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Lithuanian University Of Health Sciences

Faculty of Medicine

Department of Psychiatry

Lior Tamar

HARMFUL HABITS AMONG MEDICAL STUDENTS: THEIR INCIDENCE AND

CORRELATION WITH SUBJECTIVE WELL-BEING

English program

r. Kristina Dambrauskienė

D

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Table of contents

SUMMARY………3-6

ACKNOWLEDGEMENT……….…...….7

CONFLICT OF INTEREST STATEMENT……….……….……..….…….8

ETICS COMMITTEE CLEARANCE………..…….………9

INTRODUCTION...…...10

AIM & OBJECTIVES………...11

LITERATURE REVIEW………..…...12-13 METHODS………...14 RESULTS………...15-20 DISCUSSION………...21 CONCLUSION………22 REFERENCES………...23-24

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Summary

Author: Lior Tamar

THEME: HARMFUL HABITS AMONG MEDICAL STUDENTS: THEIR INCIDENCE AND

CORRELATION WITH SUBJECTIVE WELL-BEING.

Faculty of Medicine UHS

students in L use among

To evaluate peculiarities of psychoactive substance

: Aim

and their correlation to subjective well-being and success in studies.

B) To estimate the ;

To estimate the prevalence of substance use among medical students A) Objectives: and To estimate correlation ) C t substance abuse among students; prevalence of clinically significan

and success in studies being

-subjective well substance abuse with

peculiarities of

The first Correlative and consisted of three main questionnaires.

-was Quantitative Research type

Methods:

age criteria" looking for based of "C questionnaire second general information; gathered questionnaire via being -to asses' subjective well created

questionnaire ; third

of usage and type abundance

prevalence and

luded was chosen from LUHS Faculty of Medicine and inc articipants

p Oxford Happiness Questionnaire. The

Statistical analysis was .

foreigners and locals study programs:

among both students

the first to sixth course

Mann Whitney U test was performed for differences in the

performed using SPSS version 21 package.

parameters between male vs. female. Spearman's rho eing

b -Subjective well addiction parameters and

by study being

-subjective well correlation was demonstrated for the relation between addiction parameters and

. substance abuse being and

-subjective well year. Also Pearson Correlation was used for the relation between

Selected statistical significance level was p <0.05.

Results: The research included 222 (51.4% females and 48.6% males) participants among the Lithuanian University of Health Sciences Medical faculty students from the first to sixth courses. 162 students which are 72.9% of the whole sample has the grades of 7-9.No difference was found among genders in grades (P=0.25) and study year (P=0.41). Those results indicate that the statistical deviation of grades among the years and among genders for research participants was similar. Clinically significant addiction was found abusing Caffeine (41%), Tobacco (35%), Alcohol (11%), and Cannabis (8%). For others psychoactive substances: cocaine, amphetamine, methyl-phenidate, inhalants, MDMA, hallucinogens and benzodiazepine usage showed no abused. None of the participants have ever used opiates nor barbiturate. No statistical significance was found between substance abuse for the study years (p=0.41) and genders (p=0.27), which means, approximately same rates of usage exist among all academic courses, however, was found higher addiction severity at senior years. Junior years majority usually mark "cut down" (41.67%) and senior years majority usually mark "eye opener" (47.8%). The third questionnaire known as subjective well-being screening tool consisted of 29 questions. The common score among LUHS is 4.5 ( SD=0.564) indicating fair satisfaction. Average grade of subjective well-being in men was 4.31 (SD=0.58) and in women 4.69 (SD=0.5). Subjective well-well-being Index with correlation to gender showed result P=0.041. This significant statistical value could give us a clue that females are more likely to rate in more optimistic fashion the questionnaire. Correlation of subjective well-being to study year Spearman's rho p=0.062. was not strong enough to indicate significance which mean subjective well-being is not dependent on what academic year. Subjective well-being correlation with substance abuse questionnaire showed no correlation. No statistical correlation was found between subjective well-being substance abuse and

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common grade. Correlations between subjective well-being, substance abuse and common grade weren't found (Pearson correlation Total value -0.253, p=0.131).

