This study aims to evaluate the lifetime and past three-months prevalence of psychoactive substance use among students at Oujda University while also exploring its associations with sociodemographic, academic, and health factors. We employed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) to assess the lifetime and past three-months use of various substances, including alcohol, tobacco, cannabis, cocaine, amphetamine-type stimulants, sedatives, opioids, inhalants, hallucinogens, and “other” substances [22], and also to evaluate the level of ASSIST-recommended interventions for each substance [22–26].

The study found that among Mohammed First University students, the overall lifetime and past three-months prevalence of psychoactive substance use were 28.7% and 27.6%, respectively. Unfortunately, there is a lack of comparative data from other universities in the kingdom to contextualize these results. In comparison to other studies conducted worldwide, our findings revealed significantly lower rates of psychoactive substance use. For instance, a cross-sectional study of 763 undergraduate students in Nigeria reported a high lifetime rate of 84.5% [27], while a systematic review and meta-analysis conducted in Ethiopia found an overall prevalence of 32.28% among students [28]. Similarly, a study conducted in France between 2015 and 2017 reported a lifetime use rate of 83.32% for at least one psychoactive substance [29]. These prevalence rates observed in different countries are notably higher than those found in our study and in other Muslim-majority countries such as Turkey [30], where the estimated prevalence is 6.4%. This discrepancy may suggest the influence of religion on the variations in lifetime substance use prevalence across different regions [31, 32].

Notably, our research revealed tobacco as the most commonly used psychoactive substance, with a lifetime prevalence of 24.1% and a past three-months prevalence of 17.2%. These findings were consistent with similar studies conducted at other universities. For instance, at Marrakech University [18], 24.6% of students reported tobacco consumption during their lifetime, while at Fes and Meknes Universities [19], the figure stood at 29.5%. Comparatively, our observed lifetime prevalence exceeded the rates of tobacco use in Ethiopia [33], with a prevalence of 7.4%, and Nigeria [27], with a prevalence of 13.6%. Conversely, it fell below the prevalence rates observed in Lebanon [34] at 36.3%, France [29] at 30.6%, and Spain [35] at 78.8%.

Alcohol emerged as the second most commonly used substance, with a lifetime prevalence of 15.9% and a past three-months prevalence of 11.5%. These findings align with similar studies conducted at other universities, such as Marrakech University [18], where 17.5% of students reported alcohol consumption during their lifetime, Fes and Meknes University [19], where the prevalence stood at 17.4%. However, when comparing our observed lifetime prevalence, it was lower than the rates of alcohol use in all the aforementioned studies. For instance, in Ethiopia [33], the prevalence was 16.0%, while in Nigeria [27], it was significantly higher at 82.7%. Similarly, Spain [35] reported a prevalence of 98.4%, France [29] reported 73.7%, and Lebanon [34] reported 47.7%.

With a lifetime prevalence of 13.4% and a past-three-months prevalence of 9.0%, cannabis emerged as the third most commonly used substance. These findings fall within the range of comparable studies conducted at other universities, such as Marrakech University [18], where 9.8% of students reported lifetime cannabis consumption, and Fes and Meknes Universities [19], where the prevalence was 16.1%. However, when comparing the prevalence of cannabis use in other countries, a similar pattern emerges, as seen with tobacco use. Sub-Saharan countries tend to have lower prevalences, while European countries have higher prevalences. For instance, in Ethiopia [33] the prevalence was 4.5%, while in Nigeria [27] it was 7.6%. In contrast, Spain [35] reported a prevalence of 17.7%, and France [29] reported a significantly higher prevalence of 57%. We can attribute this similarity to the fact that students often smoke cannabis by combining tobacco and cannabis in the form of joints or blunts.

Our research findings revealed that 6.9% of students reported having used sedatives and sleeping pills at some point in their lives, with 4.6% indicating recent usage within the past three months. It is noteworthy that our study’s results closely align with those reported by Fes and Meknes universities [19], where the lifetime usage rate was found to be 5.1%. This similarity suggests a consistent pattern within the national context. However, when compared to broader trends observed in other regions, our study indicates comparatively lower prevalence rates. For example, in Lebanon [34], the prevalence of sedative and sleeping pill usage was recorded at 11.0%, while in Nigeria [27], it reached a significantly higher rate of 14.2%. Most concerning is the prevalence in Spain [35], which stood at an alarming 18.8%.

Turning our attention to cocaine use, we found lifetime and past-three-months prevalences of 4.4% and 2.1%, respectively, among our sample. Despite these relatively lower figures, it is still a cause for concern given the substantial evidence of its short- and long-term health consequences [23, 36]. Comparatively, the prevalence of cocaine use among university students was lower in sub-Saharan countries, with Nigeria [27] reporting 1.4% and Ethiopia [33] reporting 2.5%. In contrast, France [29] exhibited a prevalence of 7.0%, while Spain [35] reported a significantly higher prevalence of 19.1%.

