literature review on effect of drug abuse

An Overview of Drug Abuse: Causes, Effects, and Control Measures

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• Published: 13 November 2021

Risk and protective factors of drug abuse among adolescents: a systematic review

• Azmawati Mohammed Nawi 1 ,
• Rozmi Ismail 2 ,
• Fauziah Ibrahim 2 ,
• Mohd Rohaizat Hassan 1 ,
• Mohd Rizal Abdul Manaf 1 ,
• Noh Amit 3 ,
• Norhayati Ibrahim 3 &
• Nurul Shafini Shafurdin 2  

BMC Public Health volume  21 , Article number:  2088 ( 2021 ) Cite this article

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Drug abuse is detrimental, and excessive drug usage is a worldwide problem. Drug usage typically begins during adolescence. Factors for drug abuse include a variety of protective and risk factors. Hence, this systematic review aimed to determine the risk and protective factors of drug abuse among adolescents worldwide.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted for the review which utilized three main journal databases, namely PubMed, EBSCOhost, and Web of Science. Tobacco addiction and alcohol abuse were excluded in this review. Retrieved citations were screened, and the data were extracted based on strict inclusion and exclusion criteria. Inclusion criteria include the article being full text, published from the year 2016 until 2020 and provided via open access resource or subscribed to by the institution. Quality assessment was done using Mixed Methods Appraisal Tools (MMAT) version 2018 to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.

Out of 425 articles identified, 22 quantitative articles and one qualitative article were included in the final review. Both the risk and protective factors obtained were categorized into three main domains: individual, family, and community factors. The individual risk factors identified were traits of high impulsivity; rebelliousness; emotional regulation impairment, low religious, pain catastrophic, homework completeness, total screen time and alexithymia; the experience of maltreatment or a negative upbringing; having psychiatric disorders such as conduct problems and major depressive disorder; previous e-cigarette exposure; behavioral addiction; low-perceived risk; high-perceived drug accessibility; and high-attitude to use synthetic drugs. The familial risk factors were prenatal maternal smoking; poor maternal psychological control; low parental education; negligence; poor supervision; uncontrolled pocket money; and the presence of substance-using family members. One community risk factor reported was having peers who abuse drugs. The protective factors determined were individual traits of optimism; a high level of mindfulness; having social phobia; having strong beliefs against substance abuse; the desire to maintain one’s health; high paternal awareness of drug abuse; school connectedness; structured activity and having strong religious beliefs.

The outcomes of this review suggest a complex interaction between a multitude of factors influencing adolescent drug abuse. Therefore, successful adolescent drug abuse prevention programs will require extensive work at all levels of domains.

Peer Review reports

Introduction

Drug abuse is a global problem; 5.6% of the global population aged 15–64 years used drugs at least once during 2016 [ 1 ]. The usage of drugs among younger people has been shown to be higher than that among older people for most drugs. Drug abuse is also on the rise in many ASEAN (Association of Southeast Asian Nations) countries, especially among young males between 15 and 30 years of age. The increased burden due to drug abuse among adolescents and young adults was shown by the Global Burden of Disease (GBD) study in 2013 [ 2 ]. About 14% of the total health burden in young men is caused by alcohol and drug abuse. Younger people are also more likely to die from substance use disorders [ 3 ], and cannabis is the drug of choice among such users [ 4 ].

Adolescents are the group of people most prone to addiction [ 5 ]. The critical age of initiation of drug use begins during the adolescent period, and the maximum usage of drugs occurs among young people aged 18–25 years old [ 1 ]. During this period, adolescents have a strong inclination toward experimentation, curiosity, susceptibility to peer pressure, rebellion against authority, and poor self-worth, which makes such individuals vulnerable to drug abuse [ 2 ]. During adolescence, the basic development process generally involves changing relations between the individual and the multiple levels of the context within which the young person is accustomed. Variation in the substance and timing of these relations promotes diversity in adolescence and represents sources of risk or protective factors across this life period [ 6 ]. All these factors are crucial to helping young people develop their full potential and attain the best health in the transition to adulthood. Abusing drugs impairs the successful transition to adulthood by impairing the development of critical thinking and the learning of crucial cognitive skills [ 7 ]. Adolescents who abuse drugs are also reported to have higher rates of physical and mental illness and reduced overall health and well-being [ 8 ].

The absence of protective factors and the presence of risk factors predispose adolescents to drug abuse. Some of the risk factors are the presence of early mental and behavioral health problems, peer pressure, poorly equipped schools, poverty, poor parental supervision and relationships, a poor family structure, a lack of opportunities, isolation, gender, and accessibility to drugs [ 9 ]. The protective factors include high self-esteem, religiosity, grit, peer factors, self-control, parental monitoring, academic competence, anti-drug use policies, and strong neighborhood attachment [ 10 , 11 , 12 , 13 , 14 , 15 ].

The majority of previous systematic reviews done worldwide on drug usage focused on the mental, psychological, or social consequences of substance abuse [ 16 , 17 , 18 ], while some focused only on risk and protective factors for the non-medical use of prescription drugs among youths [ 19 ]. A few studies focused only on the risk factors of single drug usage among adolescents [ 20 ]. Therefore, the development of the current systematic review is based on the main research question: What is the current risk and protective factors among adolescent on the involvement with drug abuse? To the best of our knowledge, there is limited evidence from systematic reviews that explores the risk and protective factors among the adolescent population involved in drug abuse. Especially among developing countries, such as those in South East Asia, such research on the risk and protective factors for drug abuse is scarce. Furthermore, this review will shed light on the recent trends of risk and protective factors and provide insight into the main focus factors for prevention and control activities program. Additionally, this review will provide information on how these risk and protective factors change throughout various developmental stages. Therefore, the objective of this systematic review was to determine the risk and protective factors of drug abuse among adolescents worldwide. This paper thus fills in the gaps of previous studies and adds to the existing body of knowledge. In addition, this review may benefit certain parties in developing countries like Malaysia, where the national response to drugs is developing in terms of harm reduction, prison sentences, drug treatments, law enforcement responses, and civil society participation.

This systematic review was conducted using three databases, PubMed, EBSCOhost, and Web of Science, considering the easy access and wide coverage of reliable journals, focusing on the risk and protective factors of drug abuse among adolescents from 2016 until December 2020. The search was limited to the last 5 years to focus only on the most recent findings related to risk and protective factors. The search strategy employed was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) checklist.

A preliminary search was conducted to identify appropriate keywords and determine whether this review was feasible. Subsequently, the related keywords were searched using online thesauruses, online dictionaries, and online encyclopedias. These keywords were verified and validated by an academic professor at the National University of Malaysia. The keywords used as shown in Table  1 .

