The drugs phenomenon from the perspective of nursing students: patterns of consumption, attitudes and beliefs

El fenómeno de las drogas en la perspectiva de los estudiantes de enfermería: perfil del consumo, actitudes y creencias

Abstract

Objective:

To describe and analyze patterns of drug use and abuse of first- and fifth-year undergraduate nursing students and to investigate their attitudes and beliefs regarding drugs and users.

Method:

A quantitative, descriptive and cross-sectional study of 160 students from the Federal University of the State of Rio de Janeiro was performed. Participants were interviewed using the instruments: ASSIST and NEADA FACULTY SURVEY. Collected data were analyzed with significance being set for p-values < 0.05.

Results:

Students of the first and the fifth years reported that alcohol had been the most frequently used drug in the previous three months (69.4% and 80.0%, respectively). Students believe they have adequate basic education about drugs however they present a prejudiced view and negative attitudes toward users.

Conclusion:

The pattern of drug use among students and the lack of education about the care of drug users reinforce the need to review and reformulate course contents and practices on the subject.

Keywords:
Substance-Related Disorders; Substance Abuse Detection; Students, Nursing; Health Knowledge, Attitudes, Practice; Alcoholism

Resumen

Objetivo:

Describir y analizar el perfil del uso y abuso de drogas entre estudiantes de enfermería del primer y quinto años de graduación e investigar sus actitudes y creencias en relación con las drogas y los usuarios.

Método:

Estudio cuantitativo, descriptivo y transversal, con 160 estudiantes de la Universidade Federal do Estado do Rio de Janeiro, que respondieron a los instrumentos: ASSIST y NEADA FACULTY SURVEY. Los análisis estadísticos se realizaron con un nivel de significancia de p < 0,05.

Resultados:

Los estudiantes apuntaron el alcohol como la droga más utilizada en los últimos tres meses, del primer y del quinto años, respectivamente (69,4% y 80,0%). Ellos creen tener una educación básica adecuada sobre las drogas, sin embargo, presentan una visión preconcebida y actitudes negativas en relación con los usuarios.

Conclusión:

El patrón de consumo de drogas entre los estudiantes y el despreparo para atender a los usuarios refuerza la necesidad de revisar y reformular contenidos y prácticas sobre la temática.

Palabras claves:
Trastornos Relacionados con Sustancias; Detección de Abuso de Sustancias; Estudiantes de Enfermería; Conocimientos, Actitudes y Práctica en Salud; Alcoholismo

Resumo

Objetivo:

Descrever e analisar o perfil do uso e abuso de drogas entre estudantes de enfermagem do 1º e 5º ano de graduação e investigar suas atitudes e crenças em relação às drogas e aos usuários.

Método:

Estudo quantitativo, descritivo e transversal, com 160 estudantes da Universidade Federal do Estado Rio de Janeiro, que responderam aos instrumentos: ASSIST e NEADA FACULTY SURVEY. As análises estatísticas foram realizadas com nível de significância de 5%.

Resultados:

Os estudantes do 1º e 5º ano apontam o álcool como a droga mais usada nos últimos três meses - 69,4% e 80,0% respectivamente. Os estudantes acreditam ter educação básica adequada sobre drogas, porém, apresentam visão preconceituosa e atitudes negativas em relação aos usuários.

Conclusão:

O padrão de consumo de drogas entre os estudantes e o despreparo para atender usuários reforçam a necessidade de revisar e reformular conteúdos e práticas sobre a temática.

Palavras-chave:
Transtornos Relacionados ao Uso de Substâncias; Detecção do Abuso de Substâncias; Estudantes de Enfermagem; Conhecimentos, Atitudes e Práticas em Saúde; Alcoolismo

INTRODUCTION

Drug use affects societies worldwide, posing a major threat to health, well-being and social development.¹ It is a public health issue that is challenging to solve considering the complexity, severity and diversity of problems arising from drug use and a health system with unequal delivery of services. Thus, there are difficulties to meet the needs of this group fully.² The drug problem has intensified in all social classes,³ establishing a challenge, especially with regard to the formulation and proposal of public policies and coping strategies to deal with this phenomenon.

