SURVEY REPORT

Are Medical Undergraduates more Likely to Indulge in Substance Abuse than Non-Medical Undergraduates? A Survey from Huma Mamun Mahmud1, Mehreen Kalam2, Amna Nawaz2, Saleha Khan2, Hira Imam2 and Osama Ahsan Khan2

ABSTRACT Objective: To determine frequency of substance abuse and the commonest substance of abuse among medical and non-medical undergraduates. Study Design: Survey report. Place and Duration of Study: Dow International Medical College, Karachi, from June 2012 to August 2012. Methodology: Semester VIII students from Dow International Medical College, Dow University of Health Sciences who visited the selected medical and non-medical universities, data collected through self responding questionnaire which was handed out to the participants. Data was collected from 4 medical and 4 non-medical universities. All responding undergraduate students in selected universities were included. Data was maintained and analyzed on SPSS version 16 for descriptive statistics. Results: Total number of responders was 572 with male: female ratio of 1.23: 1.0 and mean age of 21.76 ± 2.168 years. Frequency of regular substance abuse was 20.1%. Males were abusing substance more than females, ratio being 4.7: 1.0 among abusers. The most common substance of abuse was tobacco. Frequency of regular substance abuse in non- medical undergraduates was 29.4% which was higher than medical graduates (13.4%). Conclusion: Substance abuse among undergraduates in selected universities in Karachi was overall 20.1%. Male non- medical undergraduates were more frequently using such substances; tobacco being the most common.

Key Words: Undergraduates students. Karachi. Substance abuse.

INTRODUCTION Substance abuse in adolescence is a social experience Substance or drug abuse is a patterned use of a and a 'learned behavior' which is largely practiced in substance in an amount and with a method neither schools and it is a worldwide problem. Substance abuse 4 approved nor supervised by a medical professional and among school students from India is 12.5%, native American adolescents is 37%,5 66% among students in it also includes the use and of drugs for non-medical 6 reasons to enhance performances like use of steroids in a Nigerian University and 33% among adolescents in Bosnia and Herzegovina.7 sports.1 A cross-sectional survey from report substance Substance abuse can lead to physical, social and abuse to be 33%.8 In Karachi one of the studies on psychological harm and dependence in individuals dental care seeker demonstrated oral substance abuse consuming them and it can also result in criminal to be 39.1%.9 behavior and penalty depending on local jurisdiction.2 A number of international studies are suggestive of If we look at data from Pakistan, substance abuse is medical students to be more involved in substance very common in our society. According to the 5th (and up abuse than non-medical students.10 Tobacco is the till now the last) national survey (National Survey on commonest substance of abuse reported.7 Drug Abuse-N.S.D.A) conducted in 1993 by the Pakistan Narcotic Control Board, there were nearly 3 million drug The aim of this study was to determine the frequency of dependents in Pakistan. This represents nearly a three- substance abuse among the medical versus non- fold increase in the total number of dependents when medical undergraduate students. compared to the findings in the first N.S.D.A report of 1982.3 METHODOLOGY It was a cross-sectional survey report done at Dow Department of Medicine1 / Medical Student2, Dow International International Medical College, Karachi over a period of 3 Medical College, DUHS, Karachi. months from 15th June 2012 till 15th August 2012. Correspondence: Dr. Huma Mamun Mahmud, A-34, Block-13, Inclusion criteria were undergraduate students in Shamoonabad, Gulshan-e-Iqbal, Karachi. defined universities who were willing to participate. E-mail: [email protected] Exclusion criteria was anyone who was not an under- Received: January 11, 2013; Accepted: February 26, 2014. graduate student or did not belong to specified campus.

