforcing and balanced approach to count for 3.3 million deaths every year, or drug supply, demand reduction and harm 6percent of all deaths (Sudhinaraset, Wig- reduction strategies, as well as ensuring glesworth & Takeuchi, 2016). The debilitat- the availability of controlled substances ing effects of alcohol and drug misuse are USORO ET AL. not only complex but far reaching, ranging Binge drinking is conceptualized here from individual health risks, mortality, mor- as the number of instances in the past bidity and many other unpleasant conse- 12months that women drank 4 or more quences for family, friends, associates and drinks and men drank 5 or more drinks the society at large. Many researches and within a 2-hour period (Sudhinaraset, studies on alcohol and drug abuse seem et al. 2016). Among racial and ethnic to have a dedicated focus on risk factors, groups, researches have shown that, from the societal perspectives down to the Whites report the highest overall al- individual level (Sudhinaraset et al. 2016). cohol use among persons age 12 and According to a report from World Health over(57.4 percent). American Indian/ Organization[WHO] report, cited in Center Alaska Natives report the highest - lev for Disease Control and Prevention(2014), els of binge drinking (30.2percent), fol- Worldwide, 3.3million deaths were at- lowed by Whites (23.9percent), Hispanic/ tributed to alcohol misuse in 2012. Exces- Latinos(23.2percent), African American sive alcohol use is the third leading cause (20.6 percent), and Asians (12.7percent) of death in the United States, accounting (SAMHSA, 2013). for 88,000 deaths per year. Alcohol-attrib- Asians, on the other hand, generally utable disease and injury are responsible are thought to have higher abstention for an estimated 4percent of mortality and rates compared with other racial and 4 to 5 percent of disability-adjusted life- ethnic groups, especially when they are years[DALYs] (Rehm and Popova, 2009). integrated within their ethnic cultures In the United States alone, the costs of (Cook, Mulia & Karriker-Jaffe, 2012). One excessive alcohol use were estimated at measure of the retention of ethnic values $223.5billion in 2006 or $746 per person and cultural norms is generation status. (Bouchery, Harwood & Sacks, J. 2011). That is, the longer immigrants have lived Much of these costs accounted for dwin- in the United States, the more likely they dling productivity at work place as well are to acculturate to the cultural norms of as health care expenses, criminal justice their destination community (Berry, Phin- involvement and motor vehicle crashes ney, Sam, & Vedder, 2006). Lower levels (Rehm et al. 2009). Sudhinaraset, et al. of ethnic identity may be one explana- (2016) reported that alcohol consumption tion for these differences across Asian varies across gender, race or ethnic incli- subgroups. Japanese Americans, Filipino nation. Across the world, men consumed Americans, and Korean Americans often more alcohol than women, and women have been in the United States longer in more developed countries drink more than other Asian subgroups, such as Cam- than women in developing countries. bodians, Thais, and Vietnamese, and also American men are much more likely than report higher levels of alcohol use com- women to use alcohol (56.5percent Vs pared with other Asian Americans and 47.9 percent respectively, to binge drink Asian immigrants (Iwamoto, Takamatsu (30.4percent Vs 16percent respectively) & Castellanos, 2012). Ethnic identity may and to report heavy drinking (9.9percent promote stronger family values and tra- Vs 3.4 percent, respectively) (Substance ditional ties, leading to lower levels of Abuse and Mental Health Services Ad- alcohol use. Moreover, Asian-American ministration [SAMSHA], 2013). adolescents who have a high attachment

148 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS to family or who share their family’s neg- regional hot spots and having emphasized ative attitudes toward drinking are less hot-button topics such as HIV AIDS, ma- likely to consume alcohol (Hahm,, Lahiff, laria, and lagging agricultural production, & Guterman, 2003). Carson turned his attention to a topic Scholars have amply documented Afri- that he reminded his audience would not can drinking practices. The history of drug have been included on his list of “African use is much less studied, but in the recent problems” a decade or even five years past at least illicit drug use has become ago (Marry, 2016). Addressing a large au- ubiquitous in many African societies. And dience at the African Studies Association the fact is that African fiction and auto- meeting in Washington in mid-November, biography are awash in alcohol—and in- Carson, who has had a long career at State creasingly provide rich accounts of local and was formerly Ambassador to Kenya, drug cultures as well (Marry, 2016). In a Zimbabwe and Uganda, reminded fellow panel on “Drugs in Africa” at the African Africanists that a claimed 40% of illicit Studies Association annual meeting in drugs interdicted in Europe had passed Washington, DC in November, Donna Pat- through West Africa. What is a major is- terson, a historian in the Department of sue for Europe and the USA must there- Africana Studies at College, presented a fore become a major issue for Africa. paper on “Drug Trafficking in Africa: His- All of the focus on Guinea Bissau as torical Cases from West Africa,” which the first African narcostate has tended to in contrast to other papers on the panel distract us—according to Carson—from looked at the commerce in legal pharma- a much broader and growing pattern of ceuticals. The discussion that followed drug trafficking throughout Africa. Al- made clear the value of exploring the though Guinea Bissau may provide a dra- histories “legal” and “illegal” drugs in matic tale of high level politicians in the conjunction one with the other—some- thrall of global drug lords gunning each thing that has rarely been done for Africa, other down in the ramshackle capital of where the focus has been much more on a marginal state, the drug trade routes understanding the linkages between “tra- run through virtually every West African ditional” and Western medicine. At the country and certainly through Sénégal, same time, the discussion led us to con- Côte d’Ivoire, Ghana and especially Nige- sider how those very linkages might in- ria—which has been a nexus of trafficking form our understanding of the trade and and drug gangs that spread across five consumption of various kinds of drugs— continents through networks that reach however categorized—in African societ- across the Indian Ocean as well as the ies. Are Africans simply more abstemi- Atlantic. Unsurprisingly, Carson made the ous? This is hardly the case (Marry, 2016). case for US official support for efforts in In a recent talk on “African Issues” and African countries to combat the trade. US policy on those issues, Assistant Secre- Again unsurprisingly, he talked exclusively tary of State for African Affairs, Ambassa- about the need to provide moral, material dor Johnnie Carson, chose to conclude by and training support to the USA’s African stressing the growing challenge of drug 13allies in a global war on drugs. trafficking in Africa. Having discussed de- The literature on community influ- mocratization, having covered all of the ences on alcohol use focuses primarily