Conclusions: A. The research showed prevalence that 85% of all students was using Alcohol, Caffeine and

Tabacco. From illicit drugs Cannabis was used in 59% of the students. No statistical significance was found between substance abuse for the study years and genders. B. The research showed that in all study years and both genders clinically significant addiction was found abusing Caffeine, Tobacco, Alcohol, and Cannabis. Higher addiction severity was found at senior years. Other substances: Cocaine, amphetamine,

methyl-phenidate, inhalants, MDMA, hallucinogens and benzodiazepine usage showed no abuse. C. Average score for Subjective well-being among students was 4.5 out of 6. Subjective well-being was rated more optimistic in females than males. Women and men in all academic courses were using and abusing equally. No statistical correlation was found between subjective well-being, substance abuse and common grade.

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Autorius: Lior Tamar

TEMA: MEDICINOS STUDENTŲ ŽALINGI ĮPROČIAI: JŲ PAPLITIMAS IR KORELIACIJA SU

SUBJEKTYVIOS GEROVĖS VERTINIMU

Tyrimo tikslas: Tyrimas skirtas įvertinti psichoaktyvių medžiagų vartojimo paplitimą tarp LSMU Medicinos

fakulteto studentų (toliau studentai) ir koreliaciją su subjektyvia gerove bei pažangumu studijose.

Tyrimo objektai: A) Nustatyti psichoaktyvių medžiagų vartojimo paplitimą tarp medicinos studentų; B)

Įvertinti kliniškai reikšmingo piktnaudžiavimo psichoaktyviomis medžiagomis paplitimą tarp medicinos studentų; C) Nustatyti koreliaciją tarp piktnaudžiavimo psichoaktyviomis medžiagomis ir subjektyvios gerovės vertinimo, pažangumo studijose.

Metodika: Tyrimas buvo kiekybinis. Naudoti trys klausimynai. Pirmą klausimyną sudarė klausimai apie tiriamųjų sociodemografinius duomenis, pažangumą studijose. Antras klausimynas – klausimai apie

psichoaktyvių medžiagų vartojimą bei integruotas „CAGE“ testas, siekiant įvertinti probleminį psichoaktyvių medžiagų vartojimą; siekiant įvertinti subjektyvią medicinos studentų gerovę, naudotas Oksfordo Laimės klausimynas (Oxford Happiness Questionnaire). Tyrime dalyvavo pirmo - šešto kurso abiejų studijų programų (lietuvių ir užsienio) LSMU Medicinos fakulteto studentai. Statistinė analizė atlikta naudojantis SPSS paketo 21 versija. Siekiant nustatyti skirtumus tarp skirtingų priklausomybės variantų ir subjektyvios gerovės vertinimo

vyrų ir moterų grupėse buvo naudotas Mann Whitney U testas. Spearman's rho korialiacija- siekiant nustatyti ryšį tarp priklausomybės ir subjektyvios gerovės pagal studijavimo metus. Pearson Correlation naudota nustatant ryšį tarp subjektyvios gerovės ir žalingų įpročių priklausomybės. Pasirinktas statistinio reikšmingumo lygmuo buvo p<0.05.

Rezultatai: Tyrime dalyvavo 222 (51.4% moterų ir 48.6% vyrų) LSMU Medicinos fakulteto pirmo – šešto

kursų studentai. 72.9% tiriamųjų (162 studentai) nurodė, kad jų pažangumas 7-9 balai. Statistinio skirtumo tarp lyčių pažangumo (P=0.25) bei studijų kurso (P=0.41) nebuvo rasta. Kliniškai reikšmingas probleminis

vartojimas nustatytas 41% respondentų, piktnaudžiaujančių kofeinu, 35%- tabaku, 11%- alkoholiu ir 8%- kanapėmis. Kliniškai reikšmingo probleminio piktnaudžiavimo kitomis psichoaktyviomis medžiagos, tokiomis kaip kokainas, amfetaminas, metyl-fenidatas, inhaliantai, MDMA, haliucinogenai ir benzodiazepinai,

nenustatyta. Nei vienas iš dalyvių nenurodė kada nors gyvenime vartojęs opiatų ar barbitūratų. Nebuvo rasta statistinio reikšmingumo tarp kliniškai reikšmingo probleminio piktnaudžiavimo PAM tarp lyčių (p=0.27) ir akademinių metų, kas leidžia daryti prielaidą, kad yra panašus vartojimo lygmuo tarp skirtingų kursų studentų. Deja, vyresniuose kursuose nustatytas didesnis priklausomybės laipsnis (41.67% vs 47.8%).

