Prescription and over-the-counter drugs can be easily abused because of their exposure to daily life and the perception that they are safe. The abuse of prescription and over-the-counter medicines has been a major problem treated as a serious public health problem worldwide. The purpose of this study is to explore the factors contributing to substance abuse in Korea by examining the actual situation of substance abuse among Korean adults and evaluating their knowledge, attitudes, and intentions about substance abuse. PCA revealed the presence of seven factors: drug risk awareness, overconfidence in handling drug usage, affirmation of legal drug usage, motivation to use diet pills, acceptance of addictive substances, affirmation of public support for drug abuse, and motivation to use opioids.

It is particularly interesting that the more overconfidence in addiction coping methods in this study result in a stronger tendency to abuse drugs. The second factor, which we named “overconfidence in handling drug usage” is to do with overconfidence in their knowledge and coping skills about drug abuse. Previous researchers have found that people with high self-efficacy are overconfident in their abilities, less motivated, and less contributing to task completion [16,17]. Although there is a high belief among some drug users that substance abuse can be controlled, the results are that some people lack the motivation to refrain from using drugs [18]. It suggests that acknowledging that people are addicted to drug addiction and helplessness should be a priority.

“Affirmation of public support for drug abuse,” designated as the sixth factor in this study, represents an attitude toward government support or public health approval for the treatment of substance abuse, with a lower score indicating a belief that substance abuse is an individual’s responsibility. The results of this study showed that the tendency for substance abuse was low when it was recognized that the treatment of drug addiction should be the responsibility of the government or public responsibility and the higher the individual’s view of substance abuse as the individual’s responsibility, the higher the substance abuse tendency. According to the guidelines for the treatment of opioid dependence by the World Health Organization, if treatment is provided outside the health care system (e.g., in prisons) and is not primarily under the responsibility of health authorities, there should still be a documented chain of responsibility for health outcomes, and even in a variety of settings, it is best to have primary responsibility for care within the healthcare system [19]. Just as there are guidelines for managing drug dependence under the responsibility of public institutions, emphasizing public responsibility for substance abuse is thought to be helpful in prevention.

Several studies have shown that attribution of responsibility for the causes of substance abuse and treatment contributes to the psychosocial context in which substance use and abuse occur, and that responsibility for substance use and recovery is related to treatment processes and outcomes [20-23].

These findings will contribute to understanding the importance of attribution of responsibility through the initiation, continuation, and recovery phases of drug use. The importance of awareness of responsibility in substance abuse is suggested, and further investigation into the behavioral implications of responsibility attribution for substance abuse is necessary to better understand the clinical relevance of responsibility attribution, in particular, substance type factors and race. It may affect this perception, so more extensive-scale studies are needed.

The “acceptance of addictive substances” factor was found to affect opioid abuse. This factor means routinely taking or not being resistant to everyday addictive substances, and attitudes toward alcohol, cigarette, energy drink, and caffeine use and stereotypes about drug usage are included. According to the results, the higher the acceptance of addictive substances, the higher the opiate abuse tendency. Multi-substance use, which includes periodic, repeated, and habitual use of multiple substances, is associated with poor treatment outcomes [24,25]. Smoking and drinking more frequently are known to be associated with inappropriate drug use. Although most people with substances use multiple substances, polysubstance use has been recognized, and consequently, the presence of multiple substance abuse is associated with worse treatment outcomes [26-28].

In the results of this study, the “affirmation of legal drug usage” factor means the degree to which one is familiar with drugs and supportive of legal or medical drug usage appeared to increase. In Korea, there are many abuse cases of psychoactive appetite suppressants, especially under the influence of social pressure in favor of a slim body. Phentermine, phendimetrazine, and diethylpropion have been withdrawn in most countries due to side effects such as drug abuse and cardiotoxicity, which were not addressed in the existing clinical guidelines for the pharmacological management of obesity in adults in Korea [29]. Therefore, this suggests that the drug may be perceived by Korean adults as close to legal drugs.

Factor 1 “drug risk awareness,” factor 4, “motivation to use diet pills,” and factor 7 “motivation to use opioids” had no significant effect on drug abuse in this study. We expected that the more we believed that the drug was not harmful, the more likely we were to request or overdose on an opioid or narcotic or diet pills, and the more likely we were to be prone to substance abuse, but this was not the case. However, in previous studies, the negative effects of habitual drug use [30,31] and caffeine, energy drink consumption [32,33], purchasing and using without checking the drug label and ingredients [34,35], and indiscriminate use of drugs for weight loss [36,37] on physical and mental health were reported. Therefore, additional research is needed to explore the influence of motives for drug abuse and when the risks of drugs are recognized.

In conclusion, it suggests that substance abuse is influenced by overconfidence in handling drug use rather than social cognitive effects such as the degree of pain and dissatisfaction with body shape, or psychological prejudice that the responsibility of substance abuse lies with individuals rather than the government or the public. In a previous study, overconfident participants of a compulsory detention center underestimated their level of addiction, overestimated their self-control, and held external attributions and motivations about addiction [18]. Apart from that, the attitude of being aware of the medications being taken and being able to determine the dosage for oneself influences the frequency and amount of medication taken when making decisions about medicine intake [38]. Overconfidence in the knowledge of drugs can lead people to self-diagnose symptoms and take drugs without any valid prescription, which increases the risk of dependency and drug abuse in the future [39]. This tendency of drug abuse seems to be a common characteristic that appears in both those who have experienced opioid abuse and those who have abused diet drugs. In addition to these common characteristics, there are also unique characteristics that appear only in certain misuse and abuse. Opium abuse was stronger as the tendency to enjoy alcohol, tobacco, caffeine, etc. was stronger, but this difference did not appear in diet drug abuse. On the other hand, diet drug abuse was stronger as the tendency to support legal drug use was stronger. This suggests that opioids are perceived by people as extensions of addictive substances such as alcohol and tobacco, and on the contrary, diet drug is perceived by people as close to legal drugs.

We explained that the discussion of accountability in the problem of substance abuse is a meaningful approach to addressing this substance abuse problem. This study found that the two fundamental perspectives of public responsibility and individual responsibility have different effects on substance abuse. We may ask whether the responsibility for creating a problem lies with the public or with the individual, and may shift the responsibility to the problem-maker to solve the problem. We need professional advice and suggestions to provide people with professional help and inform the public and private about the factors that influence this issue. This study’s findings suggest the possibility that a problem may arise that the more people believed they were responsible for their substance abuse problem, and they have confidence they were able to solve the problem and the more they thought it was okay to use any legal drug although it could be harmful to their health. In Korea, specifically, there is a widespread and indiscriminate use of psychotropic appetite suppressants due to an intense preoccupation with attaining a slim figure. Moreover, the illicit consumption of marijuana and illegal drugs has led to an escalation in social problems. As a result, it becomes imperative to allocate considerable attention to this matter. Therefore, it remains imperative to acknowledge the gravity of the drug abuse issue, necessitating the implementation of comprehensive drug abuse education as a viable means to address this matter. The efficacy of drug abuse education hinges upon the elucidation of the psychological mechanisms underlying drug abuse. A comprehensive and methodical monitoring system, initiated at the national level, is indispensable to assess the extent of drug abuse. Consequently, it is crucial to emphasize the necessity of implementing systematic and regular surveys to identify issues about drug abuse.