149 USORO ET AL. on environmental aspects, such as neigh- drug dealing, and seeing peers drink were bourhood characteristics and opportuni- all associated with increased alcohol use ties for alcohol purchasing and consump- (Chung, Pedersen & Kim, 2014). tion (Sudhinarasetet al., 2016). For exam- Relating neighborhood characteristics ple, one study found that individuals who to alcohol use risk is useful for public lived in a neighborhood with a poorly built health program planning because it al- environment, characterized by inferior lows policymakers and programmers to building conditions, housing, and water understand how changing structural-level and sanitation indicators, were 150 - per factors of the built environment may af- cent more likely to report heavy drinking fect health risk behaviors, including alco- compared with those living in better built hol use (Sudhinaraset, et al.2016). How- environments (Bernstein, Galea & Ahern, ever, methodological challenges remain 2007). Other studies have examined the when analyzing the impact of complex spatial epidemiology of neighborhoods community factors on individual behav- regarding alcohol availability, individual iors. Such factors include social stratifica- consumption, and community disorgani- tion (i.e., the probability of living in cer- zation and violence (Cohen, Ghosh-Dasti- tain neighborhoods, which is higher for dar, & Scribner, 2006; LaVeist and Wallace, certain types of persons) and social se- 2000; Scribner, Cohen & Fisher 2000; Shi- lection (i.e., the probability that drinkers motsu, Jones-Webb, & MacLehose, 2013; are more likely to move to certain types Theall, Lancaster & Lynch. 2011). of neighborhoods). It remains unclear Spatial relations between alcohol whether neighborhood disadvantage outlets and individual consumption also causes alcohol problems, and whether may be a key to explaining differential frequent drinkers are in fact usually more rates in alcohol use across racial/ethnic attracted to certain neighborhoods (i.e., groups. A number of studies suggest that self-selection). These challenges limit the minority communities have higher con- interpretation of research on community- centrations of liquor stores than White level effects (Sudhinaraset, et al.2016). communities (Alaniz and Wilkes, 1998; Some studies have attempted to address LaVeist and Wallace, 2000; Pollack, Cub- these issues using propensity match- bin, Ahn, & Winkleby. 2005; Romley, Co- ing and time-sensitive indicators (Ahern, hen, Ringel & Sturm, 2007; Treno, Alaniz, Galea & Hubbard, 2008). Future studies & Gruenewald, 2000), potentially increas- should take these challenges into consid- ing access to alcohol among minority eration and address subgroup differences populations (Freisthler, Lipperman-Kreda, in alcohol use norms across race/ethnicity Bersamin, & Gruenewald. 2015; Scribner and gender. et al. 2000). Moreover, living in a disad- Peer norms play an important role at vantaged neighborhood at an early age this life stage (Jackson, Roberts & Colby, has long-term effects. Childhood expo- 2014). By the late adolescent period, sure to violence leads to increased ex- parental influences related to alcohol posure to delinquent peers and alcohol use are small compared with peer influ- use (Trucco, Colder & Wieczorek, 2014). ences (Schwinn and Schinke, 2014; Zehe In another study, realizing how easy it is and Colder, 2014). Much of the focus on to get alcohol, witnessing neighborhood peer influences has highlighted the risk

150 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS networks associated with alcohol use. be effective among adolescents (Chap- Peer pressure (Studer, Baggio & Deline, man, Buckley, Sheehan & Shoche, 2013; 2014), peer alcohol norms (Varvil-Weld, Perry, Williams,& Komro. 2002; Toum- Turrisi & Hospital. 2014), and socializ- bourou, Gregg & Shortt, 2013). ing with substance-using peers (Patrick, Existing successful interventions to re- Schulenberg, & Martz, 2013) were associ- duce alcohol use include incorporating ated with alcohol misuse and binge drink- culturally sensitive delivery models, such ing. Studies note that leaving the home as employing community health workers environment, entering college, and join- among Latino populations (Ornelas, Allen ing Greek organizations increased alcohol & Vaughan 2014) and using Web-based use as a result of more socially permissive interventions to change norms (Patrick, norms around drinking (Scott-Sheldon, Lee & Neighbors. 2014). In a recent re- Carey & Carey 2008; White, McMorris, & view, Familias: Preparando la Nueva Catalano, 2006). Generación, a culturally grounded inter- More recent studies have attempted to vention for parents to support Mexican- assess the synergistic influence of peers heritage youth, showed reductions in and families. Whereas the majority of parental drinking (Williams, et. al. 2015). studies on peers have focused on the neg- Because past studies show that parents ative consequences of social networks, may potentially moderate negative peer research shows that greater parental sup- influence, fostering synergistic solutions port and monitoring can lead to proso- between multiple contexts should be a cial peer affiliations (Williams, Marsiglia, priority (Ewing, Osilla & Pedersen, 2015). Baldwin, & Ayers, 2015). One study found that protective influences in parental do- mains can moderate the negative effects METHOD of negative peer influences among Latino college students (Varvil-Weld et al. 2014). Study Site In particular, maternal communication re- The Anaang people are in Akwa Ibom sulted in less alcohol use; conversely, ma- state, South-south of Nigeria. They are ternal permissive norms and peer norms the second largest ethnic group of the were associated with more alcohol use. state, occupying its Northwestern part. Greater parental disapproval toward alco- They are bounded in the North by the hol use is associated with lower involve- Isogbo Igbo (Abia state), in the West by ment in peer networks that use alcohol, the Ngwas (abia state), and Ndoki (Rivers less peer influence to use, and greater state) and in the South, East and North- self-efficacy and stronger negotiation east by the Ibibios. skills to avoid alcohol (Nash, McQueen, The Anaang people are territorially lo- & Bray, 2005). Interventions aimed at es- cated in eight Local Government Areas tablishing and fostering conservative peer in Akwa Ibom State: Abak, Ikot Ekpene, norms were found to be more effective Ukanafun, Ika, Obot Akara, Essien Udim, than individual resistance training (Han- Oruk Anam and Etim Ekpo. The Anaang sen and Graham, 1991), whereas multi- and Ibibio people do possess some cultur- level interventions incorporating peers, al similarities and could be traced to the families, and communities are known to same ancestral root, despite their distinct

