Journal of Addiction Research & Therapy
Open Access

Chemical dependency is a grave and increasing public health problem of the world order. Because it is multifactorial, high complexity and magnitude can have serious physical, psychological, emotional, economic, labour and social consequences, significantly affecting the quality of life of users and the population in general. Specifically, in relation to the consequences of the use of psychoactive substances on the health of user, it is verified the development of hepatic, respiratory, cardiac, gastrointestinal diseases, depressive effects in the Central Nervous System (CNS), insomnia, attention and concentration deficit, mental and behaviors disorders such as depression, anxiety, among others, in addition to infectious diseases due to the adoption of risk behaviors, such as: diversity of sexual partners, non-use of condoms in relationships, as well as sharing of syringes and needles [1,2].

In terms of the increasing problem of the abusive and uncontrolled use of psychoactive substances by the general population has aroused the interest of many researchers, not only in Brazil [3-7], but also the international ones [8-10].

The VI National Survey on the use of psychotropic drugs among elementary and middle school students of public and private educational networks in the 27 Brazilian capitals, developed by the Brazilian Center for Information on Psychotropic Drugs (Centro Brasileiro de Informações sobre Drogas Psicotrópicas-CEBRID), in partnership with the National Policy Department on Drugs (Secretaria Nacional de Políticas sobre Drogas-SENAD) in 2010, conducted with students between 10 and 19 years of age, pointed out that 25.5% of students have already used illicit psychoactive substances in their lives. Of these, 10.6% of students reported use in the last year and 5.5% in the last month. Regarding the use of licit psychoactive substances, such as alcohol and tobacco, 42.4% reported alcohol use in the year and 9.6% referred to tobacco use [11]. Among the most consumed illicit substances in the year, are according to the order of consumption, inhalants, followed by marijuana, anxiolytics, cocaine and amphetamines.

The period of entry and stay in the university is characterized by a moment where the student is faced with new social pressures, self-demanding, academic commitments. Many times, the young person presents weaknesses related to the adaptation to new habits of life, associated with the behavioral modifications and acquisition of new social and occupational roles, being able to develop stress and dissatisfaction in their life projects [12]. In this period of vulnerability, the university student, faced with the inability and/or difficulty in dealing with the challenges of academic life and increasing the availability and access to psychoactive substances, can opt for consumption, initially in a recreational way, being able to reach abusive use and dependency. An epidemiological research on the use of psychoactive substances among university students enrolled in the first and fourth year of six courses in the area of humanities and three courses in the health area of a public university located in the interior of the state of São Paulo, pointed out that 183 (68%) of the participating students had already used some psychoactive substance in their lives, since 79% of the sample still make use of some type of substance. Regarding the beginning of the use, 82% of the participants used the substance for the first time before entering the university and 18%, made use after the entrance, being the initiation, on average, to 13,9 years of age. The most cited psychoactive substances were in order of frequency: alcohol, tobacco and marijuana [4].

The abusive consumption of psychoactive substances in the academic life of university students, especially in the area of health is a concerning fact and needs specific attention, because in addition to the physical, psychic, emotional and academic damages caused to them, abusive and uncontrolled use of one or more psychoactive substances may negatively affect their future professional performance. It is important to emphasize that their professional training is related to the care, dissemination of information regarding the abusive effects of psychoactive substances and in the future, these students should serve as an example of ethical conduct and lifestyle for their patients [13,14].

From the above, the investigation on the use of psychoactive substances by university students in the area of health who perform supervised internship activities is of extreme importance to trace the usage profile of alcohol and even to create preventive actions to abuse of this substance among this population.

To identify and classify the usage pattern of psychoactive substances in a sample of graduating students from the area of health.

Ethical aspect

Descriptive, quantitative and cross-sectional research. Project approved by the Ethics and Research Committee under approval number 1.591.840. The volunteer students were properly supervised by researchers about the research, their purposes and their participation, after agreement, they signed the Informed Consent Term (ICF).

Participants

A total of 61 students from a public university in the interior of the state of São Paulo, Brazil, participated in this research. All enrolled in the last period of three courses in the area of health (Physical Therapy, Speech Language Pathology and Audiology and Occupational Therapy) and who performed supervised internship, as a mandatory criterion for completing the course as provided for in the Pedagogical Political Project of the courses.

As inclusion criteria for participation in the research, the student should agree to voluntarily participate in the research, to be performing supervised internship activities, to have no mental disorder diagnosed by a physician and to have approximately 30 min to respond to the instruments. As exclusion criteria is important to have a diagnosis of mental disorder and not to be performing all the internships.

Location of the research

Research carried out on the dependencies of a public university in the interior of São Paulo, Brazil, where courses are given in the area of humanities and health. The courses in the health area were: Physical Therapy, Speech Language Pathology and Audiology and Occupational Therapy.