Selection criteria

The systematic review process for searching the articles was carried out via the steps shown in Fig.  1 . Firstly, screening was done to remove duplicate articles from the selected search engines. A total of 240 articles were removed in this stage. Titles and abstracts were screened based on the relevancy of the titles to the inclusion and exclusion criteria and the objectives. The inclusion criteria were full text original articles, open access articles or articles subscribed to by the institution, observation and intervention study design and English language articles. The exclusion criteria in this search were (a) case study articles, (b) systematic and narrative review paper articles, (c) non-adolescent-based analyses, (d) non-English articles, and (e) articles focusing on smoking (nicotine) and alcohol-related issues only. A total of 130 articles were excluded after title and abstract screening, leaving 55 articles to be assessed for eligibility. The full text of each article was obtained, and each full article was checked thoroughly to determine if it would fulfil the inclusion criteria and objectives of this study. Each of the authors compared their list of potentially relevant articles and discussed their selections until a final agreement was obtained. A total of 22 articles were accepted to be included in this review. Most of the excluded articles were excluded because the population was not of the target age range—i.e., featuring subjects with an age > 18 years, a cohort born in 1965–1975, or undergraduate college students; the subject matter was not related to the study objective—i.e., assessing the effects on premature mortality, violent behavior, psychiatric illness, individual traits, and personality; type of article such as narrative review and neuropsychiatry review; and because of our inability to obtain the full article—e.g., forthcoming work in 2021. One qualitative article was added to explain the domain related to risk and the protective factors among the adolescents.

PRISMA flow diagram showing the selection of studies on risk and protective factors for drug abuse among adolescents.2.2. Operational Definition

Drug-related substances in this context refer to narcotics, opioids, psychoactive substances, amphetamines, cannabis, ecstasy, heroin, cocaine, hallucinogens, depressants, and stimulants. Drugs of abuse can be either off-label drugs or drugs that are medically prescribed. The two most commonly abused substances not included in this review are nicotine (tobacco) and alcohol. Accordingly, e-cigarettes and nicotine vape were also not included. Further, “adolescence” in this study refers to members of the population aged between 10 to 18 years [ 21 ].

Data extraction tool

All researchers independently extracted information for each article into an Excel spreadsheet. The data were then customized based on their (a) number; (b) year; (c) author and country; (d) titles; (e) study design; (f) type of substance abuse; (g) results—risks and protective factors; and (h) conclusions. A second reviewer crossed-checked the articles assigned to them and provided comments in the table.

Quality assessment tool

By using the Mixed Method Assessment Tool (MMAT version 2018), all articles were critically appraised for their quality by two independent reviewers. This tool has been shown to be useful in systematic reviews encompassing different study designs [ 22 ]. Articles were only selected if both reviewers agreed upon the articles’ quality. Any disagreement between the assigned reviewers was managed by employing a third independent reviewer. All included studies received a rating of “yes” for the questions in the respective domains of the MMAT checklists. Therefore, none of the articles were removed from this review due to poor quality. The Cohen’s kappa (agreement) between the two reviewers was 0.77, indicating moderate agreement [ 23 ].

The initial search found 425 studies for review, but after removing duplicates and applying the criteria listed above, we narrowed the pool to 22 articles, all of which are quantitative in their study design. The studies include three prospective cohort studies [ 24 , 25 , 26 ], one community trial [ 27 ], one case-control study [ 28 ], and nine cross-sectional studies [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. After careful discussion, all reviewer panels agreed to add one qualitative study [ 46 ] to help provide reasoning for the quantitative results. The selected qualitative paper was chosen because it discussed almost all domains on the risk and protective factors found in this review.

A summary of all 23 articles is listed in Table  2 . A majority of the studies (13 articles) were from the United States of America (USA) [ 25 , 26 , 27 , 29 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], three studies were from the Asia region [ 32 , 33 , 38 ], four studies were from Europe [ 24 , 28 , 40 , 44 ], and one study was from Latin America [ 35 ], Africa [ 43 ] and Mediterranean [ 45 ]. The number of sample participants varied widely between the studies, ranging from 70 samples (minimum) to 700,178 samples (maximum), while the qualitative paper utilized a total of 100 interviewees. There were a wide range of drugs assessed in the quantitative articles, with marijuana being mentioned in 11 studies, cannabis in five studies, and opioid (six studies). There was also large heterogeneity in terms of the study design, type of drug abused, measurements of outcomes, and analysis techniques used. Therefore, the data were presented descriptively.

After thorough discussion and evaluation, all the findings (both risk and protective factors) from the review were categorized into three main domains: individual factors, family factors, and community factors. The conceptual framework is summarized in Fig.  2 .

Conceptual framework of risk and protective factors related to adolescent drug abuse

DOMAIN: individual factor

Risk factors.

Almost all the articles highlighted significant findings of individual risk factors for adolescent drug abuse. Therefore, our findings for this domain were further broken down into five more sub-domains consisting of personal/individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance history, comorbidity and an individual’s attitude and perception.

Personal/individual traits

Chuang et al. [ 29 ] found that adolescents with high impulsivity traits had a significant positive association with drug addiction. This study also showed that the impulsivity trait alone was an independent risk factor that increased the odds between two to four times for using any drug compared to the non-impulsive group. Another longitudinal study by Guttmannova et al. showed that rebellious traits are positively associated with marijuana drug abuse [ 27 ]. The authors argued that measures of rebelliousness are a good proxy for a youth’s propensity to engage in risky behavior. Nevertheless, Wilson et al. [ 37 ], in a study involving 112 youths undergoing detoxification treatment for opioid abuse, found that a majority of the affected respondents had difficulty in regulating their emotions. The authors found that those with emotional regulation impairment traits became opioid dependent at an earlier age. Apart from that, a case-control study among outpatient youths found that adolescents involved in cannabis abuse had significant alexithymia traits compared to the control population [ 28 ]. Those adolescents scored high in the dimension of Difficulty in Identifying Emotion (DIF), which is one of the key definitions of diagnosing alexithymia. Overall, the adjusted Odds Ratio for DIF in cannabis abuse was 1.11 (95% CI, 1.03–1.20).

Significant negative growth exposure

A history of maltreatment in the past was also shown to have a positive association with adolescent drug abuse. A study found that a history of physical abuse in the past is associated with adolescent drug abuse through a Path Analysis, despite evidence being limited to the female gender [ 25 ]. However, evidence from another study focusing at foster care concluded that any type of maltreatment might result in a prevalence as high as 85.7% for the lifetime use of cannabis and as high as 31.7% for the prevalence of cannabis use within the last 3-months [ 30 ]. The study also found significant latent variables that accounted for drug abuse outcomes, which were chronic physical maltreatment (factor loading of 0.858) and chronic psychological maltreatment (factor loading of 0.825), with an r 2 of 73.6 and 68.1%, respectively. Another study shed light on those living in child welfare service (CWS) [ 35 ]. It was observed through longitudinal measurements that proportions of marijuana usage increased from 9 to 18% after 36 months in CWS. Hence, there is evidence of the possibility of a negative upbringing at such shelters.

Personal psychiatric diagnosis

The robust studies conducted in the USA have deduced that adolescents diagnosed with a conduct problem (CP) have a positive association with marijuana abuse (OR = 1.75 [1.56, 1.96], p  < 0.0001). Furthermore, those with a diagnosis of Major Depressive Disorder (MDD) showed a significant positive association with marijuana abuse.