According to the United Nations World Drug Report,⁴ an estimated 246 million people aged 15-64 years used some illicit drug at least once in 2013 and approximately 27 million people are users of problematic drugs. Among young people, the chances of experiencing this type of problem have increased, as we have seen increasingly early exposure to illicit substances.⁵ Drug abuse, which means harmful or risky use but without loss of control, can involve social, psychological, economic and political harm, reflecting negatively on family and social life.⁶ In this text, the term 'dependency' is used with the sense of harmful use with loss of control.

The I National Survey on the use of Alcohol, Tobacco and Other Drugs⁷ carried out in 2010 with 18 thousand university students, reported that 86.2% had already used alcoholic beverages while 46.7% of them reported having had smoked. As for illicit drugs, marijuana is the most consumed with 48.7% saying they had used it in their lives. Furthermore, 58.0% of the students have the profile of multiple drug use⁷ with alcohol present in most combinations.⁸ The frequency of drug use is most common among Brazilian students aged between 18 and 24 years; this rate is twice as high as drug users in the total Brazilian population aged 12-65 years.⁹

This behavior demystifies the assumption that knowledge about drugs acquired during courses is enough to curb consumption. Thus, an integrated understanding of the phenomenon is required, identifying risk and protection factors, considering the individual and characteristics inherent to the academic experience,⁹ in order to expand prevention and promote health educational, and treatment and rehabilitation measures.¹

Studies show that entering university is a facilitating event to access drugs.³ The new experiences that arise in social gatherings and the length of stay away from the family make the young person more vulnerable.^6,10 Added to these factors are the conflicts related to transition to adulthood including psychological factors, family relationships,¹ peer pressure, religion,³ and economic conditions.

However, despite the conditions that contribute to the use of drugs involved in this phase of life, nursing is a science that focuses on human care, promotion of health and disease prevention,¹¹ making it essential to identify elements that harm the health of the population. Nurses' beliefs and attitudes towards any type of drug use can arise in different ways from the time they enter the course and with their learning during graduation; these attitudes can undergo major changes to maintain a life style that is consistent with what they teach.¹² However, studies point to the limited time in nursing courses that is devoted to drug education and the inadequate information and specific training offered¹ that will interfere in the quality of care provided to drug users. Considering that a professional's attitudes are influenced, among other factors, by knowledge about a specific subject,¹³ insufficient information about these substances results in professionals tending to adopt more negative attitudes, making it difficult for them to approach dependents, identify problems associated with substance use and consequently to provide effective interventions.

Knowing the beliefs and attitudes of students allows us to have information about how they interpret their experiences with drugs and with users. As during graduation students are in a process of building their professional identity, this information is essential in the development of strategies for their formation. With this information, professors have the possibility to evaluate students' beliefs during discussions and shared reflections and offer technical-scientific content to care for drug users with a positive attitude, thereby offering effective assistance, free of uncertainties, dissatisfaction and fear,¹⁴ guaranteeing nursing actions that fit in with current public policies, especially in terms of humanitarian actions and respecting citizenship.

In addition, we did not find studies addressing both the pattern of drug use among students and their beliefs and attitudes regarding this practice in the journals of the Virtual Health Library and PubMed electronic databases. Thus, a literature review does not answer questions addressed in this study, namely, "What is the pattern of drug use among nursing students?", "What are the beliefs and attitudes of these students about users and drugs?" and "Is it possible to identify any association between the pattern of use and beliefs and attitudes?".

As university students consume drugs more frequently than non-university youths,⁹ and that this habit increases the risk of harm to health⁶ and can negatively affect learning and memory¹⁵ in particular during academic training,¹⁰ it is important to know the pattern of drug use among nursing students. This is particularly relevant as this course involves health promotion and disease prevention, with these future professionals being involved in individual and family counseling and community care.¹⁶ Information on the pattern of drug use can contribute to the development of measures to avoid abuse and the aggravation of problems, and to contribute to the elaboration of public policies focused on this segment with particular characteristics. This study, by identifying the students' beliefs and attitudes towards the use of psychoactive substances can contribute to the reformulation of the teaching process, restructuring the content offered in courses, and arouse an unprejudiced view in students of the phenomenon of drugs and consequently improve interventions provided to users.

The objectives of this study were to describe and analyze the profile of use and abuse of alcohol and other drugs among first- and final-year undergraduate nursing students and to investigate their attitudes and beliefs regarding drugs and users.

