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Lithuanian University of Health Science
Faculty of Medicine
Psychoactive substance use Dynamics among
foreign students of LUHS
Author: Shani Mednyk
Supervisor:
assoc. Prof. Benjamin Burba
Department of Psychiatry
A Thesis Submitted For The Degree of Master of Medicine
2019 Kaunas
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TABLE OF CONTANT
1. SAMMURY……….…. 3 2. SAMMURY IN LITHUANIAN………...…4-5 3. ACKNOWLEDGMENTS………..…. 6 4. CONFLICT OF INTEREST………..75. PERMISSION ISSUED BY THE ETHICS COMMITTEE………...…8
6. TERMS………....……..9
7. ABBREVIATION AND TERMS………..…10
8. INTRODUCTION………...………...11
9. AIM AND OBJECTIVES………...………...…12
10. LITERATURE REVIEW………...……...…...…13-18 Most common drug of choice among students………..……….14
Relation between the year of studies and preferred drug………..………...14
Age and gender ………..……...……15
Gender difference and drug of choice………..………...…....15
Why medical students use psychoactive substances…….………...……..15
The negative impact of psychoactive substances on students.………...…...15
The influence of drug use on academic results………...………...18
Most vulnerable student population ………..………18
11. RESEARCH METHODOLOGY..………...19-20 Participants………19 Procedure ……….………..…………19 Questionnaire ……….………..………. 19 Analysis ………..……….20 12. RESULTS………...……….…21-33 Most common drug of choice among students……….………...22
Relation between the year of studies and preferred drug………….……….24
Relation between genders differences and the drug of choice………….………..25
Relation between gender differences and the reason for using the drug….……….27
Most common psychosocial problems in association with a specific drug……..………..28
Number of usage per week in relation to a specific drug………….………...28
Psychoactive drug use tendencies………..………..29
What foreign students feel after using a specific drug?...30
Did students use drugs before admission to the university?...31
Did the use of psychoactive drugs influence the student's academic results?...31
The effect of university environment on drug use ………..…………...32
Student's opinion on the biggest risk factor to use drugs during the university period..………...33
13. DISCUSSION OF THE RESULTS………....…34-37 14. CONCLUSIONS……….…..38
15. PRACTICAL RECOMMENDATIONS……….39 16. REFERENCE………..………….40-41 17. ANNEXES……….…………42-43
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1. SUMMARY
Author: Shani Mednyk
Title: Psychoactive substance use Dynamics among foreign students of LUHS.
Aim: To evaluate the dynamics of psychoactive substance use among foreign students of LUHS, to evaluate the
preferred drugs used by students, and how the year of study influence the drug that is used, and to assess the influence gender on the preferred drug and the reason of using this drugs.
Objectives: 1. To asses the most common drug of choice among students. 2. To detect the relation between year of
studies and preferred drug. 3. To assess the relation between genders differences and the drug of choice. 4. To assess the relation between gender differences and the reason for using the drug. 5. To detect the most common psychosocial problems in association with specific drug.
Methodology: In this study, 148 foreign students participated. The purpose of the study was to evaluate the
dynamics of psychoactive drug use in foreign students of LUHS, to evaluate the preferred drug, the students year of study influences the drug that is used and to find how gender influence the preferred drug and the reason of using the drug. Only international students were enrolled. In this study used multiple choice questionnaires.
Results: alcohol is the most preferred and used drug, with the following cannabis and tobacco. There is no statistical significant difference between the year of studies and preferred drug. There is no statistical significant difference between gender and drug of choice (Male and female foreign students both prefer alcohol, cannabis, and tobacco). There is a statistical significant difference between gender difference and the reason for starting to use drugs (Females started to use drugs due to a teenager's curiosity while males due to joy seeking). Alcohol, cannabis, tobacco, and heroin consuming students declare that the use of this specific drug did not influence their academic results. Most of alcohol and tobacco consuming students, declare that the university environment did not influence their consumption, it stayed the same.
Conclusion: Most common drug of choice is alcohol, followed by cannabis and tobacco. Students prefer legal drugs,
with fewer side effects, and with low cost. There is no relation between the year of study and preferred drug, alcohol, cannabis, and tobacco are preferred by most students in all years.
There is no relation between gender and drug of choice, both males and females prefer alcohol, cannabis, and tobacco. There is a correlation between gender and the reason for starting to use drugs – female due to teenagers-curiosity and males due to joy-seeking. No correlation between gender and current use – both genders due to joy-seeking and relief stress at school. Most students use drugs less than one time per week, mostly on weekends and holidays. The most reported feeling after use is relaxed and happy. Majority of alcohol and tobacco users started before gaining admission to the university. Most students declare that the use did not influence their academic results and that the university environment has no influence on the pattern of use. From these facts, we can conclude a non-addictive pattern of use that is mostly to improve feeling, with no influence on daily activities and academic result.
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1. SANTRAUKA
Autorius: Shani Mednyk
Pavadinimas: Psichoaktyvių medžiagų vartojimo dinamika tarp LSMU užsienio studentų.
Tikslas: Įvertinti psichoaktyvių medžiagų vartojimo dinamiką tarp LSMU užsienio studentų, įvertinti, kokios
narkotinės medžiagos vartojamos dažniausiai, nustatyti, kokią įtaką studijų metai turi narkotinių medžiagų vartojimui, nustatyti sąsajas tarp tiriamųjų lyties bei psichoaktyvių medžiagų vartojimo ir įvertinti šių medžiagų vartojimo
priežastis.
Uždaviniai:
1. Įvertinti, kokias narkotines medžiagas studentai vartoja dažniausiai. 2. Nustatyti ryšį tarp studijų metų ir pasirenkamos narkotinės medžiagos. 3. Nustatyti sąsają tarp tiriamųjų lyties ir narkotinių medžiagų pasirinkimo.
4. Nustatyti sąsajas tarp tiriamųjų lyties ir narkotinių medžiagų vartojimo priežasčių.
5. Nustatyti dažniausias psichosocialines problemas, susijusias su specifinių narkotinių medžiagų vartojimu.
Metodai: Tyrime dalyvavo 148 užsienio studentai. Tyrimo tikslas buvo įvertinti psichoaktyvių medžiagų vartojimo
dinamiką tarp LSMU užsienio studentų, įvertinti specifinių narkotinių medžiagų pasirinkimą bei medžiagų vartojimo priežastis, atsižvelgiant į tiriamųjų lytį ir studijų metus. Tyrime dalyvavo tik užsienio studentai. Tiriamųjų apklausai naudoti daugybinio pasirinkimo klausimynai.
Rezultatai: Dažniausiai pasirenkama psichoaktyvi medžiaga- alkoholis, antro ir trečio pasirinkimo medžiagos- kanapės ir tabakas. Statistiškai reikšmingo skirtumo tarp studijų metų ir pasirenkamos narkotinės medžiagos
nenustatyta. Statistiškai reikšmingo skirtumo tarp tiriamųjų lyties ir pasirenkamos narkotinės medžiagos nenustatyta (vyriškos ir moteriškos lyties užsienio studentai vienodai dažnai nurodė alkoholį, kanapes ir tabaką). Nustatytas statistiškai reikšmingas skirtumas tarp lyties ir priežasties, dėl kurios buvo pradėta vartoti psichoaktyvias medžiagas (merginos teigė narkotines medžiagas pradėjusios vartoti iš smalsumo, kuomet vaikinai – siekdami pajusti naujus, malonius pojūčius). Alkoholį, kanapes ir tabaką vartoję studentai teigė nemanantys, kad šių medžiagų vartojimas turi neigiamą įtaką jų mokymosi rezultatams. Dauguma alkoholį ir tabaką vartojusių studentų nurodė, jog universiteto aplinka nedarė įtakos medžiagų vartojimo dažniui (vartojimo dažnumas išliko toks pats).
