The aim of the study was to explore the substance abuse/drug use related knowledge and attitudes among youth in Addis Ababa, Ethiopia. Substance abuse and dependence are one of the most frequently occurring disorders in adolescents, young adults, and the general population. To achieve the study objectives, the study utilized the qualitative method to gather relevant, direct and rich information from participants. The study was conducted through critical literatures review, interviews, and focus group discussions. The participants were selected using purposive sampling technique. The collected data was analyzed thematically. The study found that substances abused by the participants include alcohol, nicotine, cannabis, heroin and etc. Their reasons for using these substances include individual, family, and environmental factors. However, peer group pressure was identified as the primary factor for youth substance use. The study emphasizes the painful nature of substance abuse among youth, yet at the same time, it succeeds in highlighting the strategies that can be employed to address substance abuse among youth. In addition, the study recommends a concerted effort by all the stakeholders in addressing the substance abuse problem.

• Drug use
• Substance abuse
• Knowledge
• Attitudes

Liranso GS, Eliyas KA, Israel FF (2017) Drug and Substance Abuse Knowledge and Attitudes among Youth in Addis Ababa Ethiopia. J Subst Abuse Alcohol 5(2): 1056.

The World Health Organization (WHO) estimates that 1.1 billion people, representing a third of the world population above the age of 15 years, use tobacco, principally in the form of the cigarettes. Of these smokers, 700 million of them being males live in developing countries [1]. The common knowledge that youths openly use substances along certain streets in many towns and in recreational places like dancing halls and drinking places. Thus, the major concern of the study was to find out, from secondary students, the extent of knowledge, attitudes, and practices in relation to the use of substances.

Substance abuse and dependence are one of the most frequently occurring disorders in adolescents, young adults, and the general population. A substantial proportion of the adolescent populations uses drugs or alcohol to the extent that their health, interpersonal relationships, or school performance are adversely affected [2]. Today, drug misuse and abuse is a major problem worldwide. Its extent and characteristics, however, vary from region to region although trends among the youth especially have begun to converge over these recent years. The most commonly used and abused substance is cannabis and alcohol. Alcohol and other related problems are becoming more and more a public problems. The misuse of alcohol represents one of the leading causes of preventable death, illness and injury. Other common substances are inhalants, heroin, and cocaine. This abuse is believed to be associated with increasing amounts consumed, the frequency of use and groups involved. The substance abuse problem in Ethiopia is no different from other countries though there may be variations in the magnitude of the problem [1].

The study was conducted for the following reasons: The extent of substance abuse among youth is on the rise. Parents and educators are trying their best to prevent youth from using substances, yet their efforts seem to be ineffective. Parents and youth need to be made aware of the extent of substance use and its effects. Parents and educators seem not to be able to assist and even cope with youth once they are dependent on substances. Schools are facing a high rate of drug abuse; as a result, this has a negative effect on teaching and learning. Some of the youth who abuse drugs do not perform well in their studies. This adds to the number of illiterate and unemployed youth in the study districts. Youth abusing substances tend to be aggressive and uncontrollable.

Meqoamia Community Development Organization (MCDO) has the interest in taking advantage of this mandate so that the information generated through a youth-focused study could direct the design of evidenced-based prevention programs to address the problem. MCDO which is a nongovernmental community based organization working for youth mental health and rehabilitation. It has the mandate to assist the country in assessing the magnitude of the problem to fill in gaps in knowledge, as well as shape attitude for developing policies and prevention programs. It is, therefore, important to suggest measures which could be applied to prevent and control the substance abuse problem. The overall aim of the study was to gain insight into the current trend of drug/substance abuse related knowledge and attitudes among the youth and to analyze strategies used to address the problem.

The study has the potential to make significant contributions to make an awareness of substance use among youth. Foremost, there is a lack of reliable information focusing on youth beyond the experience and to better understand the current situation and accordingly, make changes to address the factors that contribute to drug/substance abuse among the youth. Furthermore, Government, NGOs, and other institutions are likely aware of these upward strengthening developments, it is imperative that policymakers understand what is contributing to the problem. Moreover, the study has a major impact on individuals, families, and communities. Because the effects of substance abuse are cumulative, significantly contributing to costly social, physical, mental, and public health problems. It helps to minimize many costs respect to medical, economic, criminal, and social impacts on the country.