151 USORO ET AL. ethnic inclinations. The community is be- Procedure sieged with many developmental chal- A thematic framework was designed lenges ranging from poor access to basic by the researchers to code all qualita- amenities such as good road network, tive datasets (raw narratives) and field water supply, electricity, modern health- notes emanating from participant obser- care facilities, schools, housing and other vation. Grounded theory was employed modern social amenities. Majority of the to identify key themes and variables in people are engaged in subsistent farming, the recorded interviews and participant trading and other informal sectors to earn observation conducted during the data a living. Although, good number are also collection period (Beth, Dorothy and Nsi- employed in white collar jobs. They are kanabasi, 2016). This involved immersing mostly Christians, but a good number are in the data by reading the transcribed traditional worshippers. The condition of texts over and over again (Ediomo-Ubong, living is observed to be very low. 2012). The data was thereafter coded and organized in such a manner to identify Participants and Data Collection participant type, research site and specify The study employed a multi-sited eth- their properties and dimensions to create nographic and qualitative approaches to analytic categories of thematic domains. examine the influence of cultural prac- The categories were literally placed side tices on alcohol and drug use in Anaang by side to establish similarities and dis- community. The study participants in- similarities. This is done to ensure that cluded young and adult population they are mutually exclusive. Thereafter, aged 15-60 years old. Males(n=50) and they were related to each other accord- females(n=30) participated in the study. ing to their corresponding properties Altogether, 80 participants were inter- and dimensions (Ediomo-Ubong, 2012). viewed for this study using a convenient In this study some participant’s opinions sampling method. Data was collected us- during interview are quoted verbatim to ing unstructured-open-ended in-depth illustrate their views on cultural practices, interview guide and participant obser- alcohol and drug use. vation. All interviews were conducted in Anaang dialect by three of the authors and were both audio-recorded after seek- RESULTS ing the consent of participants in addi- tion to diligent note taking of informal Culture, Belief System and Perception of discussions and interactions with study Participants on Alcohol and Drug Use participants. A Typical African is so deep in his cul- The interview guide was developed to ture. He goes to church and does every- capture participant’s perception on alco- thing with elements of his culture. There- hol and drug use and their opinions and fore, participants opined that cultural experiences on influence of cultural prac- norms, values, beliefs systems are asso- tices on drug use. Averagely, the -inter ciated with alcohol and drug misuse. It view lasted 35-60minutes. Audio-record- is a well sung saying across Anaang land ed interviews were later translated and that ” when occasion comes, drinks also transcribed by experts in that field. comes.” Alcohol drinking is so deified in

152 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS

Anaang land, to the extent that a certain socially and culturally a disgrace to date in the local calendar is set aside for her family. free drinks (Usen ibet ukot). On this day all palm wine tappers in Anaang land are Another participant (aged 25 years) forbidden from selling their wine. Men commented: are often found strolling in groups from Our culture does not sanction women one compound to another on drinking drinkers. But it is viewed as an act of episode amid songs and dance. irresponsibility for a woman to com- Participants (97%) pointed out that al- pete for alcoholic drinks with men in cohol consumption in Anaang land was the public. If she eventually become culturally tolerated as parts of ceremonial intoxicated and perhaps strip her lives of the people. It is essentially a social clothe who will marry such a wom- act subject to variety of rules and norms an? Definitely no serious minded per- regarding who may drink, when, where son will approach her for marriage. with whom and why. Raw alcohol from raffia palm is called Majority of Participants (97%) believe ukot nsung. The fermented one is distilled that alcohol consumption is normal as locally to produce the local gin kaikai. long as people do not in excess to the Another form of alcohol mainly tapped point of losing self-control and become by youths is from felled palm tree, and is a public nuisance. Excess consumption of called ukot ayop. alcohol was not a norm neither was it en- Observations and comments from par- couraged and intoxication attracted nega- ticipants revealed that, local gins are com- tive sanctions such as not allowing them monly mixed with herbs, roots as herbal to partake in active or major decision therapy for various illness condition and making, not allowed to attend meetings performance boosters. were secret/deep things of the commu- Participants (85%) pointed out that al- nity was planned to avoid leakage of vital cohol is mainly consumed by male adults information to women or enemies. for pleasure while the females and chil- According to a participant (aged 57 dren were culturally restrained from years): drinking, though there were no formal rules prohibiting them. A person that is given to excessive A participant (aged 50 years) said: drinking or a drunk was not treated with dignity as he cannot be nomi- A woman is regarded as the beauty nated to represent the village or his of the family (mkpo uto) she is not peers. His family is not regarded in the expected to take part in public dis- community. Such people do not have cussions or engaged the opposite sex future prospects as they are exposed in arguments not to talk of drinking to many adverse situations in life. freely in the public. Nevertheless, de- pending on the nature of the gather- Notions on why People Misuse Drugs ing or events, she could be offered and Alcohol a little quantity. Any woman who The misuse of drugs and alcohol is one competes for drinks in the public is of the most controversial issues in our