Previous substance and addiction history

Another study found that exposure to e-cigarettes within the past 30 days is related to an increase in the prevalence of marijuana use and prescription drug use by at least four times in the 8th and 10th grades and by at least three times in the 12th grade [ 34 ]. An association between other behavioral addictions and the development of drug abuse was also studied [ 29 ]. Using a 12-item index to assess potential addictive behaviors [ 39 ], significant associations between drug abuse and the groups with two behavioral addictions (OR = 3.19, 95% CI 1.25,9.77) and three behavioral addictions (OR = 3.46, 95% CI 1.25,9.58) were reported.

Comorbidity

The paper by Dash et al. (2020) highlight adolescent with a disease who needs routine medical pain treatment have higher risk of opioid misuse [ 38 ]. The adolescents who have disorder symptoms may have a risk for opioid misuse despite for the pain intensity.

Individual’s attitudes and perceptions

In a study conducted in three Latin America countries (Argentina, Chile, and Uruguay), it was shown that adolescents with low or no perceived risk of taking marijuana had a higher risk of abuse (OR = 8.22 times, 95% CI 7.56, 10.30) [ 35 ]. This finding is in line with another study that investigated 2002 adolescents and concluded that perceiving the drug as harmless was an independent risk factor that could prospectively predict future marijuana abuse [ 27 ]. Moreover, some youth interviewed perceived that they gained benefits from substance use [ 38 ]. The focus group discussion summarized that the youth felt positive personal motivation and could escape from a negative state by taking drugs. Apart from that, adolescents who had high-perceived availability of drugs in their neighborhoods were more likely to increase their usage of marijuana over time (OR = 11.00, 95% CI 9.11, 13.27) [ 35 ]. A cheap price of the substance and the availability of drug dealers around schools were factors for youth accessibility [ 38 ]. Perceived drug accessibility has also been linked with the authorities’ enforcement programs. The youth perception of a lax community enforcement of laws regarding drug use at all-time points predicted an increase in marijuana use in the subsequent assessment period [ 27 ]. Besides perception, a study examining the attitudes towards synthetic drugs based on 8076 probabilistic samples of Macau students found that the odds of the lifetime use of marijuana was almost three times higher among those with a strong attitude towards the use of synthetic drugs [ 32 ]. In addition, total screen time among the adolescent increase the likelihood of frequent cannabis use. Those who reported daily cannabis use have a mean of 12.56 h of total screen time, compared to a mean of 6.93 h among those who reported no cannabis use. Adolescent with more time on internet use, messaging, playing video games and watching TV/movies were significantly associated with more frequent cannabis use [ 44 ].

Protective factors

Individual traits.

Some individual traits have been determined to protect adolescents from developing drug abuse habits. A study by Marin et al. found that youth with an optimistic trait were less likely to become drug dependent [ 33 ]. In this study involving 1104 Iranian students, it was concluded that a higher optimism score (measured using the Children Attributional Style Questionnaire, CASQ) was a protective factor against illicit drug use (OR = 0.90, 95% CI: 0.85–0.95). Another study found that high levels of mindfulness, measured using the 25-item Child Acceptance and Mindfulness Measure, CAMM, lead to a slower progression toward injectable drug abuse among youth with opioid addiction (1.67 years, p  = .041) [ 37 ]. In addition, the social phobia trait was found to have a negative association with marijuana use (OR = 0.87, 95% CI 0.77–0.97), as suggested [ 31 ].

According to El Kazdouh et al., individuals with a strong belief against substance use and those with a strong desire to maintain their health were more likely to be protected from involvement in drug abuse [ 46 ].

DOMAIN: family factors

The biological factors underlying drug abuse in adolescents have been reported in several studies. Epigenetic studies are considered important, as they can provide a good outline of the potential pre-natal factors that can be targeted at an earlier stage. Expecting mothers who smoke tobacco and alcohol have an indirect link with adolescent substance abuse in later life [ 24 , 39 ]. Moreover, the dynamic relationship between parents and their children may have some profound effects on the child’s growth. Luk et al. examined the mediator effects between parenting style and substance abuse and found the maternal psychological control dimension to be a significant variable [ 26 ]. The mother’s psychological control was two times higher in influencing her children to be involved in substance abuse compared to the other dimension. Conversely, an indirect risk factor towards youth drug abuse was elaborated in a study in which low parental educational level predicted a greater risk of future drug abuse by reducing the youth’s perception of harm [ 27 , 43 ]. Negligence from a parental perspective could also contribute to this problem. According to El Kazdouh et al. [ 46 ], a lack of parental supervision, uncontrolled pocket money spending among children, and the presence of substance-using family members were the most common negligence factors.

While the maternal factors above were shown to be risk factors, the opposite effect was seen when the paternal figure equipped himself with sufficient knowledge. A study found that fathers with good information and awareness were more likely to protect their adolescent children from drug abuse [ 26 ]. El Kazdouh et al. noted that support and advice could be some of the protective factors in this area [ 46 ].

DOMAIN: community factors

• Risk factor

A study in 2017 showed a positive association between adolescent drug abuse and peers who abuse drugs [ 32 , 39 ]. It was estimated that the odds of becoming a lifetime marijuana user was significantly increased by a factor of 2.5 ( p  < 0.001) among peer groups who were taking synthetic drugs. This factor served as peer pressure for youth, who subconsciously had desire to be like the others [ 38 ]. The impact of availability and engagement in structured and unstructured activities also play a role in marijuana use. The findings from Spillane (2000) found that the availability of unstructured activities was associated with increased likelihood of marijuana use [ 42 ].

• Protective factor

Strong religious beliefs integrated into society serve as a crucial protective factor that can prevent adolescents from engaging in drug abuse [ 38 , 45 ]. In addition, the school connectedness and adult support also play a major contribution in the drug use [ 40 ].

The goal of this review was to identify and classify the risks and protective factors that lead adolescents to drug abuse across the three important domains of the individual, family, and community. No findings conflicted with each other, as each of them had their own arguments and justifications. The findings from our review showed that individual factors were the most commonly highlighted. These factors include individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance and addiction history, and an individual’s attitude and perception as risk factors.

Within the individual factor domain, nine articles were found to contribute to the subdomain of personal/ individual traits [ 27 , 28 , 29 , 37 , 38 , 39 , 40 , 43 , 44 ]. Despite the heterogeneity of the study designs and the substances under investigation, all of the papers found statistically significant results for the possible risk factors of adolescent drug abuse. The traits of high impulsivity, rebelliousness, difficulty in regulating emotions, and alexithymia can be considered negative characteristic traits. These adolescents suffer from the inability to self-regulate their emotions, so they tend to externalize their behaviors as a way to avoid or suppress the negative feelings that they are experiencing [ 41 , 47 , 48 ]. On the other hand, engaging in such behaviors could plausibly provide a greater sense of positive emotions and make them feel good [ 49 ]. Apart from that, evidence from a neurophysiological point of view also suggests that the compulsive drive toward drug use is complemented by deficits in impulse control and decision making (impulsive trait) [ 50 ]. A person’s ability in self-control will seriously impaired with continuous drug use and will lead to the hallmark of addiction [ 51 ].