METHOD

A quantitative, descriptive cross-sectional study was developed at the Alfredo Pinto Nursing School (EEAP), Federal University of the State of Rio de Janeiro (UNIRIO). The study population consisted of over 18-year-old students enrolled in the first and last years of the nursing course, who volunteered to participate in the study. The objectives of the study were presented to the students in the classroom and those who expressed their desire to participate in the study signed informed consent forms. Subsequently, trained interviewers administered questionnaires in a private room to respect the confidentiality of the information given. The time required to complete the questionnaires was approximately 20 minutes. A code was used in the database of the study, thereby ensuring the anonymity of the participants.

The research project was submitted to the Research Ethics Committee of the Federal University of the State of Rio de Janeiro (UNIRIO) for analysis and approval (# 992.346, date 04/15/2015, and approved under the CAEE: # 42629915.2. 0000.5285).

Data collection took place between September 2015 and September 2016 with a final sample of 160 participants interviewed using the Alcohol, Smoking and Substance Involvement Screening Test - ASSIST. This structured multidimensional interview is quick to apply and easy to interpret. It investigates the frequency of the use of substances (alcohol, tobacco and other drugs) during the life of the interviewee and over the three months prior to the application of the questionnaire. The questionnaire can be administered by health professionals of different specialties to track the current risk of the individual to abuse and addiction.

The NEADA FACULTY Y SURVEY of the Nursing Education in Alcohol and Drugs Project (NEADA), Connecticut, USA, was also used for data collection. This instrument consists of a self-administered scale translated by a Brazilian and a British person and later submitted to 'back translation' to check the accuracy of the translation. This questionnaire is structured with sociodemographic questions to collect data on housing, date of birth, gender, occupation, ethnicity and religion. In addition, it includes questions addressing theoretical knowledge about drugs, both national and international, acquired during graduation and questions about nursing students' beliefs regarding substance use and their attitudes towards patient care.

A database was created in Microsoft Office Excel 2007 and data were analyzed by descriptive statistics using the statistical software SPSS 21 (Statistical Package for the Social Sciences).

Fisher's exact test, used as an alternative to the chi-square test when the sample is small or 80% of the expected values are less than 5, was applied. With Fischer's exact test, we aimed to verify any correlation of dependence between the frequencies of responses to the NEADA FACULTY Y SURVEY of students enrolled in the first and fifth years who declared that they had used psychoactive substances within the previous three months. Differences with p-value < 0.05 were considered statistically significant.

RESULTS

The sample of university students was composed of 105 (65.6%) first-year undergraduate students and 55 (34.4%) fifth-year undergraduate students. The profiles of students in the first and final years were predominantly aged between 18 and 20 years old (64.8%), female (82.9% and 87.3%, respectively), residents in the state capital (80.0% and 90.1%), Caucasian (38.1% and 63.6%), living with their parents (47.6% and 47.7%), and Catholics (32.4% and 52.7%) of Catholic parents (41.0% and 58.2%).

Of the total sample, 88.5% and 69.1%, respectively of the first- and fifth-year students had never participated in academic events about the phenomenon of drugs.

The data indicate that alcohol is the most used licit drug during the lives of both first and fifth year students (81.0% and 81.8%, respectively). This is followed by tobacco (23.8%), marijuana (19.0%) and hypnotics (9.5%) for first-year and tobacco and marijuana (both 25.5%) and hypnotics (10.9%) for fifth-year students. Considering only those students who reported having used each drug at least once in their lifetime, their recent use (within the previous three months) of the reported substance was confirmed. The first- and final-year students reported using respectively alcohol (69.4% e 80.0%), tobacco (52.0% and 28.6%), marijuana (50.0% and 14.3%) and hypnotics (40.0% and 50.0%). (See Table 1).

Table 1
Use of psychoactive substances during life and in the previous three months of first- and fifth-year nursing students at the Federal University of the State of Rio de Janeiro, Brazil (n = 160).

