The prevalence of psychoactive substance use amongst undergraduate students at a medical school in South Africa

Nair, Devina

The prevalence of psychoactive substance use amongst undergraduate students at a medical school in South Africa

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

Background: Substance use and its associated problems are a global public health concern. Factors that can influence trends in substance use include the characteristics of the substance itself as well as those related to the individual and their environment (including availability and implementation of national and local policy and service delivery). Students entering a tertiary education facility show a marked increase in substance use compared to those that live at home or seek employment following graduation from high school. Several risk factors for substance use are specific to this population, including an affiliation with fraternity or sorority life, perception of high academic pressure and peer pressure. Substance use disorders develop over time following repeated episodes of misuse. It may therefore be possible to identify emerging risky substance use and to potentially arrest the development of more problematic substance use and addiction. Aim: To determine the prevalence of substance use in a sample of undergraduate students at a medical school in South Africa. Methods: This was a descriptive cross-sectional study conducted at the University of Cape Town's (UCT) medical campus. The study population included all undergraduate medical students in years one through to six who consented to participate. As this was a descriptive study no set recommendations were given regarding appropriate sample size. Data was collected using an online version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). This tool was developed as a Web App version for this study by the UCT Department of Psychiatry and Mental Health and allowed for completion of an auto-scoring version of the ASSIST. To maintain anonymity the system assigned a random identity token which was not linked to any identifying data. Screening risk scores and brief intervention outcomes, including information for inward referral for assessment and care, were shared with the participant onscreen at the end of the screening process. The anonymized data was analysed using the R statistical software package. Descriptive statistics was used to summarize the data. Results: 444 ASSIST tools were completed with signed consent and therefore appropriate for the data analysis; this equated to a response rate of 32,2%. Across all demographics, 83.1% (369 respondents) reported substance use. Alcohol (88,1%) followed by cannabis (53,8%) and tobacco (43,1%) were the most commonly used substances by our student population. Overall, our study found that the prevalence of substance use at UCT medical school is higher in females, Caucasian individuals and students in the later years of study. The vast majority of the students, 359 out of 369 (97,3%), fall into the low-risk category for substance use. Conclusion: From this study we see that the prevalence of substance use amongst undergraduate medical students at UCT is high (83,1%). However, in this study calculated risk was shown to be low. Whilst risk might be low, we know that substance use disorders develop over time with repeated episodes of misuse. Given the devastating sequelae of substance use disorders, early identification, primary prevention and intervention is needed. Further studies building on this one would be useful particularly in exploring cause and effect of substance use. It would be interesting to see whether, as seen in international literature, difficulty in social integration as well as academic pressure from increased work load could be contributing to the high prevalence of substance use that we have seen in this population. These findings might assist in streamlining and optimising the support services that the university is able to offer this student group.