Multiple factors could contribute to the variations in the lifetime prevalence of substance use across different countries and regions. These factors may include socioeconomic status, cultural differences, religion, the availability and accessibility of psychoactive substances, and the level of awareness and education on substance use. Additionally, it is important to acknowledge that sample characteristics could play a role in these variations.

Our findings revealed that a mere 1.3% of students opted for the “other” category when reporting their substance use, suggesting that the ASSIST [22] tool is generally adequate for evaluating psychoactive substance use. Nevertheless, the inclusion of supplementary categories and a wider range of substances, considering regional variations, could enhance its effectiveness in assessing psychoactive substance use among diverse populations.

Based on the results obtained from ASSIST, our findings indicate that the majority of students who use substances do not require any intervention. However, it is important to note that 10.3% of tobacco users, 5.6% of cannabis users, and 1.9% of students using sedative pills would benefit from “more intensive treatment” as recommended by the World Health Organization (WHO) [22]. These individuals necessitate a comprehensive clinical assessment and specialized treatment tailored to address their specific substance use concerns. Moreover, our study reveals that a significant proportion of students would benefit from “brief intervention.” Among tobacco users, 47.7% would benefit from this approach, along with 25.2% of cannabis users, 22.4% of alcohol users, and 11.2% of sedative pill users. Brief interventions involve providing feedback through the ASSIST feedback report card, distributing the informative “Self-help strategies for cutting down or stopping substance use: a guide” booklet [37], and offering specific substance-related information to assist them in reducing or ceasing their substance use [22].

After conducting the univariate analysis, it became evident that there was a significant correlation between the consumption of psychoactive substances and male gender (P < 0.0001), as well as age over 20 years (P < 0.0001). These associations have been consistently reported in previous studies [18, 19, 30, 33, 34], suggesting a robust pattern. The reasons behind these associations can be attributed to diverse social and cultural factors that tend to normalize substance consumption among men more than women and among young adults more than adolescents.

The observed significant association (P = 0.005) between substance consumption and anxiety and/or depressive disorders is a two-way relationship. It is important to note that internalized disorders, such as depressive and anxiety disorders can both contribute to and result from substance consumption or substance use disorder [38]. The study by Christie et al. [39] provides further evidence, showing that a preexisting history of depressive or anxiety disorders increases the risk of developing a substance use disorder in the future. These findings are consistent with other studies in the literature [40–42].

Moreover, we discovered a noteworthy and statistically significant association (P < 0.0001) between the consumption of psychoactive substances and participation in leisure activities. This association can be explained through a biosocial perspective on personality [43, 44]. According to Cloninger [43, 44], novelty seeking represents one of the fundamental traits of personality and refers to an individual’s tendency to seek out new and exciting experiences, sensations, and stimulation, including participating in leisure activities. Several authors [44–46] have found a significant link between novelty seeking and the use of alcohol, tobacco, and other substances.

In addition to our findings, we discovered a significant association (P < 0.0001) that is seldom reported, namely the link between substance use and academic failure, assessed by the number of repeated school years. Interestingly, the study conducted in Marrakech [18] reported a similar result. This association implies the potential involvement of psychosocial factors and personality traits in both academic failure and substance use.

Furthermore, we identified a significant association (P < 0.0001) between substance use and self-financing, indicating that students who have the ability to generate income are more likely to engage in substance consumption than their counterparts. Interestingly, the study in Fes and Meknes universities [18] reported a similar association, where students who received pocket money exceeding 150 euros were more susceptible to use substances. These findings suggest a potential relationship between financial resources and substance use among students.

By conducting this study, we achieved our predefined objectives and effectively utilized the data collected during the survey. However, it is important to acknowledge several limitations that deserve emphasis. First, our study relied on a cross-sectional survey design, which poses challenges in establishing causal inferences. Furthermore, the limited sample size, the sampling procedure and difficulties in accessing university students, given their diverse schedules and absenteeism, raise concerns about the representativeness of our findings and could be subject to selection bias. Another limitation is the reliance on self-assessed, subjective data, instead of clinical (assessments by healthcare professionals) and biological (blood tests, urine tests) evaluations of substance use, which can be prone to biases and inaccuracies, including recall bias. Given the sensitive nature of the subject matter from both sociocultural and judicial perspectives, the reported values may not necessarily reflect the true reality due to social desirability bias.

While our study successfully met its objectives and utilized the available data, it is essential to recognize these limitations. Future research should consider alternative study designs with larger and more diverse samples to better assess the prevalence of substance use and identify its associated risk factors. These efforts will contribute to the enhancement and guidance of national initiatives focused on reducing substance use and preventing related disorders.