On the other hand, there are articles that reported some individual traits to be protective for adolescents from engaging in drug abuse. Youth with the optimistic trait, a high level of mindfulness, and social phobia were less likely to become drug dependent [ 31 , 33 , 37 ]. All of these articles used different psychometric instruments to classify each individual trait and were mutually exclusive. Therefore, each trait measured the chance of engaging in drug abuse on its own and did not reflect the chance at the end of the spectrum. These findings show that individual traits can be either protective or risk factors for the drugs used among adolescents. Therefore, any adolescent with negative personality traits should be monitored closely by providing health education, motivation, counselling, and emotional support since it can be concluded that negative personality traits are correlated with high risk behaviours such as drug abuse [ 52 ].

Our study also found that a history of maltreatment has a positive association with adolescent drug abuse. Those adolescents with episodes of maltreatment were considered to have negative growth exposure, as their childhoods were negatively affected by traumatic events. Some significant associations were found between maltreatment and adolescent drug abuse, although the former factor was limited to the female gender [ 25 , 30 , 36 ]. One possible reason for the contrasting results between genders is the different sample populations, which only covered child welfare centers [ 36 ] and foster care [ 30 ]. Regardless of the place, maltreatment can happen anywhere depending on the presence of the perpetrators. To date, evidence that concretely links maltreatment and substance abuse remains limited. However, a plausible explanation for this link could be the indirect effects of posttraumatic stress (i.e., a history of maltreatment) leading to substance use [ 53 , 54 ]. These findings highlight the importance of continuous monitoring and follow-ups with adolescents who have a history of maltreatment and who have ever attended a welfare center.

Addiction sometimes leads to another addiction, as described by the findings of several studies [ 29 , 34 ]. An initial study focused on the effects of e-cigarettes in the development of other substance abuse disorders, particularly those related to marijuana, alcohol, and commonly prescribed medications [ 34 ]. The authors found that the use of e-cigarettes can lead to more severe substance addiction [ 55 ], possibly through normalization of the behavior. On the other hand, Chuang et al.’s extensive study in 2017 analyzed the combined effects of either multiple addictions alone or a combination of multiple addictions together with the impulsivity trait [ 29 ]. The outcomes reported were intriguing and provide the opportunity for targeted intervention. The synergistic effects of impulsiveness and three other substance addictions (marijuana, tobacco, and alcohol) substantially increased the likelihood for drug abuse from 3.46 (95%CI 1.25, 9.58) to 10.13 (95% CI 3.95, 25.95). Therefore, proper rehabilitation is an important strategy to ensure that one addiction will not lead to another addiction.

The likelihood for drug abuse increases as the population perceives little or no harmful risks associated with the drugs. On the opposite side of the coin, a greater perceived risk remains a protective factor for marijuana abuse [ 56 ]. However, another study noted that a stronger determinant for adolescent drug abuse was the perceived availability of the drug [ 35 , 57 ]. Looking at the bigger picture, both perceptions corroborate each other and may inform drug use. Another study, on the other hand, reported that there was a decreasing trend of perceived drug risk in conjunction with the increasing usage of drugs [ 58 ]. As more people do drugs, youth may inevitably perceive those drugs as an acceptable norm without any harmful consequences [ 59 ].

In addition, the total spent for screen time also contribute to drug abuse among adolescent [ 43 ]. This scenario has been proven by many researchers on the effect of screen time on the mental health [ 60 ] that leads to the substance use among the adolescent due to the ubiquity of pro-substance use content on the internet. Adolescent with comorbidity who needs medical pain management by opioids also tend to misuse in future. A qualitative exploration on the perspectives among general practitioners concerning the risk of opioid misuse in people with pain, showed pain management by opioids is a default treatment and misuse is not a main problem for the them [ 61 ]. A careful decision on the use of opioids as a pain management should be consider among the adolescents and their understanding is needed.

Within the family factor domain, family structures were found to have both positive and negative associations with drug abuse among adolescents. As described in one study, paternal knowledge was consistently found to be a protective factor against substance abuse [ 26 ]. With sufficient knowledge, the father can serve as the guardian of his family to monitor and protect his children from negative influences [ 62 ]. The work by Luk et al. also reported a positive association of maternal psychological association towards drug abuse (IRR 2.41, p  < 0.05) [ 26 ]. The authors also observed the same effect of paternal psychological control, although it was statistically insignificant. This construct relates to parenting style, and the authors argued that parenting style might have a profound effect on the outcomes under study. While an earlier literature review [ 63 ] also reported such a relationship, a recent study showed a lesser impact [ 64 ] with regards to neglectful parenting styles leading to poorer substance abuse outcomes. Nevertheless, it was highlighted in another study that the adolescents’ perception of a neglectful parenting style increased their odds (OR 2.14, p  = 0.012) of developing alcohol abuse, not the parenting style itself [ 65 ]. Altogether, families play vital roles in adolescents’ risk for engaging in substance abuse [ 66 ]. Therefore, any intervention to impede the initiation of substance use or curb existing substance use among adolescents needs to include parents—especially improving parent–child communication and ensuring that parents monitor their children’s activities.

Finally, the community also contributes to drug abuse among adolescents. As shown by Li et al. [ 32 ] and El Kazdouh et al. [ 46 ], peers exert a certain influence on other teenagers by making them subconsciously want to fit into the group. Peer selection and peer socialization processes might explain why peer pressure serves as a risk factor for drug-abuse among adolescents [ 67 ]. Another study reported that strong religious beliefs integrated into society play a crucial role in preventing adolescents from engaging in drug abuse [ 46 ]. Most religions devalue any actions that can cause harmful health effects, such as substance abuse [ 68 ]. Hence, spiritual beliefs may help protect adolescents. This theme has been well established in many studies [ 60 , 69 , 70 , 71 , 72 ] and, therefore, could be implemented by religious societies as part of interventions to curb the issue of adolescent drug abuse. The connection with school and structured activity did reduce the risk as a study in USA found exposure to media anti-drug messages had an indirect negative effect on substances abuse through school-related activity and social activity [ 73 ]. The school activity should highlight on the importance of developmental perspective when designing and offering school-based prevention programs [75].

Limitations

We adopted a review approach that synthesized existing evidence on the risk and protective factors of adolescents engaging in drug abuse. Although this systematic review builds on the conclusion of a rigorous review of studies in different settings, there are some potential limitations to this work. We may have missed some other important factors, as we only included English articles, and article extraction was only done from the three search engines mentioned. Nonetheless, this review focused on worldwide drug abuse studies, rather than the broader context of substance abuse including alcohol and cigarettes, thereby making this paper more focused.

Conclusions

This review has addressed some recent knowledge related to the individual, familial, and community risk and preventive factors for adolescent drug use. We suggest that more attention should be given to individual factors since most findings were discussed in relation to such factors. With the increasing trend of drug abuse, it will be critical to focus research specifically on this area. Localized studies, especially those related to demographic factors, may be more effective in generating results that are specific to particular areas and thus may be more useful in generating and assessing local control and prevention efforts. Interventions using different theory-based psychotherapies and a recognition of the unique developmental milestones specific to adolescents are among examples that can be used. Relevant holistic approaches should be strengthened not only by relevant government agencies but also by the private sector and non-governmental organizations by promoting protective factors while reducing risk factors in programs involving adolescents from primary school up to adulthood to prevent and control drug abuse. Finally, legal legislation and enforcement against drug abuse should be engaged with regularly as part of our commitment to combat this public health burden.