Išvados: Dažniausiai pasirenkama psichoaktyvi medžiaga- alkoholis, antro ir trečio pasirinkimo medžiagos- kanapės ir tabakas. Studentai pirmenybę teikia legalioms medžiagoms, turinčioms mažiau šalutinių poveikių ir mažesnę kainą. Nėra sąsajos tarp studijų metų ir pasirenkamų narkotinių medžiagų- alkoholį, kanapes ir tabaką vartoja visų kursų studentai. Nėra sąryšio tarp lyties ir pasirenkamos narkotinės medžiagos- ir vaikinai, ir merginos teigė vartojantys alkoholį, kanapes ir tabaką. Nustatyta skirtumas tarp lyties ir priežasties, dėl kurios pradėta vartoti psichoaktyvias medžiagas- merginos pabandė lydimos paaugliško smalsumo, vaikinai- siekdami naujų, malonių pojūčių. Nėra ryšio tarp lyties ir dabartinio medžiagų vartojimo- abiejų lyčių atstovai narkotines medžiagas vartoja norėdami geriau jaustis ir atsipalaiduoti. Dauguma studentų narkotines medžiagas vartoja rečiau nei kartą per savaitę, dažniausiai savaitgaliais
5 ir per šventes. Dažniausiai paminėti pojūčiai po medžiagų vartojimo- džiaugsmas ir atsipalaidavimas. Dauguma tabaką ir alkoholį vartojusiųjų šias medžiagas vartoti pradėjo prieš pradėdami studijas universitete. Dauguma studentų teigė nemanantys, jog narkotinių medžiagų vartojimas turi neigiamą įtaką jų mokymosi rezultatams bei kad universiteto aplinka nedaro įtakos psichoaktyvių medžiagų vartojimo dažniui. Remiantis šiais faktais, galima teigti apie priklausomybę nesukeliantį psichoaktyvių medžiagų vartojimo pobūdį, nedarantį įtakos kasdienei veiklai bei mokymosi rezultatams.
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2. ACKNOWLEDGMENTS
First of all, I want to thank my parents who help me to achieve my dream to become a medical doctor.
I want to thank my supervisor professor Benjamin Burba for guiding me through this process.
I want to thank all the students who participate in my research and help me get good results.
I want to thank my twin sister and my brother for being there for me all the time.
I want to thank my amazing friends that have been there for me every day in this challenging experience of becoming a doctor, they are my second family.
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3. CONFLICT OF INTEREST
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4. PERMISSION ISSUED BY THE ETHICS COMMITTEE
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5. TERMS
Hallucinogen - A drug that causes hallucinations (profound distortions in a person's perceptions of reality). Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings.
Psychoactive substances - substances that when taken in or administered into one’s system, affect mental processes (according to WHO)
Stimulant - any drug that excites any bodily function, but more specifically those that stimulate
the brain and central nervous system. Induce alertness, elevated mood, wakefulness, increased speech and motor activity and decrease appetite. Their therapeutic use is limited, but their mood-elevating effects make some of them potent drugs of abuse.
Tranquilizer - refers to a drug which is designed for the treatment of anxiety, fear, tension, agitation, and disturbances of the mind, specifically to reduce states of anxiety and tension.
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6. ABBREVIATION LIST
first – st 1 second -nd 2 third – rd 3 forth – th 4ATS - Amphetamine-type stimulants
LUHS – Lithuanian university of health science N – Number
PCP - Phencyclidine
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7. INTRODUCTION
According to the World Health Organization, psychoactive substances are substances that when taken in or administered into one’s system, affect mental processes [4].
Medical students, as tomorrow's doctors, hold a unique place in society and have privileges and
responsibilities different from those of other students. Different standards of professional behaviors are expected from them. Psychoactive substance use by medical students put them at risk and can also have serious consequences on their effectiveness and fitness to practice as tomorrow doctors [6].
Drug use and abuse may delay learning capabilities and the development of technical skills, and therefore, the quality of care offered to patients [9].
There are a lot of foreign students at LUHS University that came from countries all over the world. Most of the students are independent for the first time, far away from parental sight and judgment, so they feel freer to try and use psychoactive drugs during the university period. Also, foreign students are missing their family and friends back home, which also can contribute to drug use. As you know, medical school period is long, with a lot of hard exams and clinical practice, with the adding of patient's care, which may increase stress and influence drug use among students.
Medical students have relatively easy access to psychoactive substances, high levels of work-related stress, frequent contact with illness and death, relative isolation of medical school and disrupted sleep and social life [6].
Poor diet, sleep deprivation, sedentary lifestyle, the pressure to achieve high academic and professional goals, peer pressure and youth who have drug-using friends are also among the very things which can make it more likely that a student will begin to use substances to cope.
A 2013 study, "Stimulant Use Exceptionally High among Medical Students", surveyed third-year medical students and found that 20% of them had used stimulants at one point in their lives, and 15% had used them during their years as medical students. Researchers also found that 75% of students surveyed believed that the use of these drugs could enhance academic performance, even among those who had not used them [21].
In this study, I will try to evaluate the dynamics of psychoactive substance use among foreign students of LUHS, to evaluate the preferred drugs used by students, and how the year of study influence the drug that is used, to assess the influence gender on the preferred drug and the reason for using these drugs, and the psychosocial problem - influence of specific drug on academic results.
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8. AIM AND OBJECTIVES
Psychoactive substance use Dynamics among foreign students of LUHS.
This study is a survey-based study, in which randomly selected foreign students of LUHS from all faculties and all years, in total of 148 students participated.
The aim of this study is to evaluate the dynamics of psychoactive substance use among foreign students of LUHS, to evaluate the preferred drugs used by students, and how the year of study
influence the drug that is used, and to assess the influence gender on the preferred drug and the reason of using this drugs.
Objectives:
1.To asses the most common drug of choice among students.
2. To detect the relation between the year of studies and preferred drug.
3. To asses the relation between genders differences and the drug of choice.
4. To asses the relation between gender differences and the reason of using the drug.
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9. LITERATURE REVIEW
Medical students, as tomorrow's doctors, hold a unique place in society and have privileges and
responsibilities different from those of other students. Different standards of professional behaviors are hence expected from them. Substance use by medical students poses risk to them and can also have serious consequences on their effectiveness and fitness to practice as tomorrow doctors [6].
Drug use and abuse may hamper learning capabilities and the development of technical skills in medical students and, therefore, the quality of care offered to patients [9].
According to the World Health Organization, psychoactive substances are substances that when taken in or administered into one’s system, affect mental processes [4].