Vertinant studentų subjektyvią gerovę, vidutinis įvertis buvo 4.5 (SN 0.564) iš 6, kuris nurodo patenkinamą satisfakciją. Subjektyvios gerovės vidutinis įvertinimas tarp vyrų buvo 4.31(SN=0.58), tarp moterų- 4.69 (SN=0.5). Subjektyvios gerovės vertinimas su koreliacija pagal lytį p=0.041, kas parodė, kad moterys linkusios vertinti savo subjektyvią gerovę optimistiškiau nei vyrai. Subjektyvios gerovės ir studijų metų koreliacija nenustatė jokio skirtumo tarp studijų metų ir subjektyvios gerovės lygio, tai reiškia, kad subjektyvi gerovė nepriklauso nuo studijų metų. Nenustatyta koreliacijos ir tarp subjektyvios gerovės ir kliniškai reikšmingo probleminio piktnaudžiavimo psichoaktyviomis medžiagomis bei tarp subjektyvios gerovės ir pažangumo

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studijose. Nenustatyta koreliacijos tarp kliniškai reikšmingo probleminio piktnaudžiavimo psichoaktyviomis medžiagomis ir subjektyvios gerovės bei pažangumu (Pearson korel. -0.253, p=0.131).

Išvados:

A. Alkoholio, kofeino ir tabako vartojimo paplitimas tarp studentų yra daugiau nei 85%. Visų kursų studentai, nepriklausomai nuo lyties, vartojo ir piktnaudžiavo PAM vienodai. Nebuvo rasta statistiškai reikšmingo skirtumo tarp PAM vartojimo ir akademinių pasiekimų.

B. Kliniškai reikšmingas probleminis vartojimas nustatytas 41% respondentų, piktnaudžiaujančių kofeinu, 35%- tabaku, 11%- alkoholiu ir 8%- kanapėmis. Statistiškai reikšmingo probleminio vartojimo paplitimo skirtumo tarp lyčių bei skirtingų studijų metų nenustatytą, tačiau tarp vyresnių kursų studentų buvo labiau išreikštas probleminis piktnaudžiavimas PAM. Kliniškai reikšmingo probleminio piktnaudžiavimo kokainu, amfetaminu, metyl-fenidatu, inhaliantais, MDMA, haliucinogenais ir benzodiazepinais tarp medicinos studentų nenustatyta.

A. Vidutinis subjektyvios gerovės vertinimas tarp studentų buvo 4.5 iš 6. Moterys pozityviau vertino savo subjektyvią gerovę nei vyrai (p=0.041). Koreliacijos tarp kliniškai reikšmingo probleminio piktnaudžiavimo PAM ir subjektyvios gerovės vertinimo bei pažangumo studijose nenustatyta.

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Acknowledgement

Special thank for Dr. Kristina Dambrauskiene for her patience, instructions and listening ear.

I would like to thank all who supported physically spiritually and mentally in the research, and of course for all of the participants.

I would like to use this opportunity and to thank the institution, LSMU, for giving me a tremendous opportunity to acquire skills and knowledge that can make the world a better place, for high quality medical skills,

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Conflicts of Interest Statement

Manuscript title: "HARMFUL HABITS AMONG MEDICAL STUDENTS: THEIR INCIDENCE AND CORRELATION WITH SUBJECTIVE WILL-BEING"

The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author's name (typed) : Lior Tamar Author's signature Date:

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Introduction

Subjective well-being is defined as a person's cognitive and affective evaluation of his or her life. Include emotional reactions to events as well as cognitive judgements of satisfaction and fulfillment. Thus, subjective well-being is a broad concept that includes experiencing pleasant emotions, low levels of negative moods, and high life satisfaction. [1]

As we know medical students exposed to constant pressure in studies and exposed to stress of and for many reasons, which may affect their life quality tremendously.