Data availability and materials

All data generated or analysed during this study are included in this published article.

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Acknowledgements

The authors acknowledge The Ministry of Higher Education Malaysia and The Universiti Kebangsaan Malaysia, (UKM) for funding this study under the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). We also thank the team for their commitment and tireless efforts in ensuring that manuscript was well executed.

Financial support for this study was obtained from the Ministry of Higher Education, Malaysia through the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Nawi, A.M., Ismail, R., Ibrahim, F. et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health 21 , 2088 (2021). https://doi.org/10.1186/s12889-021-11906-2

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The Burden of Drug Abuse in Nigeria: A Scoping Review of Epidemiological Studies and Drug Laws

Abubakar ibrahim jatau.

1 School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia

Abubakar Sha’aban

2 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia

3 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria

Kabiru Abubakar Gulma

4 School of Global Health and Bioethics, Euclid University, The Gambia

Zayyanu Shitu

5 Hospital Services Management Board, Ministry of health, Gusau, Nigeria

Garba Mohammed Khalid

6 Department of Pharmaceutical Sciences, Università Degli Studi di Milano, Milano, Italy

Abubakar Isa

7 Malaria Consortium Nigeria, Dutse, Nigeria

Abubakar S. Wada

8 Department of Pharmacology and Therapeutics, Faculty of Pharmaceutical Sciences, Bayero University Kano, Kano, Nigeria

Mohammed Mustapha

Background: The burden of drug abuse is becoming a public health concern in Nigeria. Preventive measures should include identifying the root causes of the burden for targeted intervention. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. The review also provides appropriate recommendations as interventions for prevention.

Methods: We conducted a systematic search of the literature on PubMed to identify information on drug abuse and drug laws in Nigeria from the inception of the database to March 2020. Additional information was retrieved from Google Scholar, a manual search of included articles, discussion with experts on the subject matter, and gray literature. Study selection was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Information from gray literature was assessed for quality and accuracy using the AACODS checklist (authority, accuracy, coverage, objectively, date, significance).

Results: The systematic search of the literature generated 253 studies. Nine articles were obtained from other sources. After the selection process, 23 eligible studies were included for review. A prevalence of 20–40% and 20.9% of drug abuse was reported among students and youths, respectively. Commonly abused drugs include cannabis, cocaine, amphetamine, heroin, diazepam, codeine, cough syrup and tramadol. Sources where abusers obtained drugs, were pharmacies/patent medicine shops, open drug markets, drug hawkers, fellow drug abusers, friends, and drug pushers. Drug abuse was common among undergraduates and secondary school students, youths, commercial bus drivers, farmers, and sex workers. Reason for use included to increase physical performance, stress and to derive pleasure. Poor socioeconomic factors and low educational background were the common risk factors associated with drug abuse. We identified several drug laws and policies that were established under government agencies such as the National Drug Law Enforcement Agency (NDLEA), National Agency for Foods and Drugs Administration and Control (NAFDAC), Pharmacists Council of Nigeria (PCN) and a Presidential Advisory Committee.

Conclusion: Findings from epidemiological studies on drug abuse in Nigeria has demonstrated that the burden of drug abuse is still high despite the existing drug laws, policies, and strategies for prevention. Measures to reduce the burden should involve the community, government, and religious bodies. Preventive measures should target the youths, the students, identified sources of the drugs, reasons and risk factors associated with drug abuse in Nigeria.

Introduction

Drug abuse is emerging as a global public health issue. The recent world drug report-2019 of the United Nations Office on Drugs and Crime (UNODC) estimated that 271 million (5.5%) of the global population (aged between 15 and 64 years), had used drugs in the previous year [ 1 ]. Also, it has been projected that 35 million individuals will be experiencing drug use disorders [ 1 ]. Further, the Global Burden of disease Study 2017 estimated that, in 2017, there were 585,000 deaths due to drug use, globally [ 1 ]. The burden of drug abuse (usage, abuse, and trafficking) has also been related to the four areas of international concern, viz. organized crime, illicit financial flows, corruption, and terrorism/insurgency [ 2 ]. Therefore, global interventions for preventing drug abuse including its impact on health, governance, and security, requires a widespread understanding of the prevalence, frequently implicated drugs, commonly involved population, sources of the drugs and risk factors associated with the drug abuse.

In Nigeria, the burden of drug abuse is on the rise and becoming a public health concern. Nigeria, which is the most populous country in Africa, has developed a reputation as a center for drug trafficking and usage mostly among the youth population [ 5 , 6 ]. According to the 2018 UNODC report “Drug use in Nigeria”—The first large-scale, nationwide national drug use survey in Nigeria, one in seven persons (aged 15–64 years) had used a drug in the past year [ 3 ]. Also, one in five individuals who had used drug in the past year is suffering from drug-related disorders [ 3 ]. Drug abuse has been a cause of many criminal offences such as theft, burglary, sex work, and shoplifting [ 3 ].

Nigeria is an enormously diverse country with over 400 ethnicities and many religious groups [ 9 ]. Drug abuse is therefore viewed within a broader context in Nigeria, due to its multicultural nature. For instance, most societies do not consider the use of some drugs which do not produce overt behavioral changes as drug abuse. However, despite this multicultural nature of the Nigerian population, there is a consistent outcry from both the public, police, preachers, health professionals, teachers, regulatory agencies and parents on the growing burden of drug abuse (abuse of drugs which affect behavior) in the country. The recent call was that of the President of the Pharmaceutical Society of Nigeria [ 4 ].

Efforts to prevent the growing burden of drug abuse in Nigeria involve the identification of evidence-based information on the extent of the problem, from epidemiological studies. To date, most of the information on drug abuse in Nigeria is reported by the media (print, electronic and online). However, scientific evidence from epidemiological studies has started emerging in recent years. Although there were attempts in the past to summarize such studies in the form of a narrative review, such reviews were limited with lack of systematic search of the literature. Also, such studies were published in 1982 [ 5 ], 1991 [ 6 ], and 1992 [ 7 ]. There is, therefore, a need for recent summarized data on drug abuse in Nigeria. We, therefore, aim to conduct a scoping review of the literature to summarize the findings of epidemiological studies on drug abuse and provisions of drug laws in Nigeria. In this review, we attempt to summarize the results from various studies regarding the prevalence of drug abuse, commonly abused drugs, sources of the drugs, group of people frequently involved, the reason for drug abuse, risk factors, extant policies and laws, and to recommend intervention measures for prevention.

Literature Search

In the literature search, we have not restricted our sources of information to any specific period. A systematic search of the literature regarding drug abuse in Nigeria was conducted using PubMed from the inception of the database to March 13, 2020. A search strategy using the following terms both as medical sub-heading (MeSH) and free text as title and abstract (tiab) was developed. The search terms used included: “abuse drug” [MeSH], “abuse drug” [tiab], “illicit drug use” [tiab], “drug, illicit” [MeSH], “psychoactive drugs” [MeSH], Nigeria [tiab]. Relevant studies were also identified manually from the reference lists of the included articles and discussion with experts on the subject matter. Additional information was also retrieved from Google Scholar using the following search expression “Drug abuse, illicit drug abuse, psychotropic abuse in Nigeria.” Based on previous recommendations, only the first 200 search results from the Google scholar search were considered for inclusion [ 8 ]. The search strategies employed in the systematic search of the literature in PubMed and Google Scholar is provided in Appendix 1 . Due to limited research on drug abuse in Nigeria, gray literature related to drug abuse in Nigeria were identified in Google search, web pages of drug regulatory agencies in Nigeria, and the UNODC. Information from gray literature was evaluated for trustworthiness and relevance based on AACODS (Authority, Accuracy, Coverage, Date, Significance) checklist [ 9 ].