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (7): 515-518 515 Huma Mamun Mahmud, Mehreen Kalam, Amna Nawaz, Saleha Khan, Hira Imam and Osama Ahsan Khan

Data was collected from four medical institutes named Research data was collected by medical under- Dow Medical College, Dow International Medical graduates of semester VIII from Dow International College, Medical University, and Karachi Medical Medical College, Dow University of Health Sciences and Dental College. Non-medical institute were NED Karachi. All the researchers involved in data collection University, , Karachi University and Textile visited the selected medical and non-medical colleges Institute of Pakistan. during the research duration. Verbal permission was sought from administration of selected campuses to Table I: Frequency of substance abuse among medical and non-medical undergraduates. collect data and also consent from responders was All responders Medical Non-medical taken as their will to fill questionnaire. undergraduates undergraduates Data was collected through self-responding question- 572 334 238 naire which was handed out to the participants whoever Substance abused ever 327 (57.2%) 164 (49.1%) 163 (68.5%) wanted to fill it out and returned it within 10 - 15 minutes Substance abused regularly 115 (20.1%) 45 (13.4%) 70 (29.4%) to the researchers. Questionnaire was written in English and carry demographic data, and a checklist of Table II: Frequencies of abuse habits among regular abusers. responses to certain questions regarding frequency of Commonest substance abused: abuse, names of substance (s) abused, financial Tobacco 69/115 (60%) support, residing with whom, availability of substance, Alcohol 6/115 (5.2%) knowledge of harmful effects, and if they wanted to quit. Heroine 6/115 (5.2%) Hashish 0/115 (0%) Information regarding frequency of intake, reason for Metamphetamines 1/115 (0.9%) initiating or maintaining substance abuse was also Tranquillizers 3/115 (2.6%) asked. More than one substance 30/115 (26%) Reason of abuse: Data analysis was done on Statistical Package for Social Pleasure 53/115 (46.1%) Sciences (SPSS) version 16. Categorical data was To relieve stress 37/115 (32.1%) evaluated through frequencies and percentages. To keep awake 3/115 (2.6%) Numerical data was presented through mean and SD. Medically prescribed 2/115 (1.7%) More than one reason 20/115 (17.4%) RESULTS Live with: Family 65/115 (56.5%) Total number of questionnaire collected were 607 Alone 18/115 (15.7%) however, during the assessment, 35 were found In hostel 26/115 (22.6%) incomplete so those were not included in study. Other places 6/115 (5.2%) Total number of responders included in study were 572 Source of substance availability: out of whom males were 316/ 572 (55.2%) and females From family 8/115 (7%) were 256/572 (44.76%), ratio of 1.23:1.0. Mean age was From campus 16/115 (13.9%) 21.76 ± 2.168 years. From friends 35/115 (30.4%) More than one source 1/115 (0.9%) Among total responders, 329/572 (57.2%) accepted Don't want to tell 55/115 (47.8%) substance abused. However, 86/572 (16.3%) were Financial support: those who had it either once in life time or once during Family 57/115 (49.6%) study tenure; another 128/572 (22.3%) abused Self-earned 40/115 (34.8%) substance occasionally. Excluding these 214 subjects, Friends 6/115 (5.2%) there were 115/572 (20.1%) students who admitted Others 12/115 (10.4%) regular substance abuse.

Table III: Pattern of substance abuse among medical and non-medical undergraduates. Regular substance abusers Regular substance abusers Regular substance abusers medical graduates non-medical undergraduates Number 115 45 70 Males : Females 4.7 : 1.0 2.2 : 1.0 10.6 : 1.0 Age 22.23 ± 2.39 22.18 ± 2.58 22.27 ± 2.27 Mean year of study 2.43 ± 1.14 2.73 ± 1.17 2.24 ± 1.09 Commonest substance abused was tobacco 69 (60%) 19 (42.2%) 50 (71.4%) Most frequent reason for abuse found was pleasure 53 (46.1%) 19 (42.2%) 34 (48.6%) Friends as a source of substance availability 35 (30.4%) 16 (35.6%) 19 (27.1%) Financial support from family 57 (49.6%) 21 (46.7%) 36 (51.4%) Awareness of harmful effects 94 (81.7%) 33 (73.3%) 61(87.1%) Willingness to quit 50 (43.5%) 18 (40%) 32 (45.7%)

516 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (7): 515-518 Substance abuse among undergraduate students