Based on their common effects, psychoactive substances can be classified as stimulants (nicotine present in tobacco, caffeine contained in coffee, cocaine, amphetamine, etc.), depressants (alcohol, barbiturates, benzodiazepines, chloral hydrate, rohypnol, etc.), narcotics (heroin, morphine, codeine etc), hallucinogens (alpha-methyltryptamine, ketamine, phencyclidine, D-lysergic acid diethylamide etc), and cannabis (marijuana, hashish, hash oil etc) [4].
Psychoactive substance use among undergraduate students is a major public health issue. It is
estimated that 1 in 20 adults, or a quarter of a billion people between the ages of 15 and 64 years, used at least one drug in 2014 according to the 2016 world drug report. Globally, over 29 million people suffer from drug use disorders. The impact of drug use in terms of its health consequences continues to be devastating. The global disease burden attributed to alcohol and illicit drugs is estimated at 5.4% while 3.7% is attributed to tobacco use alone [4].
For most of the European and Asian countries, opiates continue to be the main drug of abuse and account for 62% of all treatment demands. In South America, drug- related treatment continues to be mainly linked to the use of cocaine (59% of all treatment demand). In Africa, the bulk of all treatment demand is linked to cannabis (64%) (WHO 2004) [4].
Psychoactive substance use amongst foreign and local university students is a recognized problem worldwide.
Drug consumption among medical students is of special interest since their behavior, attitudes, and beliefs do not reflect their greater access to scientific information, especially in comparison with other populations in the same age range. In reality, medical students have revealed significant vulnerability with regard to engaging in health risk behavior, a paradoxical situation that has been a matter for concern worldwide [16].
14 Medical students report that their scientific knowledge of the effect of these substances protected them from developing drug-related problems [17].
Health professionals including medical students are said to be at higher risk of substance abuse because of relatively easy access to psychoactive substances, high levels of work-related stress,
frequent contact with illness and death, the relative isolation of medical school and disrupted sleep and social life [6].
For several centuries, psychoactive substances have been widely used all over the world for various reasons. Alcoholic beverages, for example, have played significant social, economic, political, and traditional roles in many civilizations in Europe, America, and Africa [1].
Despite the medicinal benefits of some psychoactive substances and their social acceptability, they are related to some undesirable health, social, legal and economic outcomes [1].
9.1 Most common drug of choice among students
According to a study performed in Botswana University, Alcohol was the most commonly used
psychoactive substance with 31.9% current users. This was followed by tobacco which was 18.7% and cannabis, 6.2%. Inhalants, which were majorly in the form of petrol and glue, were 3.2%. ATS, which comprised of methylphenidate, street drugs, crystal meth, and khat was 3.7%, while controlled drug such as benzodiazepines was 1.1%. [1].
A study from the University of Ilorin, Nigeria showed that the most currently used substances were mild stimulants (19.4%), alcohol (12.5%), hypnosedatives (3.4%), tobacco (1.7%), cannabis (1.7%), opioids (0.9%) and organic solvents (0.4%). [4]
It depend on the university and her location, there is no regular pattern for the drug of choice.
9.2 Relation between the year of studies and preferred drug The academic year has recently been identified as a relevant factor.
One hypothesis to explain the higher illicit drug use in the early academic years is that basic-cycle medical students, especially those living away from home, usually present higher levels of clinical stress symptoms, particularly when trying to manage their lifestyle (academic stress). Thus, trying drugs and using them on a regular basis might be understood as a way of alleviating psychological stress among students in the early academic years.
Although drug use is more prevalent among medical students in the early academic years, the risk factors for drug use among students in the later years should not be disregarded. As identified in previous studies, drug use among students in the later academic years is especially due to the ease of
15 access to drugs and contact with other professionals who are already recreational users. In addition, drug use is seen as a way to achieve better academic and work performance, a common motivation for drug use among health professionals [16].
According to one study, the prevalence of drug use tends to increase from the first to the sixth year for most substances and over most time intervals. The sequence of lifetime drug use from highest to lowest prevalence figures follows the same order: alcohol, tobacco, cannabis, tranquilizers,
amphetamines to cocaine, and there tends to be a prominent increase in the prevalence of tranquilizer use in the fifth and sixth years [17].
9.3 Age and gender
Initiation to substance use mostly starts between the ages of 12 and 24 years.
Males are more susceptible than females, which is consistent with the general finding that males tend to be more risk takers than females although this gap narrows as the age of initiation increases. The usual ages of entry into the university especially in this part of the world coincide with the ages of drug initiation, and for some youths, their first contact is during their university education [12] [13] [15] [18] [19] [20].
9.4 Gender difference and drug of choice
In research conducted in Rio DE Janeiro and by the Journal of Drug Issues, males were significantly more likely than females to report alcohol, inhalant, marijuana, cocaine, LSD, barbiturate, and heroin use in the past 12 months (p<0.005), females were more likely than males to report both amphetamine and tranquilizer use (p<0.001), but no gender difference observed for narcotics other than heroin. [9][23].
In two studies, No gender difference was observed in the rates of psychoactive substance use [1] [17].
9.5 Why medical students use psychoactive substances?
Nowadays, psychoactive substances are a significant resource to help students in completing their assignments and release their stress [1].
University life especially the early part has been described as a “transitional” period during which students move from a restricted high school life, mostly supervised by parents, to a more independent life which may be readily influenced by a liberal campus environment [1] [10].
16 It also represents the perceived (by students) last period of freedom before taking on the
responsibilities of adulthood [2] [10].
A study entitled "Cognitive Enhancement Drug Use among Future Physicians", found fairly
widespread use of stimulants among the general medical student population. This study was conducted via a confidential online survey and the survey found that 18% of respondents had used such
stimulants at least once in their lifetime and 11% had been using it since beginning medical school. Of those that admitted to drug use, 71% reported that it was for purposes of cognitive enhancement to study and achieve good grades. Many others expressed that they were comfortable with the use of drugs such as barbiturates and tranquilizers in order to relax and study better.
This is not the only research that has found the pressure to achieve good grades is a powerful driver for drug use. A 2013 study, "Stimulant Use Exceptionally High among Medical Students", surveyed third-year medical students and found that 20% of them had used stimulants at one point in their lives, and 15% had used them during their years as medical students. Drugs of choice included methylphenidate, dexmethylphenidate, amphetamine salts, and dextroamphetamine. Researchers also found that 75% of students surveyed believed that the use of these drugs could enhance academic performance, even among those who had not used them [21].
It can help the students in beneficial aspects, but it also can destroy student’s life if the students misuse or overuse it [1].
Risk factors
● The medical school experience - inevitably a time of stress, with long hours, lack of sleep and a tendency towards unhealthy diets and little exercise. However, a poor diet, sleep deprivation and a sedentary lifestyle are also among the very things which can make it more likely that a student will begin to use substances to cope.
● Extreme educational and professional goals - many medical students are goal-driven, assertive, Type-A personalities. They tend to put a high degree of pressure on themselves to achieve their academic and professional goals. This pressure, however, is considered to be another risk factor for a substance abuse disorder.
● Stress of patient care - Although interaction with patients is often reported as one of the most rewarding experiences among many physicians, it can also be one of the most stressful, particularly with terminal or very difficult patients. This stress can lead to burnout over time, and burnout, in turn, can lead to the use of drugs as a way to cope.
17 to report on colleagues or of substance users to admit to their problem can easily allow the problem to continue untreated, putting both the student and their patients at risk.
● Emotional distress - related to life changes such as divorce or relocation was also found to predispose students towards substance abuse [5] [10] [15] [17] [20] [21].