153 USORO ET AL. society, and often a source of conflict be- as Ukot nsung, kaikai, ukot ayop, Beer, tween generations and sections of the Schnapps, Malt drinks etc. society. Participants (67%) pointed out that Circumcision: The practiced of circumci- people use drugs and alcohol out of per- sion for both male and female children sonal volition as nobody is compelled to was a major traditional rite, and is still be- use them under normal condition or as a ing in vogue currently, especially among matter of compunction. Users make con- the non-educated families. Family mem- scious decision by evaluating the risks and bers and friends gather to share drinks at benefits of indulging in the act. This, of the success of the surgical operation. course depends on an individual’s ability to make informed and positive decisions / Coming of Age: This is a rite of passage choices, which is a function of psychologi- in Anaang land where the females ap- cal, social and cultural variables. Insights proaching menarche are initiated into the from personal observation and partici- Nwowo (age of puberty) cult. Others are; pants’ responses identified low literacy Traditional Marriage, Death/Burials, Land rates, ignorant and lack of effective regu- Acquisition, Foundation Laying ceremo- latory mechanism as major precursors to nies, Chieftaincy Installation, Traditional drug use among other variables. festivals, etc

Some Cultural Practices that Influence The Community, Culture, Alcohol and Alcohol and Drug Use Drug Use Control Alcohol use is an intrinsic part of Although, alcohol and drug use is ac- Anaang cultural heritage. It played major ceptable practice in Anaang land, there roles in traditional activities. Ceremonial are some cultural practices that regulates rites and pouring of libation to propiti- or discourage the use of these harmful ate the angry gods or ancestors. In every substances: Religious belief, Family /Pa- gathering, cerebration of birth, death, rental Disapprovals, Sacred Days, Dedi- victory, success, achievements, and even cated Days, Gender/Age, Intertribal/Com- when somebody commits suicide which munal Conflicts, Era of Civilization, Use of is considered abominable, alcohol is de- Measure, etc. manded from the victim family among other items to cleanse the land and ap- pease the gods. Observations have shown DISCUSSION that most times, this local gin is garnished with herbs and roots which have drug ef- Cultural norms and beliefs are strong fects on drinkers. The participants iden- predictors of both current drinking and tified the following cultural practices as frequent heavy drinking (Brooks-Russell, having the potential to covertly or overtly Simons-Morton & Haynie, 2013; Caetano promote alcohol and drug use. and Clark 1999; LaBrie, Atkins & Neigh- bors 2012; O’Grady, Cullum, Tennen, & Births: The arrival of a new baby to the Armeli. 2011; family is usually celebrated with varieties Paschall, Grube, & Thomas, 2012). of drinks including alcohol beverages such Across race and ethnicity, African

154 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS

Americans and Latinos report more con- neighborhood-level norms. For example, servative attitudes toward drinking com- Ahern and colleagues (2008) found that pared with Whites (Caetano and Clark, neighborhood norms against drunken- 1999; LaBrie, et al. 2012). These more ness were a more robust and stronger conservative norms may be associated predictor of binge drinking than permis- with lower drinking rates among African sive beliefs about it held either by the Americans and Latinos compared with individual or family and friends. If an Whites (SAMHSA 2013). Few studies have individual lived in a neighborhood that examined diversity within racial and ethnic frowns on binge drinking, that individual groups such as Latinos, Blacks, and Asians, was less likely to drink, even if he or she limiting our ability to meet the needs of believed it acceptable to do so. This was specific subpopulations. Some studies particularly true for women, suggesting suggest that alcohol-related problems dif- gender norms around alcohol use may be fer substantially across Latino subgroups, a factor. including higher rates of alcohol abuse Specifically, past studies found that and dependence among Mexican-Amer- gender differences in alcohol use may re- ican and Puerto Rican men compared flect the greater social stigma directed at with Cuban Americans and Central and women who drink. This seems to be more South Americans (Caetano, Ramisetty- pronounced in certain cultures. Caetano Milke & Rodriguez, 2008). These findings and Clark (1999), for example, found may best be explained by considerable stronger gender norms related to alcohol differences in cultural norms, especially use in Latino cultures compared with the the cultural beliefs regarding appropriate United States (Kulis, Marsiglia & Nagoshi alcohol use (Greenfield and Room 1997; 2012). This results in greater gender dif- LaBrie, et al. 2012). For example, some ferences in alcohol use among Latinos scholars explain heavy-drinking patterns compared with other U.S. populations, among Latino men through the concept with recent trends suggesting similar lev- of machismo, which has been a significant els of binge drinking between men and cultural influence for generations and re- women in Western cultures (Iwamoto, et mains integral to Latino male identity al. 2012). This may reflect changing be- (Dolezal, Carballo-Diéguez, Nieves-Rosa liefs about gender and social status. Al- & Díaz, 2000). Machismo suggests that though traditionally perceived as a “mas- Latino men attempt to appear strong and culine” behavior, binge drinking is now masculine because of cultural values, and more acceptable among women in cer- drinking greater amounts of alcohol fur- tain cultures that foster more balanced ther exemplifies their masculinity. More gender roles (Lyons and Willott, 2008). recently, scholars have commented that Some of the strongest influences on ad- concepts like machismo cannot account olescent drinking behavior come from the for the complexity of Latino drinking be- people that youth spend the most time havior (Caetano, 1990) with: family and friends (Sudhinaraset, et Cultural norms also vary by context al. 2016). Studies have found that higher and place. Some alcohol researchers have levels of alcohol use among parents and used multilevel approaches to distinguish peers is associated with increased alco- among the causal effects of individual and hol use among adolescents and young

