Pattern of Substance Use among Patients Attending the Drug Unit of the University of Port Harcourt Teaching Hospital

Background: Substance abuse in various parts of the globe appears to be evolving in different patterns and this keeps threatening the physical as well as socioeconomic well-being of homes, societies and countries.

Aim: This study investigated the pattern of substance use among patients on drug treatment at the University of Port Harcourt Teaching Hospital.

Methodology: NENDU data from the Drug Unit from January 2018 to February 2020 were investigated after ethical clearance in this descriptive retrospective study. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 20.

Results: Results revealed that out of a total of 104 registered patients, cannabis was the most declared drug with 42.3% use. Cannabis was also the most frequently used drug (28 persons used it daily) followed by alcohol (8 persons used it daily). Street dealers constituted the readiest source with 96 (92.3%) while poly-drug was higher with 76 (73.1%). The majority of respondents using substances/drugs were males 98 (94.2%), singles 93 (89.4%), and college degree holders 73 (75.0%).

Conclusion: From the conclusion of this study, there are emerging varied patterns of substance use. Hence, there is a need for increased sensitization and health education programs to curb the trend.

Substance use refers to the intake of any psychoactive substance or drug, including legal and illegal drugs, except those that are medically prescribed [1]. Psychoactive substance use is a risk to the well-being, social and economic make-up of families, societies and nations [2]. Drug addiction is a growing public health problem and the consequences of drug addiction are costly to the community [3]. This habit not only affects health, study, and career but also causes a significant economic and social problem for the general public.

Alcohol, tobacco, marijuana, and more significantly, prescription drugs, are among the commonly abused substances for all age brackets; but how these drugs are used and the striking effects vary by life stage. With respect to wellbeing results, every age bracket is in danger for drug abuse, accidental and physical injuries, and suicidal ideation. Substance users are at increased risk for accidents, damaging falls, cancer, sexually transmitted diseases, cardiovascular diseases, and mental health issues [4].

According to Abudu [5], variables/elements associated with elevated probability of drug use are adulthood functions, life encounters, past usage and unemployment. It has been reported that societal usage of substances is associated with family, social and personal risk factors [6]. Risk factors classified as familial are childhood abuse and neglect, domestic abuse, and parent-child relationships. Social risk factors are connected with peer influence, popularity, and bad associations. Personal risk factors include hyperactivity disorder and depressed feelings. Studies reveal that substance use varies with the socio-demographic characteristics of individuals. Swendsen, et al. [7] observed that there was a huge association between a number of baseline socio-demographic factors (adolescence, low educational attainment, non-Caucasian ethnicity, and employment status) but not others (gender, number of children, place of residence) and later initiation of stimulant use.

According to Adolfo, et al. [8], substance abuse is more prevalent among women, people over 40 years of age, those with higher educational levels, persons who live alone, and persons who live in large cities. Patrick, et al. [9] asserted that young adults with the highest family background socio-economic status are prone to substance and alcohol abuse. The National Institute of Substance Abuse [10] found that increased drug availability was associated with increased use and overdose.

It has been proven that substance use in various areas of the globe appears to be rising amongst adults [11]. Among the adolescent particularly, new patterns of drug use have continued to emerge with associated risk factors and various risk taking behaviors [12-17]. The negative consequences of persistent substance use justify the significance of investigating the pattern of substance use problems amongst people on drug rehabilitation at the University of Port Harcourt Teaching Hospital.

Study design

The design used for this study was the descriptive retrospective.

Study subjects

The target population consisted of all adult males and females undergoing drug rehabilitation treatment at the University of Port Harcourt Teaching Hospital. Only samples who are undergoing drug rehabilitation for at least 6 months were included in the study. The study was carried out from January 2018 to February 2020. A sample size of 104 people was chosen by adopting the purposive sampling method. The sample size determination was performed using Cochran's sample size formula as shown below:

N= Z²P (1-P)/e²

where N= Sample size

P = Prevalence of drug use = (6.6%) = 0.066. [12]

d = Sampling error that can be tolerated (0.05)

Z = Level of Significance

N= 1.96² 0.066(1-0.066)/0.0025

= 0.2368115904 (0.856)/0.0025

=94.725

=94.7

10% non-respondent= 94.7 of 10% =

=9.47

N=94.7+9.47=104.17

N= 104 approx.