Also, peer pressure, unhealthy family background, high social class, desire to remain awake at night, self-reported poor mental health, and easy accessibility of drugs have also been implicated [1] [2] [10] [11] [15] [18] [19] [20].
Psychoactive drug use was found to be more common among students with a lower GPA. Students with a poorer academic record may have had problems organizing their time, and may, therefore, have been more likely to use because of the need to stay awake more hours a day [20].
One of the most important factors that influence the spread of substance use is peers and friends’ effect. Youths who have drug-using friends are more likely to have a tendency towards substance use. Therefore, if close friends are substance users and substance use is common in a large group of peers, these youths are more likely to be pushed to consumption. Several studies have also shown that
substance user parents increase the risk of substance use in children. According to one study, there was a significant association between the use of substances in students with the use of substances in their family members and friends [11].
9.6 The negative impacts of psychoactive substances on students
These include disruption of interpersonal relationships especially within the family, criminal behavior, academic failure, vocational failure and a lack of commensurate achievement. Psychoactive substance use is a leading cause of violence among individuals and a major cause of preventable mortality and morbidity. It has been implicated in the majority of cases of vehicle fatalities worldwide, with
attendant effects on physical deformity, health, social functions, loss of property, loss of jobs, loss of self-esteem and loss of lives. In addition, increased the risk of contracting HIV and other sexually transmitted diseases. Students who use substances show lowered commitment to education, declining grades, increased potential for dropout and high truancy rate. Suicides, homicides, and accidental injuries have all been linked to drug use among students [3] [7] [8] [9] [10] [11] [15].
Also, high prevalence of depression, development lag, apathy, withdrawal, drainage of family financial and emotional resources have all been reported among substance-using students. The frequent use of substances has resulted in an increase in the number of delinquent acts such as rape, robbery, cultism, violent disorders and vandalism [3] [10] [11].
18 9.7 The influence of drug use on academic results (psychosocial problem)
"Study difficulty can be defined as the impairment of the capacity to study effectively or inability to obtain maximal result from the effort put in the studying” (Morakinyo, 1990). The following have been identified as causes of study difficulty: Diminished motivation, impaired ability to concentrate, retain or recall, improper presentation of materials, faulty study pattern, poor budgeting of available time, difficulty in social adjustments to a new school environment, secondary effect of psychoactive substance use, personality-related problems, neurotic conditions and psychotic disorders. It may either be reported by the student himself or maybe the only complaint by the teacher, parents, guardian or another significant person in the student’s life.
According to a study performed at University Of Abuja, Nigeria - the findings showed that all the psychoactive substances, namely Tobacco, Alcohol, Cannabis, Cocaine, Stimulants, Hallucinogens, Volatile solvents, Tranquilizers, Sedatives, Opium, Heroin, and other Opiates were associated with Study difficulty in varying degrees. Using Fisher’s Exact tests Tobacco, Alcohol, Cannabis, Cocaine, and Stimulants had statistically significant (P <0.05) [22].
9.8 Most vulnerable student population
One study looked at patterns of drug abuse among one particular group of medical students—those studying anesthesiology. The study found that, when analyzing the rates of use among these students between 1975 and 2009, 2009 had the greatest number of users. These rates have been increasing slowly but steadily since 2003. The drugs of choice in order of popularity were fentanyl, alcohol, benzodiazepines, marijuana, and cocaine. The rates of abuse were highest in men. It was also noted that, of those who reported substance abuse, 69% completed their training and 51% became board certified in anesthesiology.
Authors of this study noted that “To our knowledge, this report provides the first comprehensive description of the epidemiology and outcomes of substance abuse disorder for any in-training physician specialty group, showing the incidence of substance abuse disorder has increased over the studied period and that relapse rates are not improving” [5] [21].
The evolution of drug consumption among medical students is an issue that deserves attention. Characterizing and monitoring that consumption is an important objective. Since substance use could have an impact on the conduct, reliability, and efficiency of future physicians, understanding such use will contribute to developing early detection and intervention strategies to prevent drug use and abuse, thereby avoiding the related personal and social problems [16].
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10. RESEARCH AND METHODOLOGY
10.1 Participants
In this study, 148 foreign students participated.
The participants in this research are studying in 4 international faculties – Medicine 81.9% (n=121), veterinary 8.7% (n=13), odontology 7.4% (n=11), pharmacy 2% (n=3) . All participants are randomly selected. The student population includes 42.6% males and 57.7% females. The participants studying in years 1-6, depending on the faculty, with the mean year of study 3.16 (SD 1.81). The age of the participant students mean is 22.26 (SD 2.559)
The purpose of the study was to evaluate the psychoactive drugs use dynamics among foreign students of LUHS. Only foreign students enrolled to participate in the study.
10.2 Data collection
The questionnaire was distributed to foreign students of LUHS University by the researcher. The questionnaire is totally anonymous and the participant volunteer to participate. Students who did not want to participate in the survey had the right to refuse.
10.3 Questionnaire
The questionnaire was anonymous and students volunteered to participate. The questions were multiple choice question with the ability of the participant to add remarks if they needed to.
The questionnaire started with questions about the socio-demographic background – gender, age, faculty, year of study. Next questions asked about drug use – yes/no and if the participant answered "no" he had to write the reason why he is not used drugs.
If the participant answered "yes" about using drugs, he had to choose which age they started using. After that, the participant had to choose which drug they prefer vs. the drug they actually use and specify the reason for the difference if one exists – "cost", "less addictive", "less side effect",
"difficulty/easier to find", "easier to use", "legality". Next question was about the reason the participant started using drugs and what is the reason they are using now. If participant uses more than one drug he needed to mark it and add which drug is it.
Next questions about the number of time the participant is using the drug per week and the place they using the most. Question about the feeling after using the drug, preferred route of administration and
20 who introduce them to drugs. After that 4 questions about the use of drugs in the university period, influence on academicals result and how the university influence drug use.
10.4 Analysis
Data were processed using MS Excel 2010 and analyzed using IBM SPSS Statistics, version 25.
The descriptive analysis included the calculation of the prevalence: categorical data were
presented as percentages (%) and frequencies (n). Continuous variable (age) was presented as mean ± standard deviation (SD), minimum and maximum.
Comparisons were done using the Chi-Square Test and Fisher's exact test. The statistical significance level was set at 95% (p<0.05).
21
11. RESULTS
11.1 Socio-demographic characteristics of participant table -1 (T-1)
Table 1 – socio-demographic characteristics of the participant table
Figure 1 – the reasons students refuse to use drugs
In this research, 41 students out of 148 participants are not using drugs at all.
We can conclude from figure 1 that the main reason students are not using drugs is that it does not
appeal to them (n=19). The second reason that was chosen by students was that psychoactive drug use
is harmful (n=10). Those 2 answers were the most popular among the participants who do not use drugs.
"It damages my alertness" and "religion" was also chosen by students, with a similar percentage (n=
6 and 5 respectably). In some religions, it is prohibited to use all type of drugs.
"I think doctors should not use drugs" was chosen only by 1 student.