Study Selection

Studies or reports were included in this review based on the following criteria: reporting prevalence/incidence of drug abuse in Nigeria; conducted among different populations in the community, government policies and interventions on drug abuse; and drug laws in Nigeria. Studies or reports were excluded from this review if they focused on alcohol abuse only. Disagreements between authors regarding study selection were resolved through discussion until consensus was reached. Figure 1 demonstrates the study selection process.

PRISMA Flowchart for the study selection process.

Data Extraction

Information extracted from the included studies included: study authors, population/sample size, settings, prevalence, commonly abused drugs, sources, reasons, and factors associated with the drug abuse.

Operational Definition

There was no universal definition of the term “Drug abuse” in the literature. In this review, the definition of drug abuse by Benjamin and Chidi (2014) was adopted and modified [ 10 ]. “the use of a drug that is not generally accepted on medical ground, i.e. continuous or occasional use of drugs that would cause overt behavioral change by the individual either of his own choice or under a feeling of compulsion, to achieve his wellbeing or what he conceives as of his own wellbeing” [ 10 ].

Results and Discussion

The initial search PubMed and Google Scholar generated 53 articles and 200 records, respectively. One study was identified following discussion with an expert, two from a manual search of included studies and six articles from Google search. The screening for duplicates excluded twenty-two articles. One hundred and forty-eight articles were removed after screening for title and abstracts, and 62 studies did not meet the eligibility criteria and were excluded. A total of 30 studies were included in this review; 23 epidemiological studies [ 3 , 11 – 21 , 23 – 32 ], one thesis inclusive [ 22 ], five reports from the websites of drug-related agencies [ 38 , 41 , 43 , 44 ] and UNODC [ 2 ], and two articles from newspapers[ 40 , 45 ]. Figure 1 illustrates the study selection process.

Nine of the included epidemiological studies were conducted among secondary school students [ 12 , 16 , 21 – 24 , 27 , 30 , 31 ], five among drug abusers [ 15 , 18 , 25 , 29 , 32 ], four among undergraduate students [ 17 , 20 , 26 , 28 ], three among members of different populations in the community [ 3 , 11 , 14 ], two among commercial vehicle drivers [ 13 , 19 ]. Table 1 shows the characteristics of the included studies.

Summary of the included epidemiological studies.

FCT, Federal Capital Territory; LSD, Lysergic acid diethylamide; NR, Percentage not reported in the study.

Prevalence of Drug Abuse in Nigeria

Of the 23 epidemiological studies, only seven reported an overall prevalence of drug abuse among the study sample [ 3 , 11 - 13 , 21 , 22 , 27 ]. Given the heterogenic nature of the studies, determination of the pool prevalence of drug abuse in Nigeria may not be possible. Four of the studies were conducted among secondary school students and reported a prevalence between 20 and 40% [ 12 , 21 , 22 , 27 ]. A prevalence of 14.4% was reported among members of the general public (all ages), 20.9% among youths in the community [ 11 ], and 81.1% among commercial bus drivers [ 13 ].

Commonly Abused Drugs in Nigeria

The most frequently implicated drugs, consistently reported by the majority of the studies were; cannabis [ 3 , 12 , 14 , 16 - 19 , 21 , 22 , 24 - 31 ], codeine [ 3 , 12 , 14 , 15 , 17 , 24 , 25 , 28 ], amphetamine/dexamphetamine [ 3 , 14 - 17 , 21 , 22 , 24 , 25 , 27 , 29 , 32 ], heroin [ 3 , 14 , 16 – 18 , 21 , 22 , 26 , 27 ], cocaine [ 12 , 14 , 15 , 17 , 18 , 21 , 22 , 25 ], diazepam [ 26 , 27 , 30 – 32 ], and cough syrup [ 3 , 14 – 16 ], Reactivan (fencamfamine) [ 16 , 31 ], Mandrax [ 27 , 29 – 31 ], and tramadol [ 3 , 11 , 13 ].

Some drugs were frequently reported by studies published in the early 80s [ 29 – 32 ]. Proplus (caffeine 50 mg) was reported by three papers published in 1982 [ 30 – 32 ], and Madrax (Methadone and diphenhydramine) in studies published between 1981 and 2011 [ 27 , 29 – 31 ]. The absence of these drugs in recent studies may be related to the decline in their availability in Nigeria.

Cannabis was the most abused drug reported across the different study populations. The prevalence of cannabis abuse among members of the general public was 10.8% [ 3 ] and 22.7% among adolescents of 25 years and younger [ 14 ]. The frequency of abuse among secondary school students was between 0.6 and 34%, with a pooled prevalence of 12.5% [ 12 , 16 , 21 , 22 , 24 , 31 ]. The abuse of cannabis among undergraduate students was also common, with a prevalence of 8–11% [ 17 , 26 , 28 ].

The frequency of cocaine abuse ranges from 1.6 to 4.8% among secondary school students [ 12 , 16 , 21 , 22 ], 0.6–10% among undergraduate students [ 26 , 28 , 33 ] and 0.1–0.6% among members of the general public [ 3 , 14 ]. The widespread use of cocaine in Nigeria may be related to easy access due to increased trafficking of drugs despite the existing legal control measures [ 22 , 34 ].

Codeine was the third most frequently reported drug of abuse from the included studies. The prevalence of abuse in the general public (all ages) was 2.4% [ 3 ], and 22.7% among adolescent [ 14 ]. A prevalence of 3–8.2% [ 17 , 28 ], and between 5.3 and 28% [ 12 , 24 ] was recorded among undergraduate students and secondary school students respectively. Table 1 indicates the frequently abused drugs. The high rates of drug abuse among the younger persons could reflect the easy accessibility of these drugs, peer group influence and possibly lack of effective counseling programs in secondary schools and universities.

Sources Where Drug Abusers Obtained Drugs

Identifying the sources where drug abusers obtained drugs is essential in preventing drug abuse in Nigeria. Interventions to block the supply of these drugs from identified sources could reduce the increasing prevalence of drug abuse. Only five studies reported the sources of the drugs being abused. The common sources included: pharmacies/patent medicine shops (23–33%) [ 15 , 25 , 31 , 32 ], open markets (17%) [ 31 ], drug hawkers [ 25 , 32 ], hawkers of traditional herbal preparations [ 25 ], fellow drug abusers (8%) [ 15 ], underground agents (57%) [ 31 ], family members (1.6–33%) [ 22 , 27 , 31 ], friends (up to 61%) [ 22 , 27 ], teachers (3%) [ 22 , 27 ], physician (8.3%) [ 22 ], other health practitioners (3.0%) [ 22 ].