The strength of qualitative research is its ability to provide complex textual descriptions of how people experience a given research issue. It provides information about the human side of an issue that is, the often contradictory behaviors, beliefs, opinions, emotions, and relationships of individuals. Qualitative methods are also effective in identifying intangible factors, such as social norms, socioeconomic status, gender roles, ethnicity, and religion, whose role in the research issue may not be readily apparent. When used along with quantitative methods, qualitative research can help us to interpret and better understand the complex reality of a given situation and the implications of quantitative data. Although findings from qualitative data can often be extended to people with characteristics similar to those in the study population, gaining a rich and complex understanding of a specific social context or phenomenon typically takes precedence over eliciting data that can be generalized to other geographical areas or populations. In this sense, qualitative research differs slightly from scientific research in general [3]. In addition, the qualitative research design enabled the researchers to describe, make sense of, interpret or reconstruct interaction in terms of the meanings that the participants attached to it.

The study was conducted in Addis Ababa that is the capital of Ethiopia. The city is located at 9.03 degree north and 38.74 East at an altitude of 2220-2800 meter above sea level. Addis Ababa is the most populated cities situated at the heart of Ethiopia with an estimated population of 2,145,418 [4]. The city has ten sub-cities including the main target of the study, Kirkos subcity. Kirkos sub city, district 05 was selected to be the study location. The sample in the study was drawn from Kirkos sub city for the study purpose, available respondents and schools were regarded as the study population. Furthermore, the schools were selected because they were convenient and participants agreed to participate. The sampling method was based on judgment regarding the characteristics of a participants. The strategy was select the participants who has more information rich and illuminative based on the previous bad experinces that offer useful manifestations of the phenomenon. Studying information-rich insights and understanding rather than empirical generalizations [5]. Keeping in mind that “there are no fixed rules for sample size in the qualitative inquiry the validity, meaningfulness, and insights have more to do with the information-richness of the cases selected”. Finally, the research result categories or clusters were summarized into major themes. Some selected respondents’ stories were presented in quotations to see the turning points of the knowledge and attitude of youth in the substance abuse, and data were analyzed thematically.

The purpose of the study was to explore the extent of substance abuse among youth in Addis Ababa, Ethiopia. Parents and educators were tried their best to prevent youth from using substances, yet their efforts seem to be ineffective. Parents and youth need to be made aware of the extent of substance use and its effects. This part of the study presents the major findings as follows (Table 1).

Table 1: An overview of sex and educational background information of the respondents.

In Table (1): an overview of sex and educational background information on the respondents. In all, there were forty respondents participated in the research. Out of this number 26 (65 %) were males, females constituted 12 (30 %). With respect to educational level, 14 (35 %) were high school, 15 (37.5 %) were certified, 3 (7.5 %) were diploma, 5 (12.5 %) were bachelor degree, and 3 (7.5 %) of the respondent were masters degree and above, and the age for the study were between 15 to 35 years (Table 2,3).

Table 2: Religious and marriage background information of the respondents.

Table 3: Single and married background information of the respondents.

The above Table (2) and (3) indicated that the religious and marriage background information of the respondents. Based on the data, 30 (75 %) were orthodox, 4 (10 %) were protestant, 5 (12.5 %) were Muslim, and 1 (2.5 %) have no religion. Furthermore, most of the respondents 34 (85 %) who comprised mainly of youth were single, and only 6 (15%) were married.

Substance abuse and drug related knowledge and attitudes among youth

The respondents generally explained substance abuse as the misuse of drugs or using drugs, which have not been prescribed by the doctor. Substance abuse is the misuse of drugs /substances. According to the most respondents, the type of substances commonly used by the youth in the study setting included: alcohol, cigarette, cannabis, cocaine, and heroin. Though the study was not looking at substances like coffee and paracetamol, they were mentioned in some of the responses [6]. The majority of the respondents illustrated that they had ever used this substance. Moreover, most of the participants explained drug abuse as taking medicine without doctor’s advice or prescription. Others described drug abuse as taking the overdose of drugs. A few, however, indicated that using a drug for the wrong purpose or taking drugs, which harm the body is drug abuse.