Data collection

The Nigerian Epidemiological Network on Drug use for drug patients who underwent UPTH remedy facility from January 2018 to February 2020 were obtained and utilized in the study after ethical clearance.

Data analysis

The data was analyzed using the Social Science Statistics Package (SPSS) version 20.

Table 1 shows that the majority of the respondents were males, 94.2%, had tertiary education, 75.0% and were single, 89.4%.

Table 2 depicts the prevalence of substance use disorders in people undergoing drug rehabilitation in University of Port Harcourt Teaching Hospital. Of the 104 samples, 42.3% use cannabis, 13.5% take alcohol, 11.5% take tobacco, 9.62% take opioids, 7.69% take tramadol, 4.81% take cocaine, 3.85% take codeine, 2.88% take pentazocine, 1.98% take cracked cocaine and 0.96% take sedative hypnotics and hallucinogens.

Table 3 shows that gender is an important factor in substance use attitude, since the majority of people who use the substances were male.

Table 4 indicates that the marital status of people is an essential thing in substance use attitude, since most of the participants that use substances are singles.

Table 5 shows that the educational status of individuals is very important in substance use behavior, as the majority of the respondents that use substances had tertiary education.

Table 6 shows the patterns of substance use disorders in people undergoing drug rehabilitation based on the frequency of use and route of administration at the University of Port Harcourt Teaching Hospital. The majority consume cannabis (due to smoking) and alcohol (due to swallowing) daily.

Table 7 depicts the sources of substance use/abuse among people undergoing drug rehabilitation at the University of Port Harcourt Teaching Hospital. The majority of participants (92.3%) access the substances of use/misuse from street dealers.

Table 8 shows that 73.1% of the respondents practice polydrug use.

Findings from the study show that the majority of the respondents were males, 94.2%, had tertiary education, 75.0% and were single, 89.4%. Generally, there is a male predominance in drug use. Illicit drug use by men has twice the reported prevalence rate of women's drug use [18]. Heavy alcohol use is almost 3 times more frequent in men. Also, the trajectory for these patterns of drug use may be found in childhood and adolescence, where drug use is generally higher in boys than in girls [19]. Heavy alcohol and tobacco use is found more frequently in male students than in their female peers [19].

In short, for girls, the absence of resiliency (ie, skills that allow a person to cope with adverse situations) and the lack of self-control during early childhood predict both marijuana and hard drug use in adolescence. In boys, lack of self-control is strikingly important. Involvement with harder drugs seemed to represent an extension of the behavioral characteristics that predisposed to marijuana use in boys, while in girls additional psychopathological characteristics were usually present when harder drug use was evidenced. In another study, Luthar, et al. [20] reported that women who abused drugs had a higher incidence of internalizing problems, eg, depression, anxiety, and withdrawn behaviors, during childhood and had more severe psychiatric symptoms as adults.

Girls seem to be more influenced by environmental factors in the home [21]. Unkempt, crowded, noisy, disorderly conditions where there is little emphasis on conventions and religion are very potent predictors of later drug use in girls [22]. For boys, the family environment had an only chance association with later marijuana use [22].

The study equally revealed a higher rate of drug use with a higher level of education. Although not many studies have reported on the relationship between education and drug use, this finding may seem that knowledge and awareness of drugs of abuse may naturally increase with a higher level of education.

Marriage appears to be a protective factor for substance abuse because of the amount of respect society accords to the marriage institution. There is a high level of freedom associated with singlehood together with a heightened desire to explore curiosities and yield to experimentation.