Medical school is recognized as a stressful environment that often exerts a negative effect on the academic performance, physical health and psychological wellbeing of the student. A study among undergraduate medical students in the United States of America found that 23% had clinical depression and 57% were under

known risk factor in the development of addiction and in addiction -Stress is a well 2] [ . psychological stress

relapse vulnerability. There is a substantial literature on the significant association between stress and the 3]

[ . substances motivation to abuse addictive

The relevancy of the research is very big, first the exploration of prevalence and incidence of drug abuse among medical faculty students in LSMU, determination of the medical student individual satisfaction in life by subjective well-being and trying to find correlations to study year, gender and grades.

Theoretically it seeks to check student success in studies and if it is correlated with subjective well-being and association with any drug abuse correlation.

Practically, if such correlation was found, we could easily implicate those tools in the university and clinical practice and to increase quality of the student's life.

The research was performed in order to explore harmful habits among student, prevalence and incidence with focusing on psychoactive substance abuse with the correlation to subjective well-being and correlation with success in studies.

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Aim & Objectives

Aim:

To evaluate peculiarities of psychoactive substance use among students in LSMU Faculty of Medicine and their correlation to subjective well-being and success in studies.

Objectives:

To estimate the prevalence of substance use among medical students A)

B) To estimate the prevalence of clinically significant substance abuse among students

and success in being

-subjective well substance abuse with

and peculiarities of correlation To estimate ) C studies.

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Literature review

The student experience of today is very different to that experienced in the 1960's, 70's or 80's. Factors include: student debt, greater material expectations, greater pressure on academic institutions and staff, and expansion of student numbers. Leaving one's family and making a new start elsewhere also contributes to stress. As many students place great value on social and familial support, a change in environment can disrupt this support and it may take some time to find adequate substitutes[4] Another research which was performed in Yale university, USA at 2000 showed 45% of the students reported drinking above the recommended UK limits for alcohol

Preclinical research has shown that ]

5 [ consumption. Cannabis was the most frequently used illicit drug (45%).

role in perpetuating drug abuse and relapse. However, the stress, in addition to drug itself, plays a key

mechanisms underlying this association in humans remain unclear. A greater understanding of how stress may nt development in the perpetuate drug abuse will likely have a significant impact on both prevention and treatme

] 6 [ field of addiction.

The DSM-IV-TR diagnoses, substance abuse and substance dependence, were replaced by one

diagnosis, substance use disorder, in DSM-5. Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to substance use disorder, moderate to severe subtype, while substance abuse is similar to the mild subtype. [7]

Unhealthy alcohol and other drug use — “Unhealthy use” refers to the spectrum of use that can result in health consequences, from use that risks consequences, to use with consequences that do not reach a diagnostic threshold, to use that meets DSM-5 criteria for substance use disorder.

Moderate to severe disorder — for patients with a moderate to severe disorder (roughly equivalent to alcohol dependence in DSM-IV), the optimal clinical goal of brief intervention is abstinence and reduction in

consequences [8].

Patients who abuse alcohol and drugs are much more likely to develop medical problems than the general population.[9] It is thought that approximately 10 percent of American adults have a problem with drugs or alcohol, and an estimated 20 percent of patients seen by family physicians have substance-abuse problems, excluding tobacco use. [10] Substance abuse, defined as the problematic use of alcohol, tobacco, or illicit drugs, has been called the nation's number one health problem.[11] The costs to society are enormous; the National Institute on Alcohol Abuse and Alcoholism estimates that alcohol and drug abuse are associated with 100,000 deaths per year and cost society $100 billion per year. [12]

Occupational risk factors for developing a Substance Use Disorder (SUD) are evident as early as medical The goal of medical education is to ]

13 [ school, likely due to increased access and higher levels of stress.

graduate knowledgeable, skillful, and professional physicians. The medical school curriculum has been accomplish these ambitions; however, some aspects of training may have unintended negative developed to

Drinking and illicit effects on medical students' mental and emotional health that can undermine these values.

drug use were assessed longitudinally in a cohort of medical students who were surveyed in the second and fifth year of their undergraduate studies, experimentation with illicit drugs had increased from 50% to 63% [14]

poor throughout Studies suggest that mental health worsens after students begin medical school and remains

training. On a personal level, this distress can contribute to substance abuse, broken relationships, suicide, and attrition from the profession. On a professional level, studies suggest that student distress contributes to

bsequently may affect students' care of patients, relationship with faculty, and ultimately the cynicism and su

] 5 [1 culture of the medical profession.