However, many of the respondents were start using substance between the ages of 13-17 years. These results concerning the variety of drugs listed above indicated that the main drugs of concern in a study area. On the other hand, the age at which the youth were introduced to drugs varied but most of the ages indicated were within the teenage group, 19 years upward, only a few mentioned ages below 16 years. With respect to what influences the youth to use drugs, most participants were of the view that peer pressure and curiosity were the major factors. A few however, mentioned that poor parental care and advertisements in the media especially with alcoholic beverages also play a role. It was evident in discussions that the youth were usually convinced into drug use by being told of the benefits of taking drugs such as it will make you happy, learn, brave and create a sense of belongingness.

Moreover, a newcomer is given a little of whatever substance he/she is being introduced to and this increased as the days go by. Some of the participants explained it as follows;

The addicted person teaches the new one on the left over to “die it off that is finish it”.With alcohol you were given a lot if you cannot take all it is halved, the next time it will be increased to one, two, three, and so on (Mp 14).

There were varied responses on the level of the youth in drug abuse. Most of the participants were of the view that drug use among the youth was decreasing because of the unacceptance of substance abuse/drug use. A few who believed it was increasing indicated that youth still causal to get these drugs. One of the informants sums it up by saying:

As to me, drug abuse is increasing in the number of broken homes. Students were also performing poorly in school achievements. Therefore, taking the drugs with the hope that they will be able to learn properly and being successful in the academics (Mp7).

Furthermore, one participant stated that:

Drug use is increasing because most of the youth find it very fashionable/modernization that may be able to identify or categorize them with their peers. With the false belief that able to perform in rap music or belief that able to rap more after taking the drugs (Fp11).

Almost all respondents have agreed that peer pressure influences the youths to involve in substance abuse. Among the participant who reported, one had this to say:

I started taking drugs because all of my friends were drinking and I felt left out then I had the drink to feel as part of the group”. All my friends were smoking so I had to smoke too. Imagine hanging out with your friends and all of them were drinking and having a good time while we were taking substance/drugs (Mp2).

Another participant who thought that a person who is idle is at risk of using substance stated that:

Even though I also continued to drink when I was away from my friends because of idleness when I reach home since there was nothing to keep me busy.Therefore, I continued drinking so I believe that when someone is idle he/she can be tempted to use the drugs more with the false belief that able to keep the mind busy(Mp10).

Furthermore, all participants who were interviewed reported that prevention of substance use among the youths is possible if one purpose to do so for instance; One of the respondents had this to say:

There are times when I can stay for six months without smoking and sometimes even more and only I was smoking when I got depressed (Mp 08).

Also, another respondent said that:

If I detach myself from my friends, I think, I can gradually stop drinking and take drugs but it will take time since drinking has become a daily routine (Mp 03). 

One of the respondents were stated prevention is possible if the family members’ attitude towards the youth who use the substances change and they become loving. She further said that:

I know I can stop drinking alcohol but my parents have already labeled me as a drunkard and whatever I do they do not care whether am around or not and so the only people who make me feel a sense of belonging are my friends (Fp 09). 

The reasons were given for drug use among the youth centered on the perceived benefits such as enabling the user to study, do hard work /over work, for fun and get rid of shyness, rebellion and forget about one’s problems [7]. Others, however, indicated that some youth use drugs out of curiosity, for fun or due to peer pressure. Furthermore, social/peer pressure was assigned as the major reason why the youth abuse drugs. Parental influence was also an important cause of substance abuse.Also, the participants illustrated that youth were trained by observation and serving as an errand boy, smelling and gradually tasting. Some also secretly put the drug into food for the youth to eat over a period of time. As the youth were being initiated into the habit, friends were those who commonly were the buy the drugs. In line with this, the following quote illustrates further.I started taking cigarette and alcohol at the age of fourteen. I was influenced by friends to take these drugs. Besides, I love singing rap music and they realized that when I take the drug I able to sing for long hours. Then I usually engaged in alcohol drinking. Also, I smoke the cigarette every day (Mp 16).