Procedures for data collection

It was performed the contact with the university, which reported that during the period in which the research was carried out, there was a total of 87 students enrolled in the last period of the health courses and, therefore, they performed supervised internship as a compulsory criterion for completion of the course, as provided for in the Pedagogical Political Project of the courses. Of the students enrolled: 34 were students from the Physical Therapy course, 31 from Speech Language Pathology and Audiology and 22 from Occupational Therapy. The invitation to participate of the research was carried out to 73 students through a direct approach. Of these, 61 met the inclusion criteria and agreed to participate voluntarily. After they accepted, the students were pre-scheduled and the application was carried out collectively in a classroom with groups of eight to 12 students. The meetings took place between the third and fifth month of the 2017 school year. Six meetings were necessary to reach the total sample. The duration of the meetings was approximately 20 min. The application was based on the presence of the researcher so that he could answer possible doubts of the volunteer during the filling of the questionnaires.

Instruments of data collection

Two instruments were used: A questionnaire on socio-demographic characteristics, specifically designed for this study and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to evaluate the use of psychoactive substances [15]. The questionnaire was consisted of 38 questions regarding the characterization of the participant profile: name, age, sex, marital status, income, course, occupation, etc. Before the application and to verify possible inconsistencies or difficulties of interpretation of the content of the questionnaire, the same questionnaire was applied in three students and later adjustments were made to the final version, which was applied.

The ASSIST is a questionnaire consisting of eight questions related to the use of nine types of psychoactive substances. The test investigates about the frequency of use in life and the last three months, as well as problems related to use, concern of people close to person due to the use, difficulties and deficits in performing activities, failures in the experiences to stop or decrease use, compulsion and use of injectable substances. This instrument had its version adapted to the Portuguese language from its validation in a Brazilian sample of 147 individuals, aged between 18 and 45 years, of both sexes, from several specialized and non-specialized in dependence health services [15]. The choice of the ASSIST application was due to the instrument being easy and quick to apply, as well as addressing the use of various types of substances. In addition, it was taken into account its accessibility for using by several health professionals.

To analyse the responses, the analysis protocol proposed by the instrument was used, which states that for each response there is a score from 0 to 4 and the sum of these can reach a total of 20 points. The results are classified into three ranges, since the score ranging from 0 to 3 is indicative of occasional use, 4 to 15 abuse and 16 to 20 dependence [15]. For the statistical analysis of the results we used basic calculation of descriptive statistics by means of the Statistical Package for the Social Sciences (SPSS) software.

A total of 61 students in the area of health participated in the study. Of these 22 from the Physical Therapy course, 21 from Speech Language Pathology and Audiology and 18 from Occupational Therapy. The mean age was 22.2 years (SD ± 2.25), there was predominance of female, single and with religion. Table 1 presents the characterization of the sociodemographic profile of the participants.

Table 1: Characterization of the sociodemographic profile of the participants.

In relation to the use of psychoactive substances, 54 (88.5%) reported have already used some type of psychoactive substance in their lives and 7 (11.5%) never used. Of the 54 students who reported use, 52 (96.3%) reported alcohol as the substance with the greatest use, followed by 20 (37.0%) tobacco uses and 15 (27.8%) marijuana. It should be emphasized that no student mentioned cocaine use and derivatives. In relation to the use in the last three months, the most commonly used substance was alcohol, mentioned by 52 (96.3%) students, followed by marijuana by 13 (24.1) and tobacco by 9 (16.7%) as can be seen in Table 2.

Table 2: Use of psychoactive substances in life and in the last three months.

There was no noticed increase in use in the last three months, but similar use behavior was maintained in life. There was a reduction in the number of students who reported having consumed tobacco, marijuana and amphetamine in the past three months. However, all students continue their behavior of ingesting alcohol in the last three months. It is important to highlight that this study does not aim to compare the variables "use in life" and "use in the last three months", however the results of these variables provide to identify the continuity, increase or reduction of the use behavior.

Among the substances that the students mentioned have already consumed, the frequency of use of each one in the last three months is presented in Table 3.

Table 3: Frequency of use of each substance in the last three months.

The analysis of the scores by substance allowed classifying the usage pattern of in the last three months in occasional use, abuse and dependence. It was verified that among the 52 alcohol users, 30 (57.7%) were abusive and 4 (7.7%) presented dependence. Of the 13 marijuana users, 6 (46.2%) were abusive. In relation to the nine tobacco users, 5 (55.6%) were abusive and 3 (33.3%) presented dependence. It is important to note that, when classified as an abuse, the ASSIST indicates a brief intervention and when there is dependence, it recommends referral for more intensive intervention (Table 4).

Table 4: Classification of the type of use for each substance in the last three months and type of intervention suggested by ASSIST.

In relation to substance abuse, it was detected that the most prevalent substance was alcohol, followed by marijuana and tobacco. In relation to substance dependence, it was verified prevalence of alcohol, followed by tobacco. Regarding to the consumption of two or more substances by the participant, nine participants presented polyconsumption of substances, of which nine (100%) used tobacco and alcohol, six (66.6%) used tobacco, alcohol and marijuana and one (11.1%) used tobacco, alcohol, marijuana, amphetamine and hallucinogen.

It is possible that the predominance of the female gender in the sample is due to the increase in female professionalization that occurred approximately since the end of the 19th century, being process associated with professions focused on care and education, where women are given the gift or vocation to work in these areas [16].

