Medical students follow general young adult behavior and are not exempt from the consequences of substance use, which may include injuries, work, and social impairment, violence, risky sexual behavior, health hazards, and sometimes death. Substances such as tobacco, alcohol, cannabis, and various allopathic drugs have been widely abused by students for various reasons despite their known ill effects. This has certain hazardous ramifications. Researchers have suggested that substance use in medical school may be the root of the ongoing problem of increased substance use in practicing physicians. This gives rise to negligence in professionalism and also jeopardizes their lives and also the lives of others they are to serve in the time ahead.
Peer pressure is also an important factor that instigates the idea of getting into substance abuse. The medical school in itself is very stressful and so, to cope with it, the students go into a bit frenzy.
Awareness about substance abuse is very less among students. Education on alcohol and drugs for students remains a crucial but under-provided part of the undergraduate medical curriculum. Cape G et al. demonstrated that while positive teaching outcomes were apparent, further changes to the medical student curriculum need to be considered to address specific knowledge. The information about substance use in students can be useful in devising effective educational programs for preventing the development of substance abuse disorder in this high-risk population. This study aimed at checking that awareness aspect as well as promoting it.
MATERIAL AND METHODS
It is an observational cross-sectional study done on medical students studying in MBBS medical colleges in the Pune region of Maharashtra State. All UG and PG medical students who are willing to participate in the study are included. A total of 704 participants answered the questionnaire to check awareness in UG and PG medical students regarding alcohol and drug abuse along with their legal implications. A google form link of a questionnaire of 25 questions (20 MCQs and 5 True/False questions) was sent to willing participants. From October 2020 to July 2021, we distributed Google form links via emails and social media. The email provided information about the survey to participants i.e., Undergraduate MBBS and Postgraduate students who completed a questionnaire with 25 questions. After completion of the survey, a detailed answer sheet was provided to participants to increase awareness.
Mandatory permission from the Institutional ethical committee was obtained vide ref. no. DYPV/EC/531/2020 dated August 4, 2020.
OBSERVATIONS AND RESULTS
A total of 704 participants responded to the questionnaire; 316 participants shared their names while 388 preferred to be anonymous. About 331 (47%) of them mentioned male, 321 (45.6%) female and 52 (7.4%) didn’t share gender information. All participants were in the age group of 18 to 30 years [Table 1].
Around 600 (85.23%) participants are UG students, of which the highest number are from Phase III 242 (34.4%) followed by Phase II 176 (25%). About 104 (14.77%) participants are Interns/PG students [Chart 1].
In our study, 411 (58.4%) participants accepted taking some or other form of substance abuse in the past, while 293 (41.6%) denied it. Out of 315 responses for specifics, alcohol was most common 231 (73.3%) followed by cannabis 98 (31.1%), tobacco 78 (24.8%) and other recreational drugs 43 (13.7%) [Chart 2].
In this study, 478 (67.9%) participants responded affirmatively to question, whether peer pressure plays important role in substance abuse and 226 (32.1%) denied it [Chart 3].
For 20 MCQs, only three questions have more than 50% correct reply; and, for 5 questions with true/false or yes/no reply, three questions got more than 50% correct responses [Table 2 and Chart 4].
Substance use amongst doctors is an issue of significant concern. For some, it may progress to substance abuse/dependence that is detrimental both to the individual and to society. Signs of substance can be easily missed due to subtle and misleading variability. Denial is common and the affected person is last to acknowledge a problem; hence, it is important to increase its awareness among medical students.
A total of 704 participants answered the questionnaire to check awareness in UG and PG medical students regarding alcohol and drug abuse along with their legal implications.
A total of 704 participants responded to the questionnaire; 316 participants shared their names, while 388 preferred to be anonymous. About 331 (47%) of them mentioned male, 321 (45.6%) female and 52 (7.4%) didn’t share gender information. All participants were in the age group of 18 to 30 years.
600 participants are UG students of which the highest number is from Phase III 242 (34.4%) followed by Phase II 176 (25%). About 104 (14.77%) participants are Interns/PG students.
Globally, alcohol dependence was the most prevalent substance use disorder accounting for 1321 cases per 100,000 people. The most common drug use disorders in 2016 were cannabis dependence prevalence 289 cases per 100,000 people and opioid dependence prevalence 3530 cases per 100,000 people.
In a US study done by Erica Frank most (78%, 3777/4847) students reported drinking alcohol of which 34% participants admitted to drinking in high quantity typically in the form of binge drinking. Men (43%) outnumbered women (24%) in binge drinking.