155 USORO ET AL. adults (Cruz, Emery & Turkheimer, 2012; is subjected to variety of rules and norms Dawson, 2000; Mares, Engels and Lich- of usage in terms of who offers it, when, twarck-Aschoff, 2011; Trucco, et al. 2014; why and where to drink. Excessive drink- Varvil-Weld, et al. 2014; Wallace, Forman, ing has some unpleasant consequences & Guthrie, 1999; Walsh, Djalovski, Boniel- socially, economically and health wise. Nissim, & Harel-Fisch,. 2014; Williams & Alcohol education programs need to also Smith, 1993). Developmentally, people’s address individual intent and motivations social contexts shift from the family unit while offering personalized feedback and during childhood to focus more on their protective behavioral strategies (Patrick peers and their schools during adoles- et. al. 2014). Public health and treat- cence. Reflecting this, parental alcohol ment programs needed to be culturally use seems to exert a greater influence sensitive, paying particular attention to before age 15 and diminishes over time cultural factors such as ethnic identifica- (Dawson, 2000). tion and orientation. This study attempts Conversely, family support, bonding, to explore how cultural practices, norms, and parental monitoring is associated and belief system can influence drug and with lower alcohol use (Bahr, Marcos & alcohol use as well as a community per- Maughan, 1995; White, et al. 2006) and spective on the war against substance social networks and social support also misuse. have protective effects (Ramirez, Hin- man & Sterling. 2012). For example, one study that assessed the effects of leaving REFERENCES home and attending college found that although the transition overall was asso- Ahern, J., Galea, S, Hubbard, A. (2008). ciated with higher levels of alcohol use, “Culture of drinking” and individual young people with fewer friends who problems with alcohol use. American use alcohol reported higher levels of re- Journal of Epidemiology. 167(9):1041- ligiosity. Higher parental monitoring also 1049. protected against alcohol and marijuana Alaniz, M. L, Wilkes, C. (1998) Pro-drink- use (White, et al. 2006). Moreover, higher ing messages and message environ- levels of familism (values that place fam- ments for young adults: The case of ily needs over individual needs) and being alcohol industry advertising in African in a nuclear family served as protective American, Latino, and Native Ameri- factors among adolescents (Ewing, et al. can communities. Journal of Public 2015). Health Policy. 19(4):447-472. Bahr, S. J, Marcos, A. C, Maughan, S.L. (1995). Family, educational and peer CONCLUSION influences on the alcohol use of fe- male and male adolescents. Journal Traditionally in Anaang land, alcohol of Studies on Alcohol. 1995;56(4): consumption is not just a social act but 457-469. is deeply entrenched and engraved in the Berkman, L.F, Kawachi, I. (2000). Social heart of Anaang cultural heritage. Even Epidemiology. 1st ed. New York: Ox- though consumption is seen as normal, it ford University Press.

156 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS

Bernstein, K.T, Galea, S, and Ahern, J. Maps— Alcohol. Atlanta: CDC; 2014. (2007). The built environment and [Accessed June 22, 2015]. Available alcohol consumption in urban neigh- at: http://www.cdc.gov/alcohol/data- borhoods. Drug and Alcohol Depen- stats.htm. dence. 91(2-3):244-252. Chapman, R. L, Buckley, L., Sheehan, M. Berry, J. W, Phinney, J. S, Sam, D. L, Ved- and Shochet, I.(2013). School-based der, P. (2006). Immigrant youth: Ac- programs for increasing connected- culturation, Identity, and Adaptation. ness and reducing risk behavior: A Applied Psychology. 55(3):303-332. systematic review. Educational Psy- Beth, S. P, Dorothy N. O and Nsikanabasi chology Review.25(1):95-114. W. U (2016). Complicating Causality: Chung T, Pedersen, S. L, Kim, K. H.(2014). Patient and Professional Perspectives Racial differences in type of alcoholic on Obstetric Fistula in Nigeria. An In- beverage consumed during adoles- ternational Journal for Research, In- cence in the Pittsburgh Girls Study. tervention and Care. Taylor & Francis. Alcoholism: Clinical and Experimental Bouchery, E. E, Harwood, H. J, Sacks, J. Research.38(1):285-293. J, (2011). Economic costs of exces- Cohen, D.A, Ghosh-Dastidar, B. and Scrib- sive alcohol consumption in the U.S. ner, R. (2006). Alcohol outlets, gonor- American Journal of Preventive Medi- rhea, and the Los Angeles civil unrest: cine.; 41(5):516-524. A longitudinal analysis. Social Science Brooks-Russell, A, Simons-Morton, B. & Medicine. 62(12):3062-3071. and Haynie, D.(2013). Longitudinal Cook, W. K, Mulia, N and Karriker-Jaffe, relationship between drinking with K.(2012). Ethnic drinking cultures peers, descriptive norms, and adoles- and alcohol use among Asian Ameri- cent alcohol use. Prevention Science. can adults: Findings from a na- 15(4):497-505. tional survey. Alcohol and Alcohol- Caetano, R.(1990). Hispanic drinking in the ism.47(3):340-348. US: Thinking in new directions.British Common African Position [CAP] for the Journal of Addictions.;85:1231-1236. UN General Assembly Special Session Caetano, R, Clark, C.L. (1999). Trends in on the World Drug Problem, April 19- situational norms and attitudes to- 21, 2016. ward drinking among whites, blacks, Cruz, J. E, Emery, R.E, Turkheimer, and Hispanics: 1984-1995. Drug and E.(2012). Peer network drinking pre- Alcohol Dependence.54(1):45-56. dicts increased alcohol use from ado- Caetano, R., Ramisetty-Milke, S., Ro- lescence to early adulthood after con- driguez, L. A.(2008). The Hispanic trolling for genetic and shared envi- Americans Baseline Alcohol Survey ronmental selection. Developmental (HABLAS): Rates and predictors of al- Psychology.48(5):1390-1402. cohol abuse and dependence across Dawson, D. A. (2006). The link between Hispanic national groups. Journal family history and early onset alco- of Studies on Alcohol and Drugs. holism: Earlier initiation of drinking or 69(3):441-448. more rapid development of depen- Center for Disease Control and Preven- dence? Journal of Studies on Alcohol. tion (CDC) CDC—Data, Trends and 61(5):637-646.