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In the National Household Survey on Drug Abuse were data describing prevalence among US physicians are dated, with most studies being conducted in the 1980s and 1990s. Research suggests that physicians are as likely as their age peers to have experimented with illicit substances, but are less likely to be current users of illicit substances. [16] [17] The most of the published data on this subject are limited to physicians in the US, where treatment of physicians with SUDs is typically overseen by a physician health program (PHP). Much of the information may be relevant to other types of clinicians and other countries where these problems have received attention. The best approach to screening in primary care is to use a brief, simple set of questions that is validated in the setting for its intended use, and that identifies the full spectrum of unhealthy use. Brief questionnaires are easier for clinicians to memorize and use. [18]

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Methods

used to quantify the problem by way of generating was

Correlative technique with questionnaires

-Quantitative

. numerical data or data that can be transformed into useable statistics The Research consisted of 3 questionnaires.

1) Informative questionnaire - general details such as gender, study year, chosen program to study and average grade in studies.

2) Substance abuse questionnaire consisted of 13 substances and combined within the "CAGE substance abuse screening tool"

The chosen substances were: alcohol, caffeine, cannabis, hallucinogens (without separate categories for phencyclidine nor for arylcyclohexylamines and other hallucinogens), inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants: amphetamine-type substances, cocaine, methyl-phenidate, and tobacco. The four CAGE alcohol screening questions are geared towards detection of DSM-IV diagnoses of substance abuse and dependence. The questions are not sensitive for detecting the full spectrum of unhealthy use. [20] Since the CAGE criteria is sutures more for people with alcohol addiction the questionnaire were modified and added more three simple prior questions which corresponded still with the severity of the criteria, first options was "no", second option was "one time experiment" third option was "Recreational purposes" and next 4 options were the classical CAGE criteria. Item responses on the CAGE questions are scored 0 for "no" and 1 for every "positive answer. Correspondents with a higher score being an indication of problematic usage. A total score of two or greater is considered as clinically significant usage.

3) Subjective well-being questionnaire consisted of 29 questions graded 1-6 which finally was calculated into mean, it is defined as a person's cognitive and affective evaluation of his or her life. Questionnaire included emotional reactions to events as well as cognitive judgements of satisfaction and fulfillment. Thus, subjective well-being is a broad concept that includes experiencing pleasant emotions, low levels of negative moods, and high life satisfaction, Subjective well-being questionnaire, which was issued at the year of 2001 by Oxford Brookes University school of psychology under "The oxford happiness project" also known as Oxford Happiness Questionnaire which is improved tool of "The Oxford Happiness Inventory. [21]

Statistical analysis was performed using SPSS version 21 package. Descriptive statistics in terms of mean, STD and percentiles were demonstrated to the whole parameters in the study. Mann Whitney U test was performed for differences in the addiction parameters and Quality of Life parameters between male vs. female. Spearman's rho correlation was demonstrated for the relation between addiction parameters and quality of life by study year. Also Pearson Correlation was used for the relation between quality of life and addiction. Selected statistical significance level was p <0.05.

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Results

General data

The research included 222 participants (51.4% females and 48.6% males) among the Lithuanian University of Health Sciences Medical faculty students from the first to sixth courses.

Fig.1. LUHS medical faculty participants' deviation

Academic course

I 10.8% (24) II 13.5% (30) III 18.9% (42) IV 8.1% (18) V 18.9% (42) VI 29.7% (66)

Fig.2. LUHS medical faculty students grades deviation

Common grade deviation

< 5 0% ( 0 ) 5-6 2% ( 5 ) 6-7 17% ( 37 ) 7-8 32% ( 72 ) 8-9 41% ( 91 ) 9-10 8% ( 17 )

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162 students which are 72.9% of the whole sample has the grades of 7-9. No difference was found among genders in grades (P=0.25) and study year (P=0.41). Those results indicate that the statistical deviation of grades among the years and among genders for research participants was similar.