Alcohol and cannabis were the two most commonly used drugs from the study. The younger a child initiates alcohol and other drug use, the higher the risk for serious health consequences and adult substance abuse [23]. Addiction is also largely a function of the neurotransmitter system and particularly not unrelated to the profound influence on dopamine and other monoamine functions [24,25]. Fatalities, accidental and intentional, that are associated with drug and alcohol use in the adolescent population represent one of the leading preventable causes of death for the 15- to the 24-year-old population [23].

As adolescence starts and people take on greater personal, familial, and social roles, the gains and the possibilities to use substances normally reduce, and issues concerning fitness and wellbeing dangers and terrible outcomes of substance use have a tendency to grow. As expected, substance usage happens throughout the life span, and even at adolescence, many nonetheless use illegal drugs once in a while, licit substances above the normal level, or prescribed drugs without being prescribed by a doctor [26]. Substance use is associated with sicknesses like emphysema, lung cancer, and liver disease, and abuse of alcohol and other hard drugs is still a risk factor for road incidents [17].

The study findings revealed that cannabis and alcohol ranked highest as the substances of use/misuse as the majority used cannabis (by smoking) and alcohol (by swallowing) daily. Opioids (by swallowing), cocaine (by sniffing) and codeine (by swallowing) were among the least frequently used/misused drugs, and were taken once or twice monthly. This agrees with the findings of Morello, et al. [13] and Jegede, et al. [14].

Drug use among adolescents is a persistent and recurring problem-one that needs consistent and unremitting attention. It is a long-term problem, which means that we must institutionalize prevention efforts [19,23]. The importance of early adolescent drug use is that it places the child on a deleterious trajectory for future drug use [27]. If a child smoked tobacco or drank alcohol, they were 65 times more likely to use marijuana than a child who never smoked or drank. Children who used marijuana were 104 times as likely to use cocaine compared with their peers who never used marijuana [27]. This also conforms to the gateway theory.

Addiction develops from a complex interplay between the individual, the agent (drugs and alcohol), and the environment. The initiation of first drug use is determined by interactions between social, cognitive, cultural, attitudinal, personality, and developmental factors [28,29]. The earliest influences to smoke, drink alcohol, or use drugs may come from the family including genetic vulnerability [29,30]. Factors that are related to drug use during adolescence include poor self-image, low religiosity, poor school performance, parental rejection, family dysfunction, abuse, under-or over-controlling by parents, and divorce [27-30].

Also, the major sources of the substances of use were street dealers. This is consistent with the submission of Chia [15]. The reason for this pattern of drug use could be attributed to the fact that alcohol and cannabis are generally less expensive and easier to get in our environment (usually in the streets) than cocaine and opioids etc. which are less common. This may of course not be applicable in other climes.

Findings from the study also revealed that majority 76 (73.1%) of the subjects practiced polydrug use while 28 (26.9%) did not. This result is consistent with the submission of Kahuthia-Gathu, et al. [16]. The possible reason for this pattern (polydrug use) could be due to the fact that most of these drug users were ready to use any available substance at their disposal. The sex of individuals, marital and academic fame additionally had been visible as crucial elements in substance use behavior, a majority of the people that used substances were males, singles and had a college degree. The reason males and singles were found to use drugs more than females and married/widowed counterparts is probably due to the fact that they are generally seen as more adventurous. These outcomes are in line with Okpataku's claim [17].

There are emerging varied patterns of substance use as the majority use cannabis (by smoking) and alcohol (by swallowing) daily while opioids (by swallowing), cocaine (by sniffing) and codeine (by swallowing) were among the least frequently used/misused drugs, and were taken once or twice monthly. The major sources of these substances were street dealers.

1. Public health professionals need to organize community awareness programs targeted at enlightening the society at large about the dangerous effects of substance abuse and the necessity to grow positive health-related attitudes.
2. There is a need to set up groups in different communities to help sensitize the youths on the need to stop drug use and abuse.
3. The government must properly enforce laws stopping the use of illicit drugs in society.
4. Targeted management of substance use disorders in medical facilities is also recommended.
5. Persons undergoing drug rehabilitation need to receive appropriate social and relevant support.

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