0 2 4 6 8 10 12 14 16 18 20 It does not appeal to me. it is harmful it is damage my alertness religion i think that doctor should not use drugs
why students prefer to not use psychoactive drugs? N N Percent gender male 63 42.6 female 85 57.7 faculty medicine 121 81.9 veterinary 13 8.7 odontology 11 7.4 pharmacology 3 2.0 year of study 1 35 23.6 2 35 23.6 3 37 25.0 5 15 10.1 6 26 17.6 students who use drugs yes 107 72.3 no 41 27.7 total 148 100.0
22 Figure 2 -
Most of the participants that consume drugs started to use it at age range 16-20 (58%). 35% started at age range 21-25 and only 7% at age range 26-30.
Figure 3-
Most of the participants were introduced to drugs by their friends (82%). 13% were introducing by a family member and only 5% by the television.
11.2 Most common drug of choice among students:
11.2.1. Comparison between prefer drug to actually used drug
Table 2 – comparison between prefer drug to the drug that students actually use
preferred drug drugs actually used
N Percent N Percent don't use 36 24.3 37 25.0 alcohol 54 36.5 60 40.5 cannabis 33 22.3 26 17.6 tobacco 17 11.5 20 13.5 heroin/morphine 1 0.7 3 2.0 Phencyclidine (PCP) 1 0.7 1 0.7 LSD 2 1.4 0 0.0 inhalants 1 0.7 1 0.7 amphetamines 3 2.0 0 0.0 Total 148 100.0 148 100.0 58% 35% 7%
Age range that students who uses drugs started to use
16-20 21-25 26-30
82% 13%
5% 0%
who itroduce the drug?
23 Figure 4-
In this research, 107 out of 148 participating foreign students use psychoactive drugs.
I compared the preferred drugs for students (the drug they want to use but maybe for some reason they are using different drug) to the drugs they actually use.
The most common drugs that are preferred for use and are actually used by the students:
Alcohol is the top preferred (n=54, 36.5%) and most used (n=60, 40.5%) psychoactive drug.
According to Fig 4, the number of actual users of alcohol is higher than the number of students who prefer this drug.
Cannabis is the second preferred (n=33, 22.3%) and used drug (n=26, 17.6%). There are more
students that prefer Cannabis than students that actually use this drug.
Tobacco is the 3rd preferred (n=17, 11.5%) and used drug (n=20, 13.5). More students use this psychoactive drug than students that prefer this drug.
I pointed out only the drugs marked by the participating students, in the questionnaire I asked about more psychoactive - Benzodiazepines, Cocaine, Steroids, and Ecstasy. The results could have been different if I had to use a larger sample size of responders.
0.0 10.0 20.0 30.0 40.0 50.0
comparison between prefer drug to the drug that students actually use
24 11.2.2. Reason students prefer a specific drug but use different Figure 5-
In some of the participant, there is a difference between the drug they actually use to the drug they want (prefer) to use.
According to the study, the most common reason to use a different drug than the preferred one is
legality. The majority (33%) uses a legal drug even if in reality they prefer a drug that is illegal.
The 2nd common reason is "less side effect". 21% uses drugs that have fewer side effects or that the side effects are less dangerous to the human body.
The 3rd cause is cost. 16% use cheaper drugs instead of an expensive one.
11% use drugs that are less addictive and are easier to use (explained by T-3). 8% uses drugs that are easier to find and avoid drugs that are difficult to find. Table 3 – preferred route of administration
N Percent
The preferred route of administration 46 43 smoking 56 52.33 drinking 5 4.6 sniffing 0 0.0 injecting 107 100.0 Total
According to table 3, most students chose "drinking" (n=56) and "smoking" (n=46) as the preferred route of administration. None of the students chose "injecting" as the preferred route.
11.3 Relation between the year of studies and preferred drug:
Table 4 – relation between the year of studies and preferred drug
Year of study Total
1 2 3 5 6 preferred drug don't use N 9 8 13 3 3 36 % 25.7% 22.9% 35.1% 20.0% 11.5% 24.3% alcohol N 12 11 13 6 12 54 % 34.3% 31.4% 35.1% 40.0% 46.2% 36.5% cannabis N 10 10 7 4 2 33 % 28.6% 28.6% 18.9% 26.7% 7.7% 22.3% tobacco N 3 5 3 2 4 17 21% 16% 8% 11% 33% 11%
The reason students prefer specific psychoactive drug but in reality uses different drug
less side effect cost difficulty/easier to find
25 % 8.6% 14.3% 8.1% 13.3% 15.4% 11.5% heroin/morphine N 0 0 1 0 0 1 % 0.0% 0.0% 2.7% 0.0% 0.0% .7% PCP N 0 0 0 0 1 1 % 0.0% 0.0% 0.0% 0.0% 3.8% .7% LSD N 1 1 0 0 0 2 % 2.9% 2.9% 0.0% 0.0% 0.0% 1.4% inhalants N 0 0 0 0 1 1 % 0.0% 0.0% 0.0% 0.0% 3.8% .7% amphetamines N 0 0 0 0 3 3 % 0.0% 0.0% 0.0% 0.0% 11.5% 2.0% Total N 35 35 37 15 26 148 % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% p=0,193 Fisher's test
There is no statistical significant difference ( p=0.193) between the year of studies and preferred drug. Alcohol, cannabis, and tobacco are the most popular drugs by all foreign students of LUHS University in all years (1-6).
11.4 Relation between genders differences and the drug of choice: 11.4.1
Table 5 – relation between gender difference and drug of choice Gender Total male female specific psychoactive drug used don't use N 15 21 36 % 23.8% 25.0% 24.5% alcohol N 20 40 60 % 31.7% 47.6% 40.8% cannabis N 17 9 26 % 27.0% 10.7% 17.7% tobacco N 8 12 20 % 12.7% 14.3% 13.6% heroin/morphine N 2 1 3 % 3.2% 1.2% 2.0% PCP N 0 1 1 % 0.0% 1.2% .7% inhalants N 1 0 1 % 1.6% 0.0% .7% Total N 63 85 148 % 100.0% 100.0% 100.0% p=0,065 Fisher's Exact Test
There is no statistical significant difference(p=0.065) between gender and drug of choice. Male and female foreign students both prefer alcohol (n male=20 31.7%, n female=40 47.6%), cannabis (n male=17 27%, n female=9 10.7%), and tobacco (n male=8 12.7%, n female=12 14.3%).
26 Figure 6-
11.4.2
Table 5– the preferred route of administration and gender difference
Gender Total
male female
The preferred route of administration
don't use Count 15 21 36
% 23.8% 25.0% 24.5% smoking Count 26 22 48 % 41.3% 26.2% 32.7% drinking Count 20 38 58 % 31.7% 45.2% 39.5% sniffing Count 2 3 5 % 3.2% 3.6% 3.4% Total Count 63 85 147 % 100.0% 100.0% 100.0% p=0,236 Fisher's Exact Test
There is no statistical significant difference(p=0.236) between the route of administration of the drug and gender difference. Both male and female foreign students prefer drinking (male n=20 31.7%, female n=38 45.2%) and smoking (male n=26 41.3%, female n=22 26.2%) as route of administration.
Only 2 males and 3 female students chose sniffing as the preferred route, none of the students marked
injecting as the preferred route.