Drugs	1st year (n = 105)				5th year (n = 55)
	Use during life		Use in last three months		Use during life		Use in last three months
	n	%	n	%	n	%	n	%
Do not use drugs	20	19.0	-	-	10	18.2	-	-
Alcohol	85	81.0	59	69.4	45	81.8	36	80.0
Tabaco	25	23.8	13	52.0	14	25.5	4	28.6
Cannabis	20	19.0	10	50.0	14	25.5	2	14.3
Hypnotics	10	9.5	4	40.0	6	10.9	3	50.0
Other substances	8	7.6	2	25.0	7	12.7	1	14.3

A large proportion of students in both years stated that their basic education on alcoholism (Statement 1 (S1); 86% for first and fifth year) and drug abuse (S2; 80% and 67%respectively) was adequate and that nurses should recommend consumption limits (S3; 88% and 94%). About half of both groups (56%for first year and 50% for fifth year) disagreed with the statement that a person who becomes 'drug free' will never become a social user (S4) and the two groups of students did not differ on dependence-controlled use (S6; 59% and 44%). First- and final-year students mostly agreed that nurses have the right to ask about a patient's alcohol consumption (S10; 80% and 86%), even though a proportion of about 40% first-year and a third of fifth-year students think that questions about alcohol and drug use may bother patients (S7). The two groups of students differed in the belief that the patient might be irritated when asked about their alcohol and drug use (S8) as 57% of first-year students believe in this possibility against only 30% of students in the fifth year. (See Table 2).

Table 2
Attitudes and beliefs of first- and fifth-year nursing students regarding the use of and user of psychoactive substances - Rio de Janeiro, Brazil (^*n = 96).

Statement	Year	Disagree		Indifferent		Agree		p-value
		n	%	n	%	N	%
1. My basic education on alcoholism is adequate	1st	8	13.3	0.	0.0	52	86.7	0.1844
	5th	3	8.3	2	5.6	31	86.1
2. My basic drug abuse education is adequate	1st	6	10.0	6	10.0	48	80.0	0.2375
	5th	8	22.2	4	11.1	24	66.7
3. Nurses should know how to recommend limits, that is, encourage the reduction of consumption to patients who drink heavily and frequently, but are not dependent	1st	5	8.3	2	3.3	53	88.3	0.7341
	5th	1	2.8	1	2.8	34	94.4
4. A person who becomes "drug-free" through treatment will never become a social user	1st	34	56.7	10	16.7	16	26.7	0.4534
	5th	18	50.0	4	11.1	14	38.9
5. People with genetic basis have greater influence to become dependent on alcohol	1st	20	33.3	17	28.3	23	38.3	0.0425
	5th	5	13.9	8	22.2	23	63.9
6. Many alcoholics can learn to reduce their use and keep their drinking under control again**	1st	18	30.5	6	10.2	35	59.3	0.3414
	5th	16	44.4	4	11.1	16	44.4
7. I think that by asking about their use of alcohol and drugs, I will make the patient feel uncomfortable and distressed	1st	22	36.7	12	20.0	26	43.3	0.3933
	5th	18	50.0	7	19.4	11	30.6
8. Patients become irritated when nurses ask about personal issues like alcohol and drug use	1st	11	18.3	15	25.0	34	56.7	0.0193
	5th	15	41.7	10	27.8	11	30.6
9. Patients are not likely to tell the truth about their use of alcohol and drugs when interviewed by a nurse	1st	14	23.3	7	11.7	39	65.0	0.0190
	5th	17	47.2	6	16.7	13	36.1
10. Nurses have the right to ask patients about their drinking when they suspect they have a drinking problem	1st	4	6.7	8	13.3	48	80.0	0.5117
	5th	3	8.3	2	5.6	31	86.1
11. Most people addicted to alcohol and drugs are unpleasant to care for as patients	1st	24	40.0	23	38.3	13	21.7	0.0223
	5th	24	66.7	10	27.8	2	5.6
12. Alcohol and drug users can only be treated by specialists in this area	1st	25	41.7	15	25.0	20	33.3	0.0001
	5th	31	86.1	2	5.6	3	8.3

• ^*
  n = 96 represents students who reported drug use within the previous 3 months;
• ^**
  For statement 6, the n = 59 as one participant did not respond this question in the NEADA Faculty Y Survey.

The beliefs of the first- and final-year students also differed regarding heritability. While 64% of fifth-year students recognize genetic vulnerability, only about 38% of the first year recognize this possibility (S5). They also disagreed on trusting patients' answers: 65% of first-year students said that patients were not likely to tell the truth about their use of alcohol and drugs, but only 36% of those in the fifth year agreed with this statement (S9). A much higher proportion of fifth-Year students (67%) disagreed with the statement that most alcohol and drug addicts are unpleasant to care for, compared to only 40% of the first Year (S11). The two groups of students differed widely in their belief in the need for specialization. Only 8% of the final year agreed that only specialists should care for people with drug problems versus one-third of the first-year students (S12). (See Table 2).