157 USORO ET AL.

Dolezal, C., Carballo-Diéguez, A., Nieves- born Asian Americans. Cultural Diver- Rosa, L. Díaz, F(2000). Substance use sity & Ethnic Minority. Psychology. and sexual risk behavior: Understand- 18(3):219-227. ing their association among four eth- Jackson, K. M, Roberts, M. E. and Colby, nic groups of Latino men who have S. M.(2014). Willingness to drink sex with men. Journal of Substance as a function of peer offers and Abuse.11(4):323-336. peer norms in early adolescence. Ediomo-Ubong E. N.(2012) Alcohol Use Journal of Studies on Alcohol and and Risk of HIV Infection Among Male Drugs.75(3):404-410 Adolescents. In: Substance Abuse and Kulis, S., Marsiglia, F. F. and Nagoshi, J. HIV/AIDS in Africa(Eds)Isidore, Akani- L.(2012). Gender roles and substance domo and Andrew. CRISA Pulication. use among mexican american adoles- Ewing, B. A, Osilla, K. C. and Pedersen, E. cents: A relationship moderated by R. (2015). Longitudinal family effects acculturation? Substance Use & Mis- on substance use among an at-risk use. 47(3):214-229. adolescent sample. Addictive Behav- LaBrie, J. W, Atkins, D. C. and Neighbors, iors. 41:185-191 C.(2012). Ethnicity specific norms and Freisthler, B., Lipperman-Kreda, S., Bersa- alcohol consumption among Hispan- min, M. and Gruenewald, P. J.(2015). ic/Latino/a and Caucasian students. Tracking the when, where, and with Addictive Behaviors. 37(4):573-576. whom of alcohol use: Integrating eco- LaVeist, T.A, and Wallace, J. M., (2000). logical momentary assessment and Health risk and inequitable distribu- geospatial data to examine risk for tion of liquor stores in African Ameri- alcohol-related problems. Alcohol Re- can neighborhood. Social Science & search: Current Reviews. 36(1):29-38. Medicine. 51(4):613-617. Greenfield, T. K. and Room, R.(1997). Lyons, A.C. and Willott, S. A.(2008). Alco- Situational norms for drinking and hol consumption, gender identities drunkenness: trends in the US adult and women’s changing social posi- population, 1979-1990. Addiction. tions. Sex Roles. 59(9-10):694-712. 1997;92(1):33-47. Mares, S.H.W, van der Vorst H, Engels R. Hahm, H. C, Lahiff, M, Guterman, N. and Lichtwarck-Aschoff, A.(2011). B.(2003). Acculturation and parental Parental alcohol use, alcohol-related attachment in Asian-American ado- problems, and alcohol-specific atti- lescents’ alcohol use. Journal of Ado- tudes, alcohol- specific communica- lescent Health. 33(2):119-129. tion, and adolescent excessive alcohol Hansen, W. B, Graham, J. W. (1991). Pre- use and alcohol- related problems: An venting alcohol, marijuana, and ciga- indirect path model. Addictive Behav- rette use among adolescents: Peer iors. 36(3):209-216. pressure resistance training versus Nash, S.G, McQueen, A and Bray, J. establishing conservative norms. Pre- H.(2005). Pathways to adolescent ventive Medicine. 20(3):414-430. alcohol use: Family environment, Iwamoto D, Takamatsu, S. and Castel- peer influence, and parental- ex lanos, J. (2012). Binge drinking and pectations. Journal of Adolescent alcohol-related problems among U.S.- Health.;37(1):19-28.