Jaiswal HS in an Indian study observed that Alcohol alone or in combination with tobacco was the most abused substance, but due to inadequate sample size could not establish peer pressure as a significant factor.
In our study 411 (58.4%) participants accepted taking some or other form of substance abuse in the past while 293 (41.6%) denied it. Out of 315 responses for specifics, Alcohol was most common 231 (73.3%) followed by cannabis 98 (31.1%), tobacco 78 (24.8%), and other recreational drugs 43 (13.7%).
In this study, 478 (67.9%) participants responded affirmatively to the question, of whether peer pressure plays important role in substance abuse and 226 (32.1%) denied it.
For 20 MCQs, only three questions have more than 50% correct replies; whereas, out of 5 questions with true/false or yes/no replies three questions got more than 50% correct responses. A medical student is expected to have basic knowledge of substances of abuse, dependence, and complications along with legal implications. The second-year MBBS curriculum includes these topics under Pharmacology, Forensic Medicine and Toxicology, and General Medicine. Less than 50% of the correct responses to most of the question underlines low awareness and neglect of this important social and medical issue. Much is needed to be done to raise awareness and bring out behavioral change among medical students. Targeted programs like seminars, educational plays, regular notifications, and institutional regulatory mechanisms are some of them.
The problem of substance abuse and addiction is complex, deeply rooted in societal values and sometimes in culture as well, but a sufficient amount of research data is available to physicians, educational institutions, and community leaders to make and implement rules and regulations that can decrease adolescent substance abuse. Especially medical institutions in India should take proactive measures in increasing awareness regarding the adverse effects of these substances on medical students.
Some risk factors are enlisted by the National Institute on Drug Abuse (NIDA) in its report “Science of Addiction” like peer group influence, socioeconomic status, quality of parenting, inherent/biological predispositions, and exposure to drugs. Our aim should be to systematically reduce the exposure of adolescents to drugs and counsel parents about their risks. Institutes should enact strict rules and regulations emphasizing zero tolerance for substance abuse. Proper mechanisms like a special committee, complaint boxes, and nodal officer for grievance redressal should be instituted. Periodical awareness campaigns like posters, role plays, advertisements, etc., should be undertaken. A medical student, free of any substance abuse is a role model for society and a step towards becoming an ideal citizen.
The medical college environment might influence students’ tendency toward substance abuse and addiction, hence efforts should be made to alter the substance abuse favorable environments at medical institutes to discourage these activities. If medical students are better educated about harmful effects, legal implications, and professional detrimental effects then it will not only transform medical society but the general public also. After counseling for addictive substance misuse, students might be more likely to adhere to social norms and be better equipped to identify and reduce substance abuse among their patients.
Medical colleges should support the implementation of effective measures to increase awareness among students and make stricter rules and regulations for campus behavioral practices to reduce excessive substance abuse among medical students. Mentors assigned to the students must make sure that the latter is transparent to them and help them with overcoming their hardships.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
1. Arora A, Kannan S, Gowri S, Choudhary S, Sudarasanan S, Khosla PP. Substance abuse amongst the medical graduate students in developing country. Indian J Med Res 2016;143:101–3.
2. Ayala EE, Roseman D, Winseman JS, Mason HR. Prevalence, perceptions and consequences of substance use in medical students. Med Educ Online 2017;22:1392824. doi:10.1080/10872981.2017.1392824.
3. Owens B. Growing concern over medical students'excessive drinking. CMAJ 2018;190:E1215.
4. Cape G, Hannah A, Sellman DA. Longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs. Addiction 2006;101:841–9.
5. Jagnany VK, Murarka S, Haider S, Kashyap V. Pattern of substance abuse among the undergraduate students in medical college hostel. Health Popul Perspect Issues 2008;31:212–9.
6. GBD 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016:A systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry 2018;5:987–1012.
7. Frank E, Elon L, Naimi T, Brewer R. Alcohol consumption and alcohol counselling behaviour among US medical students:Cohort study. BMJ 2008;337:a2155. doi:10.1136/bmj.a2155.
8. Jaiswal HS, Jain SL, Jaiswal SS. Pattern of substance use in first year and final year medical students:A cross-sectional study. Int J Recent Surg Med Sci 2017;3:98–101.
9. Chakravarthy B, Shah S, Lotfipour S. Adolescent drug abuse - awareness and prevention. Indian J Med Res 2013;137:1021–3.
10. U.S. Department of Health and Human Services, National Institutes of Health. Preventing drug use among children and adolescents. National Institute on Drug Abuse (NIDA) - A Research-Based Guide for Parents, Educators and Community Leaders. 2nd ed. Bethesda, Maryland, USA: NIDA; 2010. 6–11.