In order to study the distribution of drug use by sample, three categories were crated: "students who had not used drugs in the previous three months", "students who had used only licit drugs in the previous three months" and "students who had used licit and illicit drugs in the previous three months". Fischer's exact test was used to verify the dependence correlation between these categories and the beliefs and attitudes identified by the NEADA scale; no dependence was observed between the type of drug consumed in the previous three months and the beliefs and attitudes of the students.

DISCUSSION

The predominantly female sample of 82.9% and 87.3% in the first and last years, respectively, is characteristic of nursing courses.¹⁵

The data obtained show that alcohol, tobacco, marijuana and hypnotics are the substances most used by first- and fifth-year students with alcohol use being reported by all students who used any type of drug during their lives (81.0% and 81.8%). The high prevalence (85.0%) of alcohol use among nursing students was also observed by Antoniassi Junior et al.⁶ In the present study, the majority of both groups had used alcohol in the previous three months (69.4% in the first year and 80.0% in the final year). Other drugs, either during life or in the previous three months, were used only by those who had already consumed alcohol, thus these individuals used two or more drugs, as reported by the study of Vázquez et al.¹⁷

The data on alcohol consumption draws attention to the risks as a greater quantity and higher frequency of use may interfere in the student's learning and memory, in particular related to academic performance, and may affect the students' future professional practice. It is important for students to receive information about the consequences of alcohol abuse in order to promote a change in their habitual use in society.

Tobacco was the second most commonly reported drug among first-year students (23.8% for lifetime use). In the case of fifth-year students, tobacco and marijuana had the same percentage for lifetime use (25.5%), placing marijuana as the most used illicit drug and confirming the profile found in the I National Survey on the Use of Alcohol, Tobacco and Other Drugs among University Students of the 27 Brazilian State Capitals.⁷ The high prevalence of use and the risk of problems associated with alcohol and tobacco consumption may be related to their legal status with much marketing and availability.⁵

Of the students who reported using hypnotics during their lives, their use in the previous three months was common both among students in the first (40%) and in the fifth (50%) years. According to Marchi et al.,¹⁸ the consumption of these substances is associated with anxiogenic factors experienced by nursing students during graduation and can impair academic performance.¹⁰

The Brazilian National System of Public Policies on Drugs (Sisnad)¹⁹ established by Law 11.343, of August 23, 2006, prescribes, among other measures, the prevention of drug abuse. However, some authors point out the need to develop prevention activities with differentiated strategies for university students, who have a specific profile⁹ with this consideration being fundamental for the effectiveness of proposals to reduce risk and damage caused by the use of drugs.

As a positive point, considering the total sample, most of the students believe they have an adequate basic education about drugs and recognize the nurse's responsibility to counsel alcohol users, encouraging them to consider changes in consumption. However, this belief of the students portrays an incoherence when we verify their use of multiple drugs, indicating a possible failure in the quality of information they have about drugs. This may also indicate that despite having this information, the students continue with this risky behavior. Another possibility is that this practice may be related to a students' evaluation of the use of alcohol based on beliefs constructed before graduation under the influence of strong acceptance of alcohol in our society. This suggests that reflective practices should be incorporated into academic activities, with the objective of provoking critical analysis and possible changes in habits and behaviors. This discrepancy also points to the need for care of the mental health of students, since the reasons for drug use may be supported, in part, by emotional and behavioral problems. Attention to the psychological dimension of undergraduates, for example, may reinforce measures to address issues related to drug use.

The National Curricular Guidelines for Nursing Undergraduate Courses¹¹ recognize the social responsibility of this professional. However, to develop this commitment, it is necessary to go beyond the biological model in teaching about drug abuse,¹⁶ where the practical angle is addressed little.¹⁴ It is known that knowledge about the subject is indispensable to assist and guide this population in order to promote change in behavior regarding substance use. Furthermore, there is a need to develop skills and abilities, which allow nurses to act ethically and with a scientific basis, ensuring quality and integral care.

