IndianJ. Psychiat., 1994,36(3), 138-140.
PSYCHOACTIVE SUBSTANCE USE AMONG MEDICAL
STUDENTS
R.V.ZULFIKARALI, G.K.VANKAR
Using a standard epidemiological survey instrumentfor psychoactive drug use, 215 medical students
in three classes were studied. One third ofall students reported non-medical drug use. The substances
ever used were: betel nut 13%, smokeless tobacco 3%, cigarettes 12%, alcohol 12.5%, cannabis 0.9%
and benzodiazepines 3.7%. Lastmonth use was reportedforfoursubstances anddaily use was reported
for cigarettes only (3.2%). Cigarette and benzodiazepine use mostly began after entry to medical
college. Men andfinal year students had a higherprevalence ofdrug use.
Key words: Psychoactive substance, use, medical students, depression.
INTRODUCTION
Psychoactive substance related impairments may
have a detrimental and life threatening impact not
only on individual physicians but also on patients
dependent on them. Nonmedical drug use among
medical students has been surveyed in India (Agar-
wal ct al, 1975; Sethi & Manchanda, 1987; Singh,
1979; Ponnudurai et al, 1984; Vankar (personal
communication, 1984) and abroad (Maddux et al,
1986; McAuliffe et al, 1986; Baldwin et al, 1991).
As these studies were conducted with different ques-
tionnaires and with different procedures, at different
places and times and with varying response rates, the
results cannot be generalized.
This study differs in two aspects from earlier
studies. Firstly, in addition to information about
extent and nature of substances used, it also sought
information regarding impairment because of
psychoactive substance use. Secondly, it measured
depression which has been reported to coexist with
the use of alcohol and other substances. This study
aimed at finding out the prevalence and pattern of
psychoactive substance use among medical stu-
dents, sociodemographic correlates of such use and
association of depression with such use, if any.
MATERIAL AND METHODS
A self-administered questionnaire adapted from
the questionnaire used by Johnston et al (1982) was
used for the survey. The questionnaire elicited infor-
mation on sociodemographic characteristics,
psychoactive substance use and impairment due to
such use. Depression was measured by the twenty
item Zung self-rating Depression Scale (Zung,
1972). The questionnaire was distributed to first,
second and final MBBS students by one of the
investigators (Z.A.R.V.) in their respective classes
after thorough explanation of purpose of study. All
students responded to the questionnaire.
Psychoactive substance users and nonusers were
compared on several sociodemographic charac-
teristics as well as for presence of depression. Chi-
square and 't' test were used to find out statistical
significance.
RESULTS
Out of 234 medical students in the three classes,
19 provided inadequate information, leaving 215
responses for analysis.
Table 1
Prevalence of psychoactive substance use (%)
Substance
Alcohol
Betel Nut
Cigarettes
Benzodiazepines
Smokeless
Tobacco
Cannabis
Male
26.4
17.6
19.2
8.0
2.4
1.6
Life Time
Female
3.3
6.6
1.1
0.0
0.0
0.0
Total
16.7
13.0
12.0
4.6
1.4
0.9
Last Month
Total
3.2
2.3
5.5
0.5
0.0
0.0
Table 1 shows the prevalence of psychoactive
substance use. Seventy (32.5%) students had used at
least one psychoactive substance during their
lifetime. Betel nut, alcohol and cigarettes were the
three most frequently used substances. Less com-
monly used were benzodiazepines, smokeless
tobacco and cannabis. Last month substance use was
limited to four substances: cigarettes, alcohol, betel
nut and benzodiazepines, in that order. Daily use (for
twenty or more days during the last one month) was
reported by 3.2% and was limited to cigarettes only.
138
More than 90% of alcohol users also had used
another substance. Cannabis use was uncommon,
reported by only two students. Impairment in physi-
cal, social or academic spheres were reported by
only 2.3% of all and 7.1 % of drug user students. For
different substances, mean age of starting substance
use ranged from 15 to 17.5 years. The lowest mean
age for the onset of use of any substance was for
betel nut (15 years), and the highest mean age was
for benzodiazepines (17.5 years).