158 COMMUNITY PERSPECTIVES ON ALCOHOL AND DRUGS

O’Grady, M. A, Cullum, J., Tennen, H. alcohol and other drug use outcomes. and Armeli, S.(2011). Daily relation- Journal of Nursing Scholarship. ship between event-specific drinking 44(1):36-44. norms and alcohol use: A four-year Rehm, J. Mathers, C and Popova, S.(2009). longitudinal study. Journal of Studies Global burden of disease and injury on Alcohol and Drugs.72(4):633-641. and economic cost attributable to al- Ornelas, I. J, Allen, C. and Vaughan, cohol use and alcohol-use disorders. C.(2015). Vida PURA: A cultural ad- Lancet.373(9682):2223-2233. aptation of screening and brief inter- Romley, J. A, Cohen, D., Ringel, J. and vention to reduce unhealthy drinking Sturm, R. (2007). Alcohol and en- among Latino day laborers.Substance vironmental justice: The density Abuse.; 36(3):264-271. of liquor stores and bars in urban Paschall, M. J, Grube, J. W and Thomas, neighborhoods in the United States. S. (2012). Relationships between lo- Journal of Studies on Alcohol and cal enforcement, alcohol availabil- Drugs.68(1):48-55. ity, drinking norms, and adolescent Schwinn, T. M. and Schinke, S. P.(2014). alcohol use in 50 California cities. Alcohol use and related behaviors Journal of Studies on Alcohol and among late adolescent urban youth: Drugs.73(4):657-665. Peer and parent influences. Jour- Patrick, M. E, Lee, C. M. and Neighbors, nal of Child & Adolescent Substance C.(2014). Web-based intervention to Abuse.23(1):58-64. change perceived norms of college Scott-Sheldon, L. A. J, Carey, K. B. and student alcohol use and sexual be- Carey, M. P.(2008). Health behavior havior on spring break. Addictive Be- and college students: Does Greek af- haviors. 39(3):600-606. filiation matter?Journal of Behavioral Patrick, M. E, Schulenberg, J. E and Martz, Medicine. 31(1):61-70. M. E, (2013). Extreme binge drinking Scribner, R. A, Cohen, D. A, Fisher, among 12th-grade students in the W.(2000). Evidence of a structural United States: Prevalence and predic- effect for alcohol outlet density: tors. JAMA Pediatrics. 167(11):1019- A multilevel analysis. Alcoholism: 1025. Clinical and Experimental Research. Perry, C. L, Williams, C. L. and Komro, K. A, 24(2):188-195. (2002). Project Northland: Long-term Shimotsu, S. T, Jones-Webb, R. J. and outcomes of community action to re- MacLehose, R. F. (2013). Neighbor- duce adolescent alcohol use. Health hood socioeconomic characteris- Education Research. 17(1):117-132. tics, the retail environment, and Pollack, C. E, Cubbin, C, Ahn, D. and Win- alcohol consumption: A multilevel kleby, M. (2005). Neighbourhood de- analysis. Drug and Alcohol Depen- privation and alcohol consumption: dence.132(3):449-456. Does the availability of alcohol play a Studer, J., Baggio, S. and Deline, S.(2014). role? International Journal of Epide- Peer pressure and alcohol use in miology.34(4):772-780. young men: A mediation analysis of Ramirez, R., Hinman, A. and Sterling, S drinking motives. International Jour- (2012). Peer influences on adolescent nal on Drug Policy. 25(4):700-708.

159 Substance Abuse and Mental Health Varvil-Weld, L. and Turrisi, R. Hospital, M. Services Administration (SAM- M.(2014). Maternal and peer influ- HSA) Rockville, MD: SAMHSA, ences on drinking among Latino col- Center for Behavioral Health Sta- lege students. Addictive Behaviors. tistics and Quality; 2013. [Ac- 239(1):246-252. cessed June 22, 2015]. National Wallace, J. M, Forman, T. A and Guthrie, Survey on Drug Use and Health, B. J.(1999). The epidemiology of al- 2011 and 2012. Avaible at: http:// cohol, tobacco and other drug use media.samhsa.gov/data/NSDUH/ among black youth. Journal of Studies 2012SummNatFindDetTables/ on Alcohol. 60(6):800-809. DetTabs/NSDUH-DetTabsSect2pe- Walsh, S. D, Djalovski, A, Boniel-Nissim, Tabs1to42-2012.htm#Tab2.1A. M. and Harel-Fisch, Y. (2014) Parental, Sudhinaraset, M., Christina, W. and David, peer and school experiences as pre- T.T. (2016). Social and Cultural Con- dictors of alcohol drinking among first texts of Alcohol Use: Influences in a and second generation immigrant ad- Social-ecological Framework. Alcohol olescents in Israel. Drug and Alcohol Research vol.38(1). Dependence.; 138:39-47. Theall, K. P, Lancaster, B. P, Lynch, S.(2011). White, H. R, McMorris, B. J and Catala- The neighborhood alcohol environ- no, R. F. (2006). Increases in alcohol ment and at-risk drinking among and marijuana use during the transi- African-Americans. Alcoholism: tion out of high school into emerg- Clinical and Experimental Research. ing adulthood: The effects of leav- 35(5):996-1003. ing home, going to college, and high Toumbourou, J. W, Gregg, M.E.D. and school protective factors. Journal of Shortt, A. L.(2013). Reduction of ado- Studies on Alcohol. 67(6):810-822. lescent alcohol use through family- Williams, J. G and Smith, J. P.(1993). Alco- school intervention: A randomized hol and other drug use among adoles- trial. Journal of Adolescent Health. cents: Family and peer influences.Jour - 53(6):778-784. nal of Substance Abuse. 5(3):289-294. Treno, A. J, Alaniz, M. L and Gruenewald, Williams, L. R, Marsiglia, F. F, Baldwin, A P. J. (2000). The use of drinking places and Ayers, S.(2015). Unintended ef- by gender, age and ethnic groups: An fects of an intervention supporting analysis of routine drinking activities. Mexican-heritage youth: Decreased Addiction. 95(4):537-551. parent heavy drinking. Research on Trucco, E. M, Colder, C. R, Wieczorek, Social Work Practice. 25:181-189 W.F. (2014). Early adolescent alcohol Zehe, J. M and Colder, C. R.(2014). A la- use in context: How neighborhoods, tent growth curve analysis of alcohol- parents, and peers impact youth. use specific parenting and adolescent Development and Psychopathology. alcohol use. Addictive Behaviors. 26(2):425-436. 39(12):1701-1705.