Contrary to the good evaluation of the training itself, first-year students believe in the users' ability to control the use of alcohol and other drugs, although they do not have scientific knowledge on the subject yet. However, the students in the final year presented divided opinions regarding control, which denotes an ineffective approach to the subject during graduation. Lack of knowledge may lead to the future professional making improper interventions¹³ and even negatively influencing the use of substances by students, who arrive at the university with a formed idea about the use of drugs and make judgments on the use of substances based on their beliefs. According to the results, alcohol was the drug most used by students without any reduction in consumption by the fifth year of graduation. Possibly the high acceptance of this substance by the group is supported by their beliefs about this drug, evidencing a probable need to review the contents covered during the course as this judgment can be modified with more scientific evidence.

Although it is evident to both groups that it is the responsibility of the nursing professional to investigate the consumption and know how to counsel these individuals, this study identified a contradictory attitude to this statement among the students of the first year, where less than half disagreed when asked about it being unpleasant to care for drug users. This feeling encompasses our value system with a negative attitude toward users. In fifth-year students, there is a positive change in their beliefs and attitudes regarding the view they present about caring for users and the recognition that it is the responsibility of the nurses to care for these people, even if they are not specialists.

Regarding students' attitudes toward the questioning of users by nurses, first-year students believe that questions may make the user distressed, annoyed, and irritated, and likely to lie about drug use. This moralistic interpretation and the negative attitude can impair the communications necessary to identify and counsel about drug-related problems.²⁰ This obstacle may hinder the approach to and guidance of these people, thus suggesting a need to increase attention to the course contents, since the lack of preparation to take care of users is related to insufficient knowledge about drugs. It is known that in order to increase adherence to treatment, it is necessary to create a link between the user and professionals through dialogue and acceptance.¹⁶ Regarding the final year students, although the majority disagree that questions may make the user distressed, annoyed or irritated, this percentage corresponds to half of the sample, revealing that these students present difficulties in communicating with the drug user as was also reported by Santos et al.²⁰ As a consequence, both national and international researchers^16,20 report that these students are inclined to offer assistance based on their beliefs, tending to use their judgment of values with a prejudiced attitude interfering negatively in the exercise of their function. To improve teaching, it is necessary to expand drug content in the training of nursing professionals who deal with drug users at the different levels of health care.²¹

As for the use of drugs among university students, it is necessary to intervene early in order to promote changes in their beliefs, since the substances are used, among other reasons, due to family and economic problems, for fun, to reduce anxiety and to facilitate socialization.⁵

This study can contribute to a review and reformulation of curriculum content and practices on care of people with problems related to psychoactive substances to be worked out during graduation. This is essential for the better training of nurses who are qualified to work in this area of health care.

CONCLUSION

Knowing the beliefs and attitudes of nursing students regarding drug users as well as the pattern of drug use among them is important, as nurses are responsible for prevention of disease, and for the promotion of health and rehabilitation. In order to perform this function, it is necessary to acquire technical-scientific knowledge that results in assistance that offers comprehensive care in respect to the health of the population.

We found that although nursing students believe they have adequate basic knowledge about drugs, alcohol use was reported by all students who said they had consumed at least one type of drug and all users of other types of drugs, also used alcohol. Although consumption was common in both groups of students, less than half of the students in the final year believe in the possibility of users controlling their ingestion of alcohol. This highlights a deficiency in the content of the course, implying a lack of knowledge about the ways to reduce one's own consumption and the user's consumption, and also the ineffective assistance offered, which is limited to common sense.

On the other hand, the data indicate that students of the fifth year have a less prejudiced view about caring for these individuals and, more often than the first year students, have an understanding that it is the nurse's responsibility to care for drug users. Contradictions are more apparent among first-year students, most of whom acknowledge that nurses should investigate drug use and know how to counsel, but are ambiguous when they state that the user may become irritated, uncomfortable, and distressed, and omit information about use when they are asked questions essential to a good understanding of the consumption pattern and subsequent intervention. These beliefs can be modified during graduation with well-developed theoretical content conferring quality to the professional's future competence and with the student's contact with drug users. Contact can be promoted during training, where the student will have the chance to apply theoretical content, developing practical skills during interventions and consequently causing changes in their attitudes.

The type of study participant is a limitation in this study, as only nursing students were included with the investigation of students on other courses being of equal importance. The data were collected at the university itself, which can cause embarrassment and fear regarding the use of drugs. Additionally, the questionnaires applied are based on self-reports and no tests were performed to confirm the use or non-use of a particular drug; this would require student acceptance and increase test-related expenses.

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• ¹
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Publication Dates

• Publication in this collection
  2018

History

• Received
  10 July 2017
• Accepted
  09 Dec 2017