Table 2
Chronology of psychoactive substance use
Substance Student Use (n = 215)
Before During Neve?
medical medical
college college
n (%) n (%) n (%)
Alcohol 22 (10.0) 14 (7.0) 179 (83)
Betel nut 21 (9.8) 7 (3.0) 187 (87)
Cigarettes 11 (5.0) 14 (7.0) 190 (88)
Benzodiazepines 2 (1.0) 8 (3.7) 205 (95)
Smokeless
Tobacco 2 (1.0) 1 (0.5) 212 (99)
Cannabis 1 (0.5) 1 (0.5) 213 (99)
Table 3
Reasons cited for substance use
Substance Most cited Second Third
most cited most cited
(Per cent users per substance)
Alcohol Experiment
(36.1.)
Betel Nut Experiment
(57.1)
Cigarettes Experiment
(60.1)
Benzodiazepines
Sleep
(100)
Smokeless Tobacco
Experiment
(66)
Cannabis Feelgood
(50)
Anger
(50)
Good time Feel good
(30.5) (11.1)
Good taste Good time
(17.8) (14.3)
Relax Good time
(12.0) (4.0)
Avoid problems
(4.0)
Relax
(33)
Table 4
Sociodemographic characteristics
Users Nonusers
n =70 n = 145
Gender'
Age (yrs)
Class*
Domicile
Residence
Religion
Marital
Status
Annual
Income(Rs)
Health status
Academic status+
Men
Women
Range
Mean(SD)
IMBBS
IIMBBS
IIIMBBS
Urban
Rural
Hostel
Day scholar
Hindu
Other
Single
Married
<60,000
>60,000
Good
fair/poor
Upper
Middle
Lower
(%)
89
11
17 to 25
19.7(2.0)
30
24
46
63
37
61
39
93
7
94
6
57
43
81
19
37
53
10
(%)
43
57
17to23
19.5(1.4)
47
37
16
77
23
63
37
92
8
99
1
68
32
77
23
43
41
16
+
Data of 49 users and 47 nonusers
* p < 0.001
As shown in Table2, use ofalcohol, betel nut and
smokeless tobacco started more often prior to enter-
ing medical college. After admission to medical
college, the use of two substances: cigarettes and
benzodiazepines became more frequent. Cannabis
use did not show any difference before or after
medical college entry. The reasons cited for ex-
perimenting with drugs are mentioned in Table 3.
Table 4 compares sociodemographic charac-
teristics of psychoactive substance users and non-
users. Life time use was more often by men as
compared to women (89% vs 11%); use was most
frequent amongfinalMBBS students. The users and
nonusers did not differ as regards age, domicile,
residential arrangement, religion, marital status,
parental income, perceived health and academic
status.
On Zung self-rating Depression Scale (Zung,
1972) more non-users compared to users had depres-
sion (25.5% vs 20%). However, the difference was
not statistically significant.
ZULFIKAR ALI & G.K. VANKAR
DISCUSSION
Almost one third of medical students reported a
lifetime use of psychoactive substances. The lower
prevalence may be related to inclusion of younger
students belonging to the first and second years. Use
of opioids, stimulants, hallucinogens or cocaine was
nonexistent. Impairment due to drug use were also
uncommon. Use of two substances: cigarettes and
benzodiazepines started more often after medical
college entry. Easy access to benzodiazepines for
medical students may be a factor leading to its use.
Drug use was not associated with more depression.
Clark and Zeldo (1987) observed that medical stu-
dents with depression did not report alcohol or other
substance use more frequently; in fact severely dys-
phoric students reported less consumption of al-
cohol. Drug use might have improved the mood state
of users. Psychoactive drug use started in most in-
stances at younger age. Emphasis in medical cur-
riculum on psychoactive substance use cannot be
overemphasized.
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R. V.ZulfikarAli MBBS, DPM, Post Graduate student; G.K. VankarMD, DPM, Associate Professor
and Head, Department of Psychiatry, Government Medical College, MajuraGate, Sural 395 001.
Correspondence
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