Reasons for Drug Abuse in Nigeria

Determination of the reasons why people indulged in drug abuse may guide the development and implementation of targeted interventions for reducing the burden of drug abuse in Nigeria. The eleven studies that reported the reasons for drug abuse gave several reasons. The commonly reported reasons included the following: to increase physical performance [ 11 , 13 , 14 , 17 , 19 , 30 , 32 ], to drive pleasure [ 13 , 14 , 17 , 27 , 30 ], desire to relax/sleep [ 13 , 14 , 17 , 27 , 30 ], experiment/curiosity [ 15 , 19 , 26 , 30 , 31 ], to keep awake [ 19 , 25 , 27 , 30 , 32 ], to relieve stress [ 13 , 14 , 17 ], to relieve anxiety [ 13 , 15 , 27 ], unemployment [ 14 , 17 ], frustration [ 14 , 15 ], and easy access [ 16 , 25 ].

Exterior or curiosity motives, often in the form of extreme explorative curiosity to experience ‘the unknown’ about drugs, motivate individuals into drug use and subsequent drug misuse and abuse. The first experience in drug abuse produces a state of arousal in the form of extreme happiness and pleasure, which in turn motivates users to continue [ 34 ]. With the high poverty rate of about 50% of people living in extreme poverty in Nigeria [ 35 ], and the rising rate of unemployment (23.1%) [ 36 ], indicate how challenging the socioeconomic condition could be for many Nigerians. These conditions could predispose people to engage in drug abuse to work harder to earn a living or to ward off the stress and frustration of daily living in hardship.

Risk Factors Associated With Drug Abuse

Nineteen of the included studies examined factors that could raise people’s likelihood of drug abuse [ 3 , 11 – 23 , 25 , 27 – 32 ]. Among the frequently reported factors included being a male gender [ 3 , 12 , 13 , 15 , 16 , 18 - 20 , 22 , 23 , 25 , 27 , 28 , 32 ], younger age [ 3 , 15 , 17 , 27 , 29 , 32 ], poor economic status [ 13 , 14 , 25 , 28 ], unemployment [ 14 , 18 , 25 ], and parental deprivation (broken home) [ 14 , 15 , 28 , 30 , 31 ], Other factors included having a lower education level [ 13 , 28 , 32 ], and peer-group influence [ 15 , 22 , 23 , 28 , 30 , 31 ].

Younger population aged ≤35 years older was the most common group of people indulged in drug abuse based on the data of the included studies. The prevalence of drug abuse among this population may be the reason why some of the studies were specifically conducted among this group of people in the general population [ 11 , 14 ], undergraduate students [ 17 , 20 , 26 ], and secondary school students [ 12 , 16 , 21 – 24 , 26 , 27 , 30 , 31 ]. Also, studies have shown that over 50% of persons with drug abuse-related psychiatric admission were secondary school students [ 29 , 32 ]. These findings also suggest that the prevalence of drug abuse among secondary school students is high. Young people are the most valuable asset for sustainable social development in any society, but most of this population lacks awareness of substance addiction which would empower them to escape drug abuse. This limitation is demonstrated in a study carried out among secondary school teachers and students in Nigeria [ 37 ]. The study revealed that approximately 60% of students were never exposed to drug abuse education, while 73% of teachers reported that they currently did not teach their students about drug abuse education. This finding could be another reason for the highest prevalence in younger populations, and a crucial gap that could be targeted for interventions.

Determinants of drug abuse also included those related to family background. Individuals from polygamous family backgrounds, dysfunctional families (parental deprivation), being single and having parents or relatives who abuse drugs are more likely than those who are not to abuse drugs [ 14 , 17 , 18 , 28 ]. Since in most cases children from broken families or polygamous families are left alone to feed themselves and their desire to go to school is often not of great concern to family members. Thus, to escape the reality of frustration and family strain, they find themselves entangled in substance abuse habits.

The peer-group influence was a predictor of drug abuse which most studies consistently reported. People with friends who abuse drugs are more likely than those with friends who do not abuse drugs to engage in the act [ 15 , 22 , 23 , 30 , 31 ].

The same author identified religion as a protective determinant of drug abuse in Nigeria in two studies [ 19 , 20 ]. Makanjuola et al. found that undergraduate medical students who are religious are less likely than those who were not to engage in drug abuse [ 20 ]. Further, religious commercial drivers are less probable to engage in drug abuse than those who are not religious [ 19 ]. Commercial drivers in Nigeria constitute an integral part of socioeconomic growth, on which the majority of the public depend for transport. Preventing drug abuse among commercial vehicle operators in Nigeria will, therefore ensure optimum safety for the people.

Psychiatric Admission due to Drug Abuse

Three studies were on psychiatric admission due to drug abuse [ 25 , 29 , 32 ]. The studies were conducted in Kaduna state (northwestern region) in 1986 [ 29 ], Edo state (south southern region) in 1976 [ 32 ], and the other was performed at all psychiatric facilities in Nigeria [ 25 ]. Findings of these studies showed the psychiatric symptoms resulting in admissions included toxic psychosis, anxiety state, schizophrenia, delusion [ 25 , 32 ]. There was no suicide case recorded in all the studies.

Policy and Laws Against Drug Abuse in Nigeria

In Nigeria, the fight against drug abuse is backed by federal laws as far back as 1935. Since then, many laws were enacted, while others were amended leading to the establishment of the National Drug Laws Enforcement Agency (NDLEA) -an agency with the sole responsibility of tackling drug abuse and related offences [ 38 ]. Some of the most important laws against the cultivation, trafficking, and abuse of illicit drugs in Nigeria are as follows [ 38 ]:

• 1 The Dangerous Drugs Ordinance of 1935 enacted by the British Colonial administration.
• 2 The Indian Hemp Decree No. 19 of 1966.
• 3 The Indian Hemp (Amendment) Decree No. 34 of 1979.
• 4 The Indian Hemp (Amendment) Decree, and the Special Tribunal (Miscellaneous Offences) Decree No. 20 of 1984.
• 5 >The Special Tribunal (Miscellaneous Offences) (Amendment) Decree of 1986 and the National Drug Law Enforcement Agency Decree No. 48 of 1989 (as amended by Decree No.33 of 1990, Decree No 15 of 1992 and Decree No. 62 of 1999). These laws were harmonized as an Act of the parliament, CAP N30 Laws of the Federation of Nigeria (LFN) 2004. This Act established the NDLEA.

Government Efforts in Preventing Drug Abuse in Nigeria

The NDLEA has been launching nationwide enforcement activities to seize drugs of abuse and arrest drug abusers in the community; sensitization program, rehabilitation and border patrol to checkmate trafficking of illicit drugs to and from Nigeria [ 38 ]. The 2019 NDLEA report has shown that in the last 10 years of operations, a total of 56, 745, 795, 555 kg of drugs were seized, 85, 058 persons with drug-related offences were arrested and 16, 937 cases were secured and convicted [ 39 ].

Recently, The Federal government of Nigeria, through Pharmacists Council of Nigeria (PCN) -an agency in charge of regulating the practice of pharmacy in Nigeria, banned the operation of open drug markets in Nigeria [ 40 ]. This effort was introduced to sanitize the drug distribution system in the country. The PCN also prohibits the handling of drugs by unlicensed personnel, especially prescription and controlled only drugs [ 41 ].