Moreover, the participants were illustrated substance abuse is more common in the school environment. A higher proportion of respondents felt that the youths that use drugs were introduced to it by their friends and drug pushers.

Various ways used in convincing the youth to use drugs include statements like make one brilliant, happier, stronger/ work for long hours, brave, increase confidence, and boost appetite (Fp 05).

The respondents were indicated about alcohol and drug/ substance use in the study area. The practice of chewing khat, smoking cigarettes and ‘shisha’ and drinking alcohol is common among youth. Most respondents were said that some jobless youngsters street children are largely involved in those activities including a number of female students in this practice. This is because places where youth chew khat and smoke ‘shisha’ have grown in numbers in the surrounding of schools. The easy availability of those substances and the low price leads to use those substances. The following excerpt, from one respondent, illustrates more.

In our village, ‘khat is the second we consume next to food like injera and bread’. And the price of one cigarette is lower than the price of one biscuit so it is easy to use those substances (Mp 1).

Besides, the respondents also discussed on why youth have problems with alcohol or substance/drug use. Most of the time students use substances like khat during examination times to increase their concentration on the study then they continue to use those addictive substances for a long times and they face difficulty to stop those substances and also other substances they use for recreation but they continue to use them to use for a long times and they got into addicted behaviors. The participants indicated that the youth were usually convinced into drug use by telling them of the perceived benefits such as “it will enable you to be brave, overcome shyness, learn, boost your appetite and work for long hours”.

The majority of the respondents indicated that drug use among the youth is increasing. The reasons indicated were drugs are becoming more common in the area; lack of job for the youth; elders send children to by drugs; there are no laws against drugs; watching of foreign culture on TV and the Internet; production of drugs is on the increase in the country; peer group influence and more people are using it to study or work [8]. Most participants stated that knowledge of the side effects and observation of the effects of drug use on addicts or users such as madness is the major reason why some youth do not abuse drugs, others also mentioned the following: who has a goal/aim in life, religious beliefs/ teachings and respect themselves.

The relationship between the community and drug users were described as poor. They are most often ignored, disliked, suspected as criminals and usually associated with bad things as one participant put it. The following citation illustrates further:

Society does not like them because they think they were evil doers. But those were involved in drug use like them/drug users (Fp 13).

Furthermore, the major reasons given for drug use among the youth was based on perceived effects or benefits of the drugs such as makes the users feel high, strong, stay awake for a long time, forget thier emotional and social problems, overcome shyness, lack of parental control and to rebel against parents, financial problems/frustration and unemployment. To get more information on effects of substance use interviews and FGDs were conducted. The result presented as follows: bad temper, health problems, and tiredness, the breakdown in the family relationship, disgrace, and loss of confidence in the child, and anxiety/fear, crime, violence and high cost of treatment. Other minor effects mentioned generally include poor academic performance, depression, disturbed sleep, the breakdown in relationships at work, low productivity and accidents.

Also, most respondents indicated that problems associated with alcohol or substances/ drug use were problematic, eventhough the users acknowledged it was useful in some ways. Regarding their usefulness, the participants were indicated that both help one to cope with a difficult situation as a energizer, stimulate one’s mind, curative, relieve stress and cause one to become brave. However, the negative effects of substances were categorized into physiological (general deterioration of health), behavioral (aggressive behaviors) and social (loss of status, family, and friends). Under physiological, subjects mentioned that substances damage the liver, it make smells bad, and depresses brain activities. The physiological effects of cigarettes that were mentioned were lung damage and that khat makes people thin. Physical violence, loss of jobs and marital disharmony were also commonly associated with substances abuse decrease in academic performance.