Frequency of regular abusers among medical and non- medical universities accommodate less number of medical undergraduates is shown in Table I which shows students and keeping a check on them is comparatively abuse of substance was more (29.4%) in non-medical easy than non-medical universities. undergraduates than medical (13.4%). Frequencies of These results are showing that male gender is more abusing habits among regular abusers is defined in involved in substance abuse, male: female ratio among Table II which shows the commonest substance of substance abusers is 4.7: 1.0. This may be because out abuse was tobacco in 60%, commonest reason of abuse door and social activities of females is more observed by is pleasure in 46.1%. Most abusers (56.5%) were living families in our society in comparison with age matched with their families and getting financial support from males who are considered as bread earner and decision family in 49.6%; 47.8% denied to disclose the source makers at early age and free to move. of substance availability. Table III summarizes pattern of substance abuse by medical and non-medical under- Similar, observation is found from Bosnia and Herzegovina graduates. which is also a Muslim society and shows more substance abuse among boys than girls.7 DISCUSSION Commonest substance of abuse was found to be Substance abuse is a worldwide problem. In Pakistan tobacco in the form of cigarette smoking in this study number of substance abusers is 3.5 millions and this is which was used by 60% of our regular substance increasing every year at the rate of 7%.11 abusers. Tobacco is also found as commonest substance abused in Bosnia and Herzegovina where The study results shows that among 572 University one fourth of boys and one fourth of girls were daily students aged between 18 - 29 years, substance abuse smokers.7 was found in 327/572 (49.7%) in total, if we consider the Although a number of published articles suggest that regular abusers frequency is 20.1%. In other countries in stress is leading to consumption of substance.4,2,14 This a non-institutionalized adolescents between age group study results shows 46.1% of abusers are using it for 12 - 17 years; alcohol abuse was reported in America as pleasure and stress was reported as a reason of abuse 37%.5 A report from India showed substance abuse by 32% students. Similar results are observed in study among school students to be 52/416 (12.5%).4 Alcohol from Bosnia and Herzegovina where pleasure is abuse was found in 66% students in a Nigerian reported to be the most common reason of substance University,6 and more than 33% among adolescents in abuse.7 Bosnia and Herzegovina.7 A study from Lahore showed use of substance in past in 17% and in only 3.6% Among those regularly involved in substance abuse, students abusing substance at the time of study.12 30.4% cited friends as source although a percentage of 47.8% did not mention about source of availability. This substance abuse frequency of 20.1% in our society Almost half of the responders were financially supported is no different from rest of the world and clearly by their families. demonstrate the substance abuse as a worldwide problem. This high frequency of substance abuse is also Another interesting thing to note was that 81.7% of indicative of easy availability of substance and failure of students were aware of harmful effects of substance parents and institutes to observe habits of youngsters. abuse and still only 43.5% were thinking of quitting it on Promotion of abuse by media as a sign of masculinity motivation. Efforts to motivate students by increasing and strength is also contributing to the problem and their involvement in more healthy activities like sports, need attention. organizing competitions within and between Campuses, showing healthy videos and arranging debates on This study results showed regular substance abuse current affairs and problems can also help to make them frequency of 70/238 (29.4%) among non-medical under conversant of problems and their solutions. Teaching graduates and 45/334 (13.4%) among medical under- students about harmful effects of alcohol and drug graduates. abuse can improve their knowledge, skills, and self- There are a number of studies showing that students efficacy.15,16 Steps can also be taken to keep knowledge from medical universities are more likely to indulge in about substance abuse as a part of curriculum as substance abuse because of more academic and non- reports are suggestive of an improved outcome. academic stresses.10,14 The present result show substance abuse to be more CONCLUSION frequent among non-medical undergraduates than Substance abuse among the study population was medical undergraduates. This is contrary to the common 20.1%. Male gender were more involved in substance concept that medical student are abusing substance abuse than female, their ratio being 4.7: 1.0. Frequency more due to more stresses and easy availability of of substance abuse among the non-medical under- drugs. One explanation for this result could be that the graduates was greater than medical undergraduates.

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (7): 515-518 517 Huma Mamun Mahmud, Mehreen Kalam, Amna Nawaz, Saleha Khan, Hira Imam and Osama Ahsan Khan

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