SURVEY REPORT
Are Medical Undergraduates more Likely to Indulge
in Substance Abuse than Non-Medical Undergraduates?
A Survey from Karachi
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 nonmedical 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 nonmedical undergraduates were more frequently using such substances; tobacco being the most common.
Key Words: Undergraduates students. Karachi. Substance abuse.
INTRODUCTION
Substance or drug abuse is a patterned use of a
substance in an amount and with a method neither
approved nor supervised by a medical professional and
it also includes the use and of drugs for non-medical
reasons to enhance performances like use of steroids in
sports.1
Substance abuse can lead to physical, social and
psychological harm and dependence in individuals
consuming them and it can also result in criminal
behavior and penalty depending on local jurisdiction.2
If we look at data from Pakistan, substance abuse is
very common in our society. According to the 5th (and up
till now the last) national survey (National Survey on
Drug Abuse-N.S.D.A) conducted in 1993 by the Pakistan
Narcotic Control Board, there were nearly 3 million drug
dependents in Pakistan. This represents nearly a threefold increase in the total number of dependents when
compared to the findings in the first N.S.D.A report of
1982.3
Department of Medicine1 / Medical Student2, Dow International
Medical College, DUHS, Karachi.
Correspondence: Dr. Huma Mamun Mahmud, A-34, Block-13,
Shamoonabad, Gulshan-e-Iqbal, Karachi.
E-mail: [email protected]
Received: January 11, 2013; Accepted: February 26, 2014.
Substance abuse in adolescence is a social experience
and a 'learned behavior' which is largely practiced in
schools and it is a worldwide problem. Substance abuse
among school students from India is 12.5%,4 native
American adolescents is 37%,5 66% among students in
a Nigerian University6 and 33% among adolescents in
Bosnia and Herzegovina.7
A cross-sectional survey from Pakistan report substance
abuse to be 33%.8 In Karachi one of the studies on
dental care seeker demonstrated oral substance abuse
to be 39.1%.9
A number of international studies are suggestive of
medical students to be more involved in substance
abuse than non-medical students.10 Tobacco is the
commonest substance of abuse reported.7
The aim of this study was to determine the frequency of
substance abuse among the medical versus nonmedical undergraduate students.
METHODOLOGY
It was a cross-sectional survey report done at Dow
International Medical College, Karachi over a period of 3
months from 15th June 2012 till 15th August 2012.
Inclusion criteria were undergraduate students in
defined universities who were willing to participate.
Exclusion criteria was anyone who was not an undergraduate 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
Dow Medical College, Dow International Medical
College, Sindh Medical University, and Karachi Medical
and Dental College. Non-medical institute were NED
University, Iqra University, Karachi University and Textile
Institute of Pakistan.
Table I: Frequency of substance abuse among medical and non-medical
undergraduates.
All responders
Substance abused ever
Substance abused regularly
572
327 (57.2%)
115 (20.1%)
Medical
Non-medical
334
238
undergraduates undergraduates
164 (49.1%)
45 (13.4%)
163 (68.5%)
70 (29.4%)
Table II: Frequencies of abuse habits among regular abusers.
Commonest substance abused:
Tobacco
69/115 (60%)
Heroine
6/115 (5.2%)
Alcohol
Hashish
Metamphetamines
Tranquillizers
More than one substance
Reason of abuse:
Pleasure
To relieve stress
To keep awake
Medically prescribed
More than one reason
Live with:
6/115 (5.2%)
1/115 (0.9%)
3/115 (2.6%)
30/115 (26%)
37/115 (32.1%)
3/115 (2.6%)
2/115 (1.7%)
26/115 (22.6%)
Other places
Source of substance availability:
From friends
35/115 (30.4%)
16/115 (13.9%)
55/115 (47.8%)
Family
57/115 (49.6%)
Friends
6/115 (5.2%)
Self-earned
Others
Among total responders, 329/572 (57.2%) accepted
substance abused. However, 86/572 (16.3%) were
those who had it either once in life time or once during
study tenure; another 128/572 (22.3%) abused
substance occasionally. Excluding these 214 subjects,
there were 115/572 (20.1%) students who admitted
regular substance abuse.
1/115 (0.9%)
Don't want to tell
Financial support:
Total number of responders included in study were 572
out of whom males were 316/ 572 (55.2%) and females
were 256/572 (44.76%), ratio of 1.23:1.0. Mean age was
21.76 ± 2.168 years.
6/115 (5.2%)
8/115 (7%)
More than one source
Total number of questionnaire collected were 607
however, during the assessment, 35 were found
incomplete so those were not included in study.
18/115 (15.7%)
From family
From campus
RESULTS
20/115 (17.4%)
In hostel
Alone
Data analysis was done on Statistical Package for Social
Sciences (SPSS) version 16. Categorical data was
evaluated through frequencies and percentages.
Numerical data was presented through mean and SD.
53/115 (46.1%)
65/115 (56.5%)
Data was collected through self-responding questionnaire which was handed out to the participants whoever
wanted to fill it out and returned it within 10 - 15 minutes
to the researchers. Questionnaire was written in English
and carry demographic data, and a checklist of
responses to certain questions regarding frequency of
abuse, names of substance (s) abused, financial
support, residing with whom, availability of substance,
knowledge of harmful effects, and if they wanted to quit.
Information regarding frequency of intake, reason for
initiating or maintaining substance abuse was also
asked.
0/115 (0%)
Family
Research data was collected by medical undergraduates of semester VIII from Dow International
Medical College, Dow University of Health Sciences
Karachi. All the researchers involved in data collection
visited the selected medical and non-medical colleges
during the research duration. Verbal permission was
sought from administration of selected campuses to
collect data and also consent from responders was
taken as their will to fill questionnaire.