Harmful habits

The second "Substance abuse" questionnaire was rated from 1 to 7 as follow: 1) No - never experience before in the life

2) Yes – only one time experiment

3) YES - "Recreational Purposes" (not occasionally, from time to time) 4) YES - often I feel that I have to cut down

5) YES - often I get annoyed of people criticizing me about this habit 6) YES - often I feel guilty about this habit

7) YES - often I open my eyes with this habit

The first 3 questions was made in order to know the purpose of psychoactive substance usage and has no clinical significance for abuse usage. Last 4 questions for CAGE questionnaire was used to detect clinically significant addiction and was counted only for those whom answered positive for at least 2 or more questions. In charts it was concluded in one category under "clinically significant addiction".

Tobacco usage

Fig. 3. Tobacco consumption habits among LUHS MF students

Statistical significance between tobacco usage in gender p=0.443 and for study years p=0.368 indicating tobacco usage among all academic courses is similar and also between men and women. Total tobacco consumption was 86%. Usage for recreational purposes and for abusing was equal 35%, as one time experiment was tried 16%.

Tobacco consumption

No 14% (30)

One time experiment 16% (36) Recreational purposes 35% (78) Clinically significant addiction 35% (78)

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Alcohol usage

Fig. 4. Alcohol consumption habits among LUHS MF students

Statistical significance between alcohol consumption and gender was p=0.578 and for academic courses p=0.103 indicating as before no significance between men and women as well as academic year. Total alcohol consumption was 95%. Most commonly alcohol was used for recreational purposes (84%) and 11% of participants was abusing. From all participants only 24 students had clinically significant addiction with CAGE criteria +2: 63% males and 38% females. There was no statically significance between clinically significant alcohol addiction in genders (p=0.278).

Fig.5. Clinically significant alcohol addiction deviation by gender

Alcohol consumption

No 5% (12)

One time experiment 0% (0) Recreational purposes 84% (186)

Clinically significant addiction 11% (24)

Alcohol abuse between genders

Males 63% (15) Females 38% (9)

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Caffeine

Fig. 6. Caffeine consumption habits among LUHS MF students

Significance value for caffeine consumption and gender was p=0.358 and for academic years p=0.994, again indicating no significance between study years and gender. Total caffeine consumption was 89%. For recreational purposes caffeine was used 46% of participant and 41% with clinically significant addiction.

Cannabis

Fig. 7. Cannabis consumption habits among LUHS MF students

Caffeine consumption

No 11% (24)

One time experiment 3% (6) Recreational purposes 46% (102)

Clinically significant addiction 41% (90)

Cannabis consumption

No 41% (90)

One time experiment 16% (36) Recreational purposes 35% (78) Clinically significant addiction 8% (18)

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Statistical significance for cannabis consumption and gender showed p=0.425 and for academic courses p=0.79. These numbers indicating no significance between study years and gender. Total cannabis consumption was 59%. Cannabis was never experience before in 41% of participants, for recreational purposes used in 35% and just 8% showed clinically significant addiction.

For others psychoactive substances: cocaine, amphetamine, methyl-phenidate, inhalants, MDMA, hallucinogens and benzodiazepine usage showed no abused.

For recreational purposes methyl-phenidate was used the most common 16%, MDMA and cocaine had the same popularity among 3% of the students. As one time experiment hallucinogens was used in 10% of students and others (cocaine, amphetamine, methyl-phenidate, inhalants, MDMA) in 2-4% of participants. None of the participants have ever used opiates nor barbiturate.No statistical significance was found between the study years and genders. Substance abuse deviation between genders was p=0.27, which indicate that substance abuse is similar in both genders.

Deviation between study years using spearman's rho p=0.41 did not reveal any linear parameter, which means, approximately same rates of usage exist among all academic courses, however, was statistically

assumed, higher addiction severity since statistical linear factor was missing in between academic courses letting us to assume so.