The National Agency for Foods and Drugs Administration and Control (NAFDAC), an agency of the Federal government of Nigeria, banned the manufacturing, importation and sale (without a valid prescription) of codeine and codeine-containing syrups in Nigeria [ 42 ]. In 2018, the agency shut down some pharmaceutical companies involved in the manufacturing of codeine-containing syrups in the country [ 43 ].

Other strategies by the Federal government include the establishment of the National Drug Control Master Plan (NDCMP) [ 44 ]. The NDCMP is a national blueprint for addressing the complex issues of drug trafficking, production, cultivation, and abuse in Nigeria. In 2018, the Federal government constituted a Presidential Advisory Committee for the Elimination of Drug abuse in Nigeria. The committee was saddled with the responsibility of advising the government on ways to reduce the increasing burden of drug abuse in the country [ 45 ]. However, the literature suggests that the burden of drug abuse may continue to rise in Nigeria due to the involvement of politics in law enforcement and lack of political goodwill [ 46 , 47 ].

Gaps Identified in the Included Literature

• 1 Results from the included studies have shown that, despite the existence of Federal drug laws, and national drug policies and strategies, the burden of drug abuse and proliferation of controlled drugs are still on the increase in the country.
• 2 Most of the epidemiological studies were conducted among secondary school students. Only a few studies were performed among the general population to identify other vulnerable groups of people involved in drug abuse.
• 3 Only three studies were conducted on psychiatric admission related to drug abuse. Of the three studies, the most recent was published in 1986.
• 4 Only a few studies reported sources of drugs, reasons for the abuse and risk factors associated with drug abuse. Identifying this information could guide the implementation of interventions.

Recommendations

Reports from the included studies demonstrate that intervention measures to prevent drug abuse in Nigeria should be all-inclusive. The government, society, religious bodies, Non-Governmental Organisations as well as individuals all have a role to play. The efforts are numerous and not exhaustive. Below are some recommendations that might be applied to address the growing epidemic:

• (1)The government should provide more employment opportunities to the youths and review existing drug laws to include stiffer penalties for offenders [ 38 ]. Allocation of funds to drug-related agencies should be increased to better the fight against the abuse of drugs. Enforcement activities should be more effective through strengthening the activities of taskforce at Federal and State governments levels. Nigerian borders should be well protected with surveillance activities by responsible agencies.
• (2)Applying the conceptual model for understanding adverse drug events in the community [ 48 ]. Intervention measures based on Group-focused Cognitive Behavioral Health Education Program (GCBHEP) should be adopted to improve awareness and behavioral change [ 49 ]. Based on the model, other community-based education awareness in the form of mass campaigns through media houses both print and electronic, adverts, flyers, banners, radio jingles, lectures and other programs in religious places and public functions should be created and sustained [ 48 ].
• (3)Secondary school-based programs aimed at encouraging healthy practices and lifestyle among adolescents would help to prevent substance use. There is also a need for periodic review of the curriculum in schools to introduce topics centered on dangers of drug abuse.
• (4)Parents need to educate their children early enough on the risks associated with drug abuse [ 3 , 15 , 17 , 27 , 29 , 32 ]. They should monitor the children closely and know the kinds of friends they are keeping [ 15 , 22 , 23 , 28 , 30 , 31 ].

Limitations

The present review has the following limitations; first, the systematic search of the literature was limited to two electronic databases. This approach may have excluded some eligible studies in the review. Secondly, we have not assessed the qualities of the included studies in this review. We have attempted to summarize their findings within this limitation and hope that readers, would be aware of such shortcomings, and be cautious in drawing conclusions from them.

Findings from the epidemiological studies, reports and drug laws in Nigeria have shown that the burden of drug abuse is growing despite several drug laws, policies and strategic plans to prevent it. The prevalence is higher among the younger population, males, undergraduate and secondary school students, and commercial vehicle drivers. The most abused drugs included cannabis, amphetamine, codeine, cocaine and heroin. The major sources for the drugs were pharmacies/patent medicine stores, drug hawkers, friends who are abusers and drug pushers. The frequent reasons for indulging into drug abuse were to improve physical performance, to drive pleasure, desire to sleep, to experiment/curiosity motives, and to keep awake. Factors such as poor socioeconomic status, peer-group pressure, family problems and poor academic performance were commonly associated with drug abuse in Nigeria. Drug abuse has been a cause of many debilitating conditions such as schizophrenia and psychosis, leading to psychiatric admissions. Therefore, stringent measures and sustainable interventions are urgently needed to curb the increasing burden of drug abuse in Nigeria.

Author Contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors will like to thank and appreciate the efforts of: Anas Haruna, Auwal Bala, Baraka Ado, Abubakar Bilyaminu, Sa’idu Burji, Dahiru Malami, Abubakar Danbatta, Abdulmunin Shehu, Hafsat Nasidi, Inuwa Bello, Ismaeel Yunusa, Mubarak Hussain, Safiya Abdulkadir, Sagir Mustapha, and Salim Ilyasu of the Young Pharmacists Scholars (YPS) mentoring forum for the guidance, mentoring, encouragement and support in developing this review.

Search strategies used in the systematic search of the literature

Abbreviations

AACODS, authority, accuracy, coverage, date, significance; FCT, federal capital territory; GCBHEP, group-focused cognitive behavioral health education program; FN, laws of the federation of nigeria; LSD, lysergic acid diethylamide; MeSH, medical sub-heading; NAFDAC, national agency for foods and drugs administration and control; NDCMP, national drug control master plan; NDLEA, national drug law enforcement agency; PCN, pharmacists council of Nigeria; PRISMA, preferred reporting items for systematic reviews and meta-analyses; UNODC, nations office on drugs and crime; YPS, young pharmacists scholars.

Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research

• First Online: 26 August 2018

Cite this chapter

• Ken C. Winters 6 ,
• Andria M. Botzet 7 ,
• Randy Stinchfield 8 ,
• Rachel Gonzales-Castaneda 9 ,
• Andrew J. Finch 10 ,
• Timothy F. Piehler 11 ,
• Kadie Ausherbauer 11 ,
• Kristen Chalmers 12 &
• Anna Hemze 12  

Part of the book series: Issues in Children's and Families' Lives ((IICL))

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Significant progress has been made since 1990 in the development and evaluation of treatments for adolescent drug abuse. This body of research reflects a greater focus on varying interventions using different theory-based psychotherapies, as well as a recognition of the unique developmental milestones specific to adolescents. Several modalities and approaches meet standards of evidence-based treatments, and that, in general, they are comparable in terms of outcomes.

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Acknowledgement

This work was supported in part by grants DA015347 (Winters) and DA029785 (Finch) from the National Institute on Drug Abuse.

We gratefully acknowledge the contribution of Tamara Fahnhorst and Rachel Koskey to the prior version of this chapter.

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Winters, K.C. et al. (2018). Adolescent Substance Abuse Treatment: A Review of Evidence-Based Research. In: Leukefeld, C., Gullotta, T. (eds) Adolescent Substance Abuse. Issues in Children's and Families' Lives. Springer, Cham. https://doi.org/10.1007/978-3-319-90611-9_5

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