40/115 (34.8%)
12/115 (10.4%)
Table III: Pattern of substance abuse among medical and non-medical undergraduates.
Regular substance abusers
Number
Males : Females
Age
Mean year of study
Commonest substance abused was tobacco
115
4.7 : 1.0
Regular substance abusers
medical graduates
Regular substance abusers
non-medical undergraduates
2.2 : 1.0
10.6 : 1.0
45
22.23 ± 2.39
22.18 ± 2.58
22.27 ± 2.27
69 (60%)
19 (42.2%)
50 (71.4%)
2.43 ± 1.14
2.73 ± 1.17
Most frequent reason for abuse found was pleasure
53 (46.1%)
Financial support from family
57 (49.6%)
21 (46.7%)
Willingness to quit
50 (43.5%)
18 (40%)
Friends as a source of substance availability
Awareness of harmful effects
516
70
35 (30.4%)
94 (81.7%)
19 (42.2%)
16 (35.6%)
33 (73.3%)
2.24 ± 1.09
34 (48.6%)
19 (27.1%)
36 (51.4%)
61(87.1%)
32 (45.7%)
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 nonmedical undergraduates is shown in Table I which shows
abuse of substance was more (29.4%) in non-medical
undergraduates than medical (13.4%). Frequencies of
abusing habits among regular abusers is defined in
Table II which shows the commonest substance of
abuse was tobacco in 60%, commonest reason of abuse
is pleasure in 46.1%. Most abusers (56.5%) were living
with their families and getting financial support from
family in 49.6%; 47.8% denied to disclose the source
of substance availability. Table III summarizes pattern
of substance abuse by medical and non-medical undergraduates.
DISCUSSION
Substance abuse is a worldwide problem. In Pakistan
number of substance abusers is 3.5 millions and this is
increasing every year at the rate of 7%.11
The study results shows that among 572 University
students aged between 18 - 29 years, substance abuse
was found in 327/572 (49.7%) in total, if we consider the
regular abusers frequency is 20.1%. In other countries in
a non-institutionalized adolescents between age group
12 - 17 years; alcohol abuse was reported in America as
37%.5 A report from India showed substance abuse
among school students to be 52/416 (12.5%).4 Alcohol
abuse was found in 66% students in a Nigerian
University,6 and more than 33% among adolescents in
Bosnia and Herzegovina.7 A study from Lahore showed
use of substance in past in 17% and in only 3.6%
students abusing substance at the time of study.12
This substance abuse frequency of 20.1% in our society
is no different from rest of the world and clearly
demonstrate the substance abuse as a worldwide
problem. This high frequency of substance abuse is also
indicative of easy availability of substance and failure of
parents and institutes to observe habits of youngsters.
Promotion of abuse by media as a sign of masculinity
and strength is also contributing to the problem and
need attention.
This study results showed regular substance abuse
frequency of 70/238 (29.4%) among non-medical under
graduates and 45/334 (13.4%) among medical undergraduates.
There are a number of studies showing that students
from medical universities are more likely to indulge in
substance abuse because of more academic and nonacademic stresses.10,14
The present result show substance abuse to be more
frequent among non-medical undergraduates than
medical undergraduates. This is contrary to the common
concept that medical student are abusing substance
more due to more stresses and easy availability of
drugs. One explanation for this result could be that the
medical universities accommodate less number of
students and keeping a check on them is comparatively
easy than non-medical universities.
These results are showing that male gender is more
involved in substance abuse, male: female ratio among
substance abusers is 4.7: 1.0. This may be because out
door and social activities of females is more observed by
families in our society in comparison with age matched
males who are considered as bread earner and decision
makers at early age and free to move.
Similar, observation is found from Bosnia and Herzegovina
which is also a Muslim society and shows more
substance abuse among boys than girls.7
Commonest substance of abuse was found to be
tobacco in the form of cigarette smoking in this study
which was used by 60% of our regular substance
abusers. Tobacco is also found as commonest
substance abused in Bosnia and Herzegovina where
one fourth of boys and one fourth of girls were daily
smokers.7
Although a number of published articles suggest that
stress is leading to consumption of substance.4,2,14 This
study results shows 46.1% of abusers are using it for
pleasure and stress was reported as a reason of abuse
by 32% students. Similar results are observed in study
from Bosnia and Herzegovina where pleasure is
reported to be the most common reason of substance
abuse.7
Among those regularly involved in substance abuse,
30.4% cited friends as source although a percentage of
47.8% did not mention about source of availability.
Almost half of the responders were financially supported
by their families.
Another interesting thing to note was that 81.7% of
students were aware of harmful effects of substance
abuse and still only 43.5% were thinking of quitting it on
motivation. Efforts to motivate students by increasing
their involvement in more healthy activities like sports,
organizing competitions within and between Campuses,
showing healthy videos and arranging debates on
current affairs and problems can also help to make them
conversant of problems and their solutions. Teaching
students about harmful effects of alcohol and drug
abuse can improve their knowledge, skills, and selfefficacy.15,16 Steps can also be taken to keep knowledge
about substance abuse as a part of curriculum as
reports are suggestive of an improved outcome.
CONCLUSION
Substance abuse among the study population was
20.1%. Male gender were more involved in substance
abuse than female, their ratio being 4.7: 1.0. Frequency
of substance abuse among the non-medical undergraduates 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
Commonest substance of abuse among both medical
and non-medical undergraduates was tobacco.
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Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (7): 515-518