160 ACKNOWLEDGEMENTS

This volume of the African Journal of Drug and Alcohol Studies has been published with financial support from FORUT (Campaign for Development and Solidarity), Norway. The grant has made it possible for us to publish important scientific reports on alcohol and drug use in Africa at no cost to authors and readers all over the world. We are im- mensely grateful to FORUT for the generous support we have received and look forward to continued collaboration in the dissemination of important scientific information on psychoactive substance use in Africa. The Editorial Board is also grateful to the many reviewers and others who have con- tributed in various ways to improving the quality of the papers published in the journal.

161

AFRICAN JOURNAL OF DRUG & ALCOHOL STUDIES

INSTRUCTIONS TO CONTRIBUTORS

Manuscripts. AJDAS solicits manuscripts on these Book chapter: and other aspects of substance use: epidemiology, Tumwesigye, N. M., & Kasirye, R. (2005). prevention, treatment, psychopharmacology, Gender and the major consequences of alcohol health and socio-economic issues, drug trafficking, consumption in Uganda. In I. S. Obot & R. Room and drug law and policy. The Journal is particularly (eds.), Alcohol, gender and drinking problems (pp. interested in manuscripts that report an association 189-208). Geneva: World Health Organization. between substance use and other social and health-related problems, e.g., HIV/AIDS, crime and Book: violence, injury, accidents, physical and mental MacAllister, W.B. (2000). Drug diplomacy in the health problems. The journal audience includes twentieth century. London: Routledge. researchers, practitioners, policy makers, students and educated members of the public interested in Website: alcohol and drug issues. Hence, whether reporting Include the date of access. data from an empirical study or reviewing a particular research issue, authors should have in Submission of manuscripts. All manuscripts should mind this diverse group of readers. be submitted by e-mail to the Editor-in-Chief at [email protected]. You can also submit your Preparing manuscripts. Authors are required manuscript to the deputy editor responsible for to prepare manuscripts in accordance with the the region to which you belong. Publication Manual of the American Psychological Association (5th edition). All components of the Cover Letter. Every manuscript must be manuscript should be double-spaced, including accompanied by a cover letter stating unequivocally title page, abstract, references, author note, that the manuscript and data have not been acknowledgement, and appendixes. Authors are published previously or concurrently submitted encouraged to keep manuscripts as concise as elsewhere for consideration. In addition, authors possible, with a length of 15 pages or less, including must state that the participants in their study tables, figures, and references. Unless it is absolutely have been treated in accordance with ethical necessary, tables and figure should not be more standards. In the case of manuscripts with multiple than four. Every manuscript must include an abstract authors, the corresponding/lead author must state containing a maximum of 120 words, typed on a categorically that all listed authors contributed in separate page. The full name, address, telephone significant ways to the work. number and e-mail address of the corresponding author should be shown on the cover page. Reprints. The journal does not produce reprints for authors, instead the lead author will receive a copy Please refer to the Manual for specific instructions of the journal in which his or her article appears. on preparing abstracts, figures, matrices, tables, and references. References should be cited in the Postal address: USA: African Journal of Drug and text by author(s) and dates with multiple references Alcohol Studies, P. O. Box 4230, University Post in alphabetical order. Each in-text citation should be Office, Uyo, Nigeria; 10 Sandview Ct, Baltimore, listed in the reference section. Here are examples MD 21209, USA. of how articles and books should be referenced: Subscription information: Request for information Journal article: on individual or institutional subscription should be Abdool, R., Sulliman, F.T., & Dhannoo, M. I. (2006). sent to the Editor-in-Chief at [email protected]. The injecting drug use and HIV/AIDS nexus in the Republic of Mauritius. African Journal of Drug and Alcohol Studies, 5(2), 107-116.

163 AFRICAN JOURNAL of DRUG and ALCOHOL STUDIES

VOLUME 17 NUMBER 2 2018

CONTENTS

Roles of Background Characteristics in HIV and Alcohol Use Prevention Among School Learners: The HAPS Project...... 79 Godswill N. Osuafor & Chinwe E. Okoli

Psychoactive Substance Use as a Predictor of Road Rage Behaviour in a Sample of Commercial Drivers in Enugu, South-Eastern Nigeria...... 93 Philip C. Mefoh, Joy I. Ugwu, & Timothy E. Eze

Commercial Tricycle Riders’ Perceptions of Psychoactive Drug Use and the Risk of Road Traffic Accidents in Uyo, Nigeria...... 105 Ediomo-Ubong E. Nelson, Okokon O. Umoh, Nsidibe F. Essien & Aniekan S. Brown

Some Neuropsychological Profiles of Cannabis Dependent Users on Long-Term Abstinence in a Rehabilitation Centre in Nigeria...... 119 Valentine A. Ucheagwu, Rita N. Ugwokwe-Ossai, Paul D. Okoli, & Jesse P. Ossai

Substance Use Among Youths: Roles Of Psychoticism, Social Alienation, Thriving and Religious Commitment...... 133 Steven K. Iorfa, Chinedu Ugwu, Chuka M. Ifeagwazi, & Johnbosco C. Chukwuorji

Community Perspectives on Cultural Practices and Belief Systems Influencing Alcohol and Drug Use: A Qualitative Study in Anaang Community, Nigeria...... 147 Nsidibe A. Usoro, Dorothy N. Ononokpono, Ursula Ette, & Nkereuwem N. James

ISSN 1531-4065 p u b l i s h e d b y