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% % % % % % % alcohol cannabis tobacco heroin/morphine PCP inhelants
specific psychoactive drug used
Gender difference and drug of choice
27 11.5 Relation between gender differences and the reason for using the drug:
11.5.1 Motivation for drug-seeking behavior in relation to gender
Table 6 – motivation for drug-seeking behavior in relation to gender
Gender
male female
What is the reason you started using drugs?
don't use Count 16 20
% 25.4% 23.8%
teenagers curiosity Count 16 36
% 25.4% 42.9%
cope with problems at home
Count 1 0
% 1.6% 0.0%
joy seeking Count 27 14
% 42.9% 16.7%
depression Count 0 4
% 0.0% 4.8%
influence of the media Count 1 2
% 1.6% 2.4%
peer pressure Count 0 7
% 0.0% 8.3% lack of parental/educational personal guidance Count 1 0 % 1.6% 0.0% to improve sport ability Count 0 1 % 0.0% 1.2% difficulty in the educational environment (school/university) Count 1 0 % 1.6% 0.0% Total Count 63 85 % within 2. Gender 100.0% 100.0% p<0,001 Fisher's test
There is a statistical significant differencebetween gender difference and the reason foreign students started to use drugs (p<0.001).
Most female students (42.9%) started to use psychoactive drugs due to "teenager's curiosity" compare to male students which their most common reason of starting to use psychoactive drugs is "joy
seeking" (42.9%).
The 2nd common reason for females is "joy seeking" (16.7%) and for males is "teenager's curiosity" (25.4%).
11.5.2 Motivation for the continues use of psychoactive drugs in relation to gender
Table 7 – motivation for the continues use of psychoactive drugs in relation to gender
Gender Total
male female
Why are you using now?
don't use Count 18 25 43
% 28.6% 29.8% 29.3%
joy seeking Count 31 39 70
% 49.2% 46.4% 47.6%
stress at school Count 8 14 22
% 12.7% 16.7% 15.0%
improve memory and learning ability
Count 4 4 8
28
missing home Count 1 1 2
% 1.6% 1.2% 1.4% to improve sport ability Count 1 1 2 % 1.6% 1.2% 1.4% Total Count 63 85 148 % 100.0% 100.0% 100.0% p=0,972 Fisher's test
No statistical significant difference. The most common reason foreign students, both male (49.2%) and female (46.4%) are using drugs is "joy seeking".
The 2nd common reason for both males (12.7%) and females (16.7%) is "stress at school".
11.6 Most common psychosocial problems in association with a specific drug: 11.6.1 Number of usage per week in relation to a specific drug
Table 8 – number of usage per week in relation to a specific drug Fisher's test alcohol cannabis tobacco do not use used do not use used do not use used Number of times used per week don't use Count 37 2 39 0 39 0 % 42.0% 3.3% 32.0% 0.0% 30.5% 0.0% 1-2 time a week Count 9 13 14 8 21 1 % 10.2% 21.7% 11.5% 30.8% 16.4% 5.0% 3-4 a week Count 6 3 5 4 8 1 % 6.8% 5.0% 4.1% 15.4% 6.3% 5.0% less than one time a week Count 31 41 61 11 56 16 % 35.2% 68.3% 50.0% 42.3% 43.8% 80.0% 5-6 a week Count 5 1 3 3 4 2 % 5.7% 1.7% 2.5% 11.5% 3.1% 10.0% Total Count 88 60 122 26 128 20 % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% P value P<0.001 P<0.001 p=0.002 Alcohol:
There is a statistical significant difference(p<0.001). Foreign students use alcohol mostly less than
one time a week (n=41, 68.3% of alcohol users). 21.7% (n=13) of alcohol users, uses 1-2 times a week.
Cannabis:
There is a statistical significant difference(p<0.001). Foreign students use cannabis mostly less than
one time a week (n=11, 42.3% of cannabis users). 30.8% (n=8) of cannabis users, uses 1-2 times a week.
29 Tobacco:
There is a statistical significant difference(p=0.002). Foreign students use tobacco mostly less than
one time a week (n=16, 80% of tobacco users).
There was no statistical significant differencefor the drugs heroin\morphine (p=0.328), PCP (p=1.000) and inhalants (p=1.000).
11.6.2 Psychoactive drug use tendencies:
Table 9 –drug use tendencies in relation to a specific drug
Alcohol – There is a statistical significant difference (p=<0.001). 83.3% of students that consume alcohol (n=50) prefer to consume it on weekends.
Cannabis – There is a statistical significant difference (p<0.001). 73.1% of students that consume cannabis (n=19) prefer to use it on weekends.
Tobacco – There is a statistical significant difference (p<0.001). 55% of students that consume tobacco (n=11) prefer to use it on workdays.
Heroin\morphine – There is a statistical significant difference (p=0.019). 66.7% of students that consume heroin or morphine (n=2) prefer to use it on holidays.
There was no statistical significance for the drugs PCP (p=0.243) and inhalants (p=0.243). alcohol cannabis tobacco heroin/morphine do not use used do not use used do not use used do not use used When students use drugs the most? don't use Count 37 1 38 0 38 0 38 0 % 42.0% 1.7% 31.1% 0.0% 29.7% 0.0% 26.2% 0.0% weekends Count 24 50 55 19 69 5 74 0 % 27.3% 83.3% 45.1% 73.1% 53.9% 25.0% 51.0% 0.0% workday Count 13 0 12 1 2 11 12 1 % 14.8% 0.0% 9.8% 3.8% 1.6% 55.0% 8.3% 33.3% holidays Count 14 9 17 6 19 4 21 2 % 15.9% 15.0% 13.9% 23.1% 14.8% 20.0% 14.5% 66.7% Total Count 88 60 122 26 128 20 145 3 % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% P values and statistical test p<0,001 Chi-square test p<0,001 Fisher's test p<0,001 Fisher's test p=0,019 Fisher's test
30 11.6.3 What foreign students feel after using a specific drug?
Table 10– effects reported as experienced by the students
Alcohol – a statistical significant difference (p<0.001). 38.3% (n=23) of students that consume alcohol feel happy after drinking. 36.7% (n=22) feel relaxed.
Cannabis – a statistical significant difference (p<0.001). 69.2% (n=18) of students that consume cannabis feel relaxed after consuming.
Tobacco – a statistical significant difference (p<0.001). 95% (n=19) of students that consume tobacco feel relaxed after consuming.
Heroin\morphine – a statistical significant difference (p=0.003). 33.3% of consuming students feel happy, 33.3% feel ashamed and 33.3% feel depressed.
There is no statistical significance for the drugs PCP (p=0.115) and inhalants (p=1.000). alcohol cannabis tobacco heroin/morphine do not use used do not use used do not use used do not use used What do you feel after using the drug? don't use Count 37 1 38 0 38 0 38 0 % 42.0% 1.7% 31.1% 0.0% 29.7% 0.0% 26.2% 0.0% happy Count 10 23 25 8 32 1 32 1 % 11.4% 38.3% 20.5% 30.8% 25.0% 5.0% 22.1% 33.3% relaxed Count 38 22 42 18 41 19 60 0 % 43.2% 36.7% 34.4% 69.2% 32.0% 95.0% 41.4% 0.0% ashamed Count 2 12 14 0 14 0 13 1 % 2.3% 20.0% 11.5% 0.0% 10.9% 0.0% 9.0% 33.3% sad Count 0 2 2 0 2 0 2 0 % 0.0% 3.3% 1.6% 0.0% 1.6% 0.0% 1.4% 0.0% depressed Count 1 0 1 0 1 0 0 1 % 1.1% 0.0% .8% 0.0% .8% 0.0% 0.0% 33.3% Total Count 88 60 122 26 128 20 145 3 % 100.0 % 100.0% 100.0 % 100.0 % 100.0% 100.0% 100.0% 100.0% p-value p<0,001 p<0,001 p<0,001 p=0,003 statistical test Fisher's test Fisher's test Fisher's test Fisher's test
31 11.6.4 Did students use drugs before admission to the university?