Fig.8. CAGE criteria deviation between junior and senior courses for clinically significant addiction

Clinical significant addiction deviation of CAGE criteria (for all substances counted) between junior and senior years is 41.67% for "cut down" in junior years and 30.43% in senior year. In "Getting annoyed" junior years obtained 25% and senior year only 4.78%. In "feel guilty" junior year had 17.34% and seniors 17.4%, for "eye opener" junior years had 16% and seniors 47.8%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Junior courses Senior courses

often I open my eyes with this habit

often I feel guilty about this habit

often I get annoyed of people criticizing me about this habit often I feel that I have to cut down

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Subjective well-being

The third questionnaire also known as subjective well-being screening tool consisted of 29 questions. Refers to how people experience the quality of their lives and includes both emotional reactions and cognitive judgments. Psychologists have defined happiness as a combination of life satisfaction and the relative frequency of positive and negative affect. The scale is from 1 to 6 when the mid-point is 3.5.The common score among LUHS is 4.5 (SD 0.564) indicating fair satisfaction. Average grade of subjective well-being in men was 4.31( SD=0.58) and in women 4.69(SD=0.5) which means, females are more likely to rate more positively the questionnaire. Subjective well-being Index with correlation to gender by Mann Whitney U test showed result P=0.041. The value is significant statistically, which could give us a clue that females are more likely to rate in more optimistic fashion the questionnaire.

Fig.9 Subjective well-being scores among LUHS MF students

Correlation of subjective well-being to study year Spearman's rho p=0.062 was not strong enough to indicate significance which mean subjective well-being is not dependent on what academic year. Subjective well-being correlation with substance abuse questionnaire showed no correlation, Pearson Correlation p=0.242 indicating the score among users and non-users is similar and not affected by substance usage. No statistical correlation was found between subjective well-being substance abuse and common grade. Correlations between subjective wellbeing, substance abuse and common grade weren't found (Pearson correlation Total value -0.253, p=0.131).

Standart deviation 0.564 Minimal score 3.21

Neutral level score 3.5 Male average score 4.31

Females average score 4.69 Maximal score 5.62 0 1 2 3 4 5 6

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Discussion of the results

The research was performed in order to explore harmful habits among student, prevalence and incidence with focusing on psychoactive substance abuse with the correlation to subjective well-being and correlation with success in studies. In the research we haven’t found any statistical significant correlation in genders, grades, study years and subjective well-being. Factors affecting research’s results were low compliance of participation and large homogenous group of medical students with good education of healthy life style and motivation. Perhaps, in order to find statistical significance in the research group was supposed to include more faculties’ not only medical faculty or different universities would have also to participate. In that case group supposed to be more heterogenous.

Compared with discussed research in Yale University 45% of students was drinking among recommended limit (for female 1alcohol unit per day, for male – 2units per day). And also cannabis was the most frequently used illicit drug (45%). [5] In this research we haven’t checked the frequency of consumption, but significant abuse for alcohol was 11% and only cannabis from illicit drugs was used in 59% and abused in 8%.

Another research showed that drinking and illicit drug use were assessed longitudinally in a cohort of medical students who were surveyed in the second and fifth year of their undergraduate studies,

experimentation with illicit drugs had increased from 50% to 63% [14]. Among LUHS medical students

deviation between study years (p=0.41) did not reveal any linear parameter, which means, approximately same rates of usage exist among all academic courses and statistical linear factor was not found and letting us to assume that addiction severity increase in senior years.

Subjective well-being is not synonymous with mental health and psychological health. As we know medical students exposed to constant pressure in studies and exposed to stress of and for many reasons, which may affect their life quality tremendously. Subjective well-being is a broad concept that includes experiencing pleasant emotions, low levels of negative moods, and high life satisfaction. Significant statistically number (P=0.041) was found between subjective well-being and genders. Average score of subjective well-being in men was 4.31 and in women 4.69, which means, females are more likely to rate more positively or in better optimistic fashion the questionnaire. Perhaps there was different interpretation of the questionnaire questions between males and females. It might that men are more aggressive and strict about ambitions or events that have happened for them and have effects on their subjective well-being.