Moreover, participants described the effects of alcohol and substances that were health problems (madness, lung and heart problems), financial handicaps leading to stealing, death, becomes disrespectful, rejection by others, poor academic performance and HIV/AIDS. In community level it creates a bad image of the community, destruction of property, crime becomes rampant and loss of labor force. There were also effects of drug and substance abuse as the youth revealed to be; health complications, family break-ups, poor performance in schools as well as contributor of social evils in the community, increased school dropouts, diseases like cancer, HIV, and AIDs, sexually transmitted diseases due to the influence of the drugs and substances they use, for instance, alcohol, injecting drugs among others [9]. Likewise, the partcipants were indicated that it increase in poverty due to financial breakdown and economic retardation, loss of focus in life full of regrets, indiscipline, loss of jobs for those working, low self-esteem, lack of development both physical and spiritual, insecurity, violence, hostility and confusion in everything the victim of drug abuse does.

Therefore, to protect the youth from exposure to substance abuse, the following suggestions were given by the respondents. National campaign on substance abuse; formation of self-help groups for drug users; parents should refrain from exposing their children, and formation of peer group educators were suggested. Moreover, the programs that respondents felt would help prevent substance abuse among the youth include a national campaign against drugs on TV, radio etc; law enforcement on selling of drugs; arrest and prosecution of abusers and public education on drug abuse. To protect the youth against drug abuse, mass educational campaigns on the dangers of drug abuse using Drama, films, posters and debates were indicated as a means of preventing the youth from getting into substance use. Other suggestions included that severe punishment should be meted out for culprits to deter others. These include dismissal from school and imprisonment. A few also mentioned the following: good parental care / upbringing, religious leaders should preach against substance use/abuse, formation of youth clubs, formation of rehabilitation centers; and prepare songs that prevent drug using.

Furthermore, counseling and education on the effects of drug use were indicated by most participants as means of helping the youth already in substance abuse to quit. Others also suggested the following that they should be shunned, imprisoned or sent for mental/medical treatment.

Moreover, regarding the way of management of problem with substance/ drug abuse respondents respond that the best way to solve this problem is that recreational places which are free from substance have to be built for youngsters before the closing of ‘’khat’’ and ‘’shisha’’ houses. The school surrounding has to be free from substances/drugs and the community has to take action especially with policies in controlling the places where youth abuse substances/ drugs, families have to discuss openly with their children, creation of job opportunity for jobless, teaching youth the side effect of the drug/ substances and the cost of drug /substance must be increased in order to decrease consumption possibility by youth, the side effect of that substance must be written on their covers for example on cigarettes pocket, shop owners to differentiate to whom they have to sell those substances. Furthermore, participants indicated that reduce the cultivation of such substances. Though stop licensing people to sell alcohol around schools; provide employment for the youth, and run programs that will keep the youth occupied eg. sports, games, and entertainment.

The findings of the study provide the basis for developing comprehensive prevention programs that are directed to adolescents care and support interventions. The educational programs should include information concerning addiction and forms of treatment as well as appropriate treatment and rehabilitation services. Organizations and community health programs must address the bad effects of the addictive nature of nicotine as a gateway substance abuse [10]. Majority of participants had adequate knowledge about harmful effects of addictive substances but had limited information regarding treatment and intervention options. This highlights the need for spreading more awareness about treatment of substance abuse via awareness creations, lectures, media and campaign at larger levels.

Based on the findings; the following conclusions were drawn: Youth are in a very important developmental stage of their lives. They were faced with physiological development as well as pressures from their families and social environment. They were also vulnerable to environmental pressures from their peers, role model, and the media. If they were not prepared for these developmental changes and challenges of adolescence [11], they may end up being frustrated, confused and helpless when confronted by them. In trying to cope with such challenges, youth may end up indulging in a variety of substances that endanger their own lives as well as the lives of other people. Findings of the study indicated that youth were practising substance/ drug use mainly aware of those addictive behaviours. The magnitude of substance abuse is high among youth and use mainly alcohol and khat significantly insisted adolescents sexual behaviour. The voices of youth in the study were clearly described abusing substances due to various reasons to stop the bad behavior. Parents, educators, Government, NGOs and the community at large must be at the forefront in the fight against substance abuse by youth. The substance abuse problem affects everybody. Finally, findings of the study indicated that there were no efforts and potentials recognised from both government and non-governmental organisations do not actively work against drug/substance abuse herald hope and a brighter future against the abuse phenomenon. Thus, drug/substance abuse among the youth is