Table 11 – usage of drugs in relation to admission to the university alcohol tobacco do not use used do not use used Have you been taken drugs before gaining admission into the university? don't use Count 31 0 31 0 % 35.2% 0.0% 24.2% 0.0% yes Count 40 46 68 18 % 45.5% 76.7% 53.1% 90.0% no Count 17 14 29 2 % 19.3% 23.3% 22.7% 10.0% Total Count 88 60 128 20 % 100.0% 100.0% 100.0% 100.0% p value p<0,001 p=0,003 statistical test Chi-square test Fisher's test
Alcohol – a statistical significant difference (p<0.001). 76.7% of alcohol consuming students (n=46) started consuming before gaining admission into the university, in comparison to 19.3% (n=17) who begin consuming after admission.
Tobacco - a statistical significant difference (p=0.003). 90% of tobacco consuming students (n=18) started consuming before gaining admission into the university, in comparison to 10% (n=2) who begin consuming after admission.
There is no statistical significant difference for the drugs cannabis (p=0.058), heroin\morphine (p=1.000), PCP (p=1.000) and inhalants (p=0.419).
11.6.5 Did the use of psychoactive drugs influence the student's academic results? Table 12– drug use influence on academic result
alcohol cannabis tobacco heroin/morphine do not use used do not use used do not use used do not use used How using drugs influence on your academicals results? don't use Count 37 1 38 0 38 0 38 0 % 42.0% 1.7% 31.1% 0.0% 29.7% 0.0% 26.2% 0.0% it did not influence my academic results Count 44 58 79 23 83 19 101 1 % 50.0% 96.7% 64.8% 88.5% 64.8% 95.0% 69.7% 33.3% it improves my academic results Count 6 1 4 3 6 1 6 1 % 6.8% 1.7% 3.3% 11.5% 4.7% 5.0% 4.1% 33.3% my academic results become worse Count 1 0 1 0 1 0 0 1 % 1.1% 0.0% .8% 0.0% .8% 0.0% 0.0% 33.3%
32 There is statistical significant difference for the drugs alcohol (p<0.001), cannabis (p<0.001), tobacco (p=0.007) and heroin\morphine (p=0.003).
96.7% (n=58) of alcohol consuming students, 88.5% (n=23) of cannabis consuming students, 95% (n=19) of tobacco consuming students and 33.3% (n=1) of heroin\morphine consuming students declare that the use of this specific drug did not influence their academic results.
There is no statistical significant difference for the drugs PCP (p=0.054) and inhalants (p=1.000 ).
11.6.6 The effect of university environment on drug use Table 13– alcohol tobacco heroin/morphine do not use used do not use used do not use used Has the university environment influenced you in the use of drugs? don't use Count 37 0 37 0 37 0 % 42.0% 0.0% 28.9% 0.0% 25.5% 0.0% I started using less because of the university environment Count 10 20 27 3 30 0 % 11.4% 33.3% 21.1% 15.0% 20.7% 0.0% I started using more because of the university environment Count 14 7 15 6 19 2 % 15.9% 11.7% 11.7% 30.0% 13.1% 66.7% I am using the same as before Count 24 26 39 11 50 0 % 27.3% 43.3% 30.5% 55.0% 34.5% 0.0% I started using because of the university environment Count 3 7 10 0 9 1 % 3.4% 11.7% 7.8% 0.0% 6.2% 33.3% Total Count 88 60 128 20 145 3 % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% p value p<0,001 p=0,002 p=0,014
There is a statistical significant difference for the drugs alcohol (p<0.001), tobacco (p=0.002) and
heroin\morphine (p=0.014).
43.3% (n=26) of alcohol consuming students and 55% (n=11) of tobacco consuming students declare that the university environment did not influence their consumption, it is the same as before.
Total Count 88 60 122 26 128 20 145 3 % 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% p value p<0,001 p<0,001 p=0,007 p=0,003
33 66.7% (n=2) of heroin\morphine consuming students declare that they started using this drug more
because of the university environment.
There is no statistical significant difference for the drugs PCP (p=0.068), inhalants (p=0.412) and
cannabis (p=0.053).
Figure 7-
Student's opinion on the biggest risk factor to use drugs during the university period
The participating foreign medical filed students indicate that "exam stress" is the biggest risk factor to use drugs in the university period (36.9%).
The 2nd biggest risk factor is "being away from home" (18%), the 3rd is "sedentary lifestyle" and the 4th is "extreme educational and professional goals" (11.5%).
36.9 11.5 17.2 18.0 4.9 2.5 4.1 4.9 0 5 10 15 20 25 30 35 40 Exam stress Extreme educational and professional goals Sedentary life style Being away from home Sleep deprivation stress of patient care Become independent for the first time Just for fun
34
12. DISCUSSION OF THE RESULTS
12.1 Most common drug of choice among students
12.1.1 Comparison between prefer drug to actually used drug
According to T-2 and Fig 4, alcohol [1] is the most preferred and used drug, with the following cannabis and tobacco.
The number of actual users of alcohol and tobacco is higher than the number of students who prefer this drug. A reason for it can be that those drugs are relatively cheap and accessible, they can be purchased legally and they are easy to use.
There are more students that prefer Cannabis than students that actually use this drug. Cannabis is an illegal drug in most countries and therefore more difficult to acquire. It is expensive in comparison to other drugs. This could explain the gap between preferences and actual usage of this specific drug.
The drugs Heroin, Morphine, Phencyclidine, LSD, Inhalants and Amphetamines are much less common among foreign students of LUHS University than Alcohol, Cannabis and Tobacco.
12.1.2 Reason students prefer specific drug but use a different one
According to the study, 33% prefer to use a legal drug. With the use of illegal drugs, the student has the chance to be arrested by the police and even stop his studies and be deported from Lithuania.
21% prefer drug with less side effects. Side effects can be dangerous to the human body and even cause death, Followed by 16% who uses a different drug due to cost - Foreign students pay expensive tuition fee and housing, and most of the students depend financially on their parents so they are limited with their expenses.
11% use drugs that are less addictive and are easier to use: According to T-3, most students choose
"drinking" (n=56) and "smoking" (n=46) as the preferred route of administration. None of the
students chose "injecting" as the preferred route. The drugs heroin or morphine are very addictive that needed to be injected and are less popular among the foreign students (n=1 preferred, n=3 actually using as shown in table 3), in comparison with alcohol (drinking), cannabis and tobacco (smoking).
8% uses drugs that are easier to find and avoid drugs that are difficult to find. Most illegal drugs are difficult to find in comparison with alcohol or tobacco which students can find in every supermarket.