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Conclusions

A. The research showed prevalence that 85% of all students was using Alcohol, Caffeine and Tabacco. From illicit drugs Cannabis was used in 59% of the students. No statistical significance was found between substance abuse for the study years and genders.

B. The research showed that in all study years and both genders clinically significant addiction was found abusing Caffeine, Tobacco, Alcohol, and Cannabis. Higher addiction severity was found at senior years. Other substances: Cocaine, amphetamine, methyl-phenidate, inhalants, MDMA, hallucinogens and benzodiazepine usage showed no abuse.

C. Average score for Subjective well-being among students was 4.5 out of 6. Subjective well-being was rated more optimistic in females than males. Women and men in all academic courses were using and abusing equally. No statistical correlation was found between subjective well-being, substance abuse and common grade.

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References

:

1) Ed Diener, Subjective Well-Being, University of Illinois, page 11, 1984

2) M S Sherina, MMed, L Rampal, PhD, N Kaneson, BSc, Psychological Stress Among Undergraduate Medical Students, Medicine Journal of Malaysia, Vol 59 No 2 p.207-211, June 2004

3) Sinha R. How does stress increase risk of drug abuse and relapse Psychopharmacology (Berl.) Dec 2001 [PubMed]

4) A Brief Report on the Findings of the First Year's Research. The OSMHN Interviews, 2001.

5) Dorothy Newbury-Birch, Martin White, Farhad Kamali, Factors influencing alcohol and illicit drug use amongst medical students Drug and Alcohol dependence Vol 59, May 1, 2000, Pages 125–130

6) Sinha R, How does stress increase risk of drug abuse and relapse?, Yale University School of Medicine, 2001 Dec [PubMed]

7) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.

8) Richard Saitz, MD , Brief intervention for unhealthy alcohol and other drug use, Aug 06, 2015 (UpToDate) 9) DAVID J. MERSY, M.D., Recognition of Alcohol and Substance Abuse, HealthPartners Spring Lake Park Clinic, Spring Lake Park, Minnesota, Am Fam Physician. 2003 Apr, pages 1529-1532.

10) Bradley KA. The primary care practitioner's role in the prevention and management of alcohol problems,. Alcohol Health && Research World. 1994; pages 97–104.

11) Horgan CM. Substance abuse: the nation's number one health problem, The Robert Wood Johnson Foundation, 2001

12) National Institute on Alcohol Abuse and Alcoholism, 9th special report to the U.S. Congress on alcohol and health from the Secretary of Health and Human Services., Rockville,1997.

13) Dyrbye LN, West CP, Satele D, et al. A national study of medical students' attitudes toward self-prescribing and responsibility to report impaired colleagues, Acad Med 2015;

14) Dorothy Newbury-Birch, David Walshaw, Farhad Kamali, Drink and drugs: from medical students to doctors, Drug and Alcohol dependence Vol 64, November 1, 2001, Pages 265–270

15) Liselotte N. Dyrbye, MD, Matthew R. Thomas, MD, Tait D. Shanafelt, MD, Medical Student Distress: Causes, Consequences, and Proposed Solutions, 28 September 2011 [ScienceDirect]

16) Hughes PH, Brandenburg N, Baldwin DC Jr, et al. Prevalence of substance use among US physicians. JAMA 1992;

17) Lisa J Merlo, PhD, MPE, Scott A Teitelbaum, MD, Kenneth Thompson, MD, Substance use disorders in physicians: Epidemiology, clinical manifestations, identification, and engagement; Feb 19, 2016 (UpToDate) 18) Richard Saitz, MD, MPH, FACP, FASAM, Screening for unhealthy use of alcohol and other drugs in primary care Aug 07, 2015 (UpToDate)

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19) Merlo LJ, Trejo-Lopez J, Conwell T, Rivenbark J. Patterns of substance use initiation among healthcare professionals in recovery. Am J Addict 2013;

20) Maisto SA, Saitz R., Alcohol use disorders: screening and diagnosis. Am J Addict 2003; 21) P.Hills, M.Argyle, The Oxford Happiness Questionnaire: a compact scale for measurement of

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