Regarding substance use in life, the results of this study pointed to the prevalence of alcohol, followed by tobacco and marijuana, but the analysis of use in the last three months, indicated prevalence of alcohol, marijuana and tobacco use respectively.

In Brazil and in some countries, alcohol, when compared to other psychoactive substances, is considered a licit substance, easily accessible and socially acceptable consumption, because its use is often encouraged during the dates and commemorative events [17]. The use of alcohol can also be stimulated by the lack of inspection and nonobservance of the legal restrictions for its sale, as well as the low cost and advertising with little control.

Researchers [18] report that alcohol is the most consumed psychoactive substance in the world by people of all age groups, with the initiation of consumption becoming more precocious and, in recent years, changes in the pattern of drinking have been observed (binge drinking) among university students.

An aggravating factor is when alcohol consumption becomes perceived as a mediator or facilitator for the approximation of sexual partners, role acquisition in the group, support and peer companionship, so that the student associates substance with maturity, relaxation and recognizes it as the precursor of experiences of other states of consciousness [19].

The prevalence of alcohol consumption by the majority of students found in this study is corroborated by the literature that points to alcohol as a substance consumed more frequently among university students. The authors point out as risk factors to consumption, the influence of the frequented places, companies that also make use of and difficulties in the confrontation of the feelings. As consequences, there may be a decrease in the academic performance, absenteeism and abandonment of the course [4,20,21].

The frequency of alcohol use may be associated with the overload and stress of students in the area of health due to the routine and the dense academic content of the courses in the medical area. They sometimes do not have, during their training, disciplines that assist them in recognizing their own problems and limits, as well as those of their patients. In this perspective, alcohol consumption is pointed out as a strategy used by students to reduce anxiety due to responsibilities arising from the course, heavy workload, as well as direct contact with human suffering [22].

In a study with university students to investigate about the use of psychoactive substances and associated factors, it was found that the concluding students consume more alcohol in comparison to the beginners and intermediate students and this consumption may become habitual and lead to addiction [23]. The association of alcohol use and the academic semester is pointed out in several studies, which indicate that with the course of training, there is an increase and frequency of use, thus increasing the number of alcoholic students over the school years [24-27].

In relation to the gender, the literature points out the increase of alcohol use by the female gender, which is cause for concern, since women have greater sensitivity, fragility and physical and organic vulnerability to the effects of alcohol in the body [28,29]. The increased use of alcohol by women may be directly associated with the achievement of women's rights and financial independence acquired over time, which may have been a factor influencing the development of patterns of male gender behaviors, such as drinking [30].

In a research with entrant and concluding students from the area of health of a university in the south of Brazil, pointed out that health risk behaviors are more practiced by concluding students and among these behaviors, driving drunk or hitchhiking with someone drunk. The authors further suggest that the use of licit or illicit substances has increased due to the ease of access, as well as the student's need to be accepted in the social environment [31].

The presence of risk behaviors associated with the consumption of psychoactive substances has also been verified in medical students, who although they are aware of the harmful consequences caused to the body and society, they initiate and/or continue the use [32].

Regarding tobacco use, the present study shows a relatively low number of users, a result corroborated by a group of researchers [33] when investigating the tobacco use and the university student's health condition. The authors believe that students in the area of health have knowledge related to the damages and, therefore, there is not so much tobacco use in this public.

In another study with university students in the area of health, they said that tobacco helps to reduce stress, but they do not consider it to lead to addiction [34].

It is important to emphasize that in this study, even that the students' index, tobacco users has been low, they presented concerning consumption patterns, being the use classified as abusive and dependence. The psychological dependence of tobacco was also verified in a study with nursing university students [35].

The literature points out that the easy access, the academic environment, the influence of friends who use tobacco and the easy social acceptance of the substance can be factors that facilitate the beginning and/or continuity of use [33,36].

In this study, the use of marijuana by few students was verified, but among these, the abusive use was detected. In this sense, the result found here is compatible with other research that points out that alcohol and marijuana with a higher percentage of moderate and severe risk, which may lead to damages to health and quality of life, as well as to present impacts on society [36].

This study sought to know the consumption pattern of psychoactive substances among graduating design students from undergraduate courses in the health area. The results allowed the identification and classification of the usage pattern of psychoactive substances, being the substances of greater use, alcohol, tobacco and marijuana. In relation to the classification, it was possible to detect students who make abusive use and others who already have dependence of these substances. This suggests certain incoherence in the behavior of health students, since, as future professionals, they do not consider the drug use as risk behavior and do not recognize the damages of the use for acquisition and practicing of essential theoretical-practical knowledge during the internships.

In view of the results, it is verified the importance of the development of actions, programs and prevention strategies to the use of psychoactive substances in the university context, as well as the reception and empathic listening of students' complaints and anxieties.

As limitation of the present study, it is highlighted the low sample number of the research. Further studies are recommended, with populations with a larger sample size, to confirm these results. Another limiting factor was the impossibility of applying the research instruments in the same period and areas of internship. This occurred due to the structuration model of the internships, which happens in the rotation form among groups and areas.