35 12.2 Relation between the year of studies and preferred drug:
There is no statistical significant difference ( p=0.193) between the year of studies and preferred drug. Alcohol, cannabis, and tobacco are the most popular drugs by all foreign students of LUHS University in all years (1-6). There is study contradict these findings by saying that students in the first years tend to use more alcohol, tobacco, and cannabis, in contrast to fifth and sixth years were students use more tranquilizers, amphetamines to cocaine [17].
These results have a similar distribution and therefore it is hard to find a significant difference.
12.3 Relation between genders differences and the drug of choice:
There is no statistical significant difference (p=0.065) between gender and drug of choice. Male and female foreign students both prefer alcohol, cannabis, and tobacco [T-5, Fig 6]. There are 2 studies that support this finding [1] [17], while some studies contradict it [9] [23]. The result may be different if the sample size was bigger.
12.3.2 Preferred route of administration in relation to gender difference
There is no statistical significant difference (p=0.236) between the route of administration of the drug and gender difference. Both male and female foreign students prefer drinking and smoking. These results have a similar distribution and therefore it is hard to find a significant difference. Drinking and smoking are the ways to administer the preferred drugs according to this study (Alcohol, cannabis, and tobacco) and are an easy way for administration with rapid influence on the body in comparison to injection which requires puncture the skin, a painful procedure that can cause infection.
12.4 Relation between gender differences and the reason for using the drug: 12.4.1 Motivation for drug-seeking behavior in relation to gender
There is a statistical significant difference between gender difference and the reason foreign students started to use drugs (p<0.001). Females started to use drugs due to a teenager's curiosity while males due to joy seeking.
12.4.2 Motivation for the continues use of psychoactive drugs in relation to gender
No statistical significant difference. The most common reason foreign students, both male (49.2%) and female (46.4%) are using drugs is "joy seeking". The 2nd common reason for both males (12.7%)
36 and females (16.7%) is "stress at school". These results have a similar distribution and therefore it is hard to find a significant difference.
12.5 Most common psychosocial problems in association with a specific drug: 12.5.1 Number of usage per week in relation to a specific drug
There is a statistical significant difference for alcohol, cannabis (p<0.001) and tobacco (p=0.002). Majority of students use these drugs less than one time a week.
There was no statistical significant difference for the drugs heroin\morphine (p=0.328), PCP (p=1.000) and inhalants (p=1.000).
These results are probably due to a small sample in different groups.
12.5.2 Psychoactive drug use tendencies in relation to a specific drug:
There is a statistical significant difference for alcohol, cannabis, tobacco (p=<0.001), and
heroin\morphine (p=0.019). Majority of alcohol and cannabis consumers prefer to use it on weekends probably because its effect can continue to the next day and influence the function, while on weekends there is a day off. Majority of tobacco consumers use it on work days, as tobacco is not considered as a psychoactive drug by a lot of the students. Most the tobacco users use it in the form of cigarettes and smoke one or more cigarettes per day. Majority of heroin\morphine consumers use it on holidays as the side effects are very prominent, so students use it when there are prolong vacations and the effect on the regular days is small. There was no statistical significance for the drugs PCP (p=0.243) and
inhalants (p=0.243). These results are probably due to a small sample in different groups.
12.5.3 Effect reported as experience by students
Students that prefer alcohol report feeling happy followed by relaxation with statistical significance (p<0.001). Students that prefer cannabis and tobacco describe feeling relaxation with statistical significance (p<0.001). Heroine\morphine user describes feeling 33.3% happy, 33.3% ashamed and 33.3% depressed with statistical significance (p=0.003). There is no statistical significance for the drugs PCP (p=0.115) and inhalants (p=1.000). These results are probably due to a small sample in different groups.
12.5.4 Usage of drugs in relation to admission to the university
Both alcohol (76.7% ) and tobacco (90%) users report consumption before gaining admission to university (p<0.001 and p=0.003)There is no statistical significant difference for the drugs cannabis
37 (p=0.058), heroin\morphine (p=1.000), PCP (p=1.000) and inhalants (p=0.419). These results are probably due to a small sample in different groups.
12.5.5 Drug use influence on academic results
There is statistical significant difference for the drugs alcohol (p<0.001), cannabis (p<0.001), tobacco (p=0.007) and heroin\morphine (p=0.003).
96.7% (n=58) of alcohol consuming students, 88.5% (n=23) of cannabis consuming students, 95% (n=19) of tobacco consuming students and 33.3% (n=1) of heroin\morphine consuming students declare that the use of this specific drug did not influence their academic results. Some studies contradict this result [3] [7] [8] [9] [10] [11] [15] [22] by indicating that Students who use substances show lowered commitment to education, declining grades, increased potential for dropout and high truancy rate.
There is no statistical significant difference for the drugs PCP (p=0.054) and inhalants (p=1.000 ). These results are probably due to a small sample in different groups.
12.5.6 The effect of university environment on drug use
There is a statistical significant difference for the drugs alcohol (p<0.001), tobacco (p=0.002) and
heroin\morphine (p=0.014).
43.3% (n=26) of alcohol consuming students and 55% (n=11) of tobacco consuming students declare that the university environment did not influence their consumption, it is the same as before. Some studies contradict this result by determining that students use more psychoactive drugs during the university period [1][2][10]. 66.7% (n=2) of heroin\morphine consuming students declare that they started using this drug more because of the university environment. There is no statistical significant difference for the drugs PCP (p=0.068), inhalants (p=0.412) and cannabis (p=0.053). These results are probably due to a small sample in different groups.
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13. CONCLUSIONS
This study focused on psychoactive substance use Dynamics among foreign students of LUHS.
1. Students prefer and use alcohol, followed by cannabis and tobacco. Additionally, they prefer drugs according to legality, followed by a drug that will cause less side effects and are
influenced by cost.
2. There is no relation between the year of study and the preferred drug. Most of the students in all years (1-6) prefer the same drugs – alcohol, cannabis and tobacco.
3. There is no relation between genders and drug of choice, male and female foreign students prefer alcohol, followed by cannabis and tobacco.
4. There is correlation between gender difference and the reason foreign students started to use drugs. Females started to use drugs due to teenager's curiosity while males due to joy seeking. In contrary, there is no significant relation between gender and the motivation for the continued use of psychoactive drugs, males and females using drugs in the present for the same reasons – joy-seeking and stress in school.
5. There is correlation between psychosocial problems in association with some of the drugs: a. Alcohol, cannabis, and tobacco are used less than one time per week.
b. Alcohol and cannabis are used mainly on weekends, tobacco on workdays and heroin\morphine on holidays.
c. Cannabis and tobacco make students feel relaxed after the use. Students that prefer alcohol report feeling happy after the use. There are no significant results for the other drugs. d. Majority of alcohol and tobacco users started before admission to the university.
e. Alcohol, cannabis, tobacco and heroin\morphine as no influence on the academic results of most of the using students.
f. The usage of alcohol, cannabis, and heroin\morphine as not influenced by the university environment, students continue to use it the same as before.
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14. PRACTICAL RECOMMENDATIONS
The university needs to educate students about psychoactive drug use and their influence on studies, patient care and general health with focus on the side effects, which for some of the drugs can be dangerous for the students and the patients.
The university should pay attention especially to fresh students that need to adjust to a new stage of life, new place, far away from parent's supervision, stressful study environment. These could be through classes and activities on drug education and counseling that will be available for all students.
University can provide activities to relief stress (sports for example), that will replace the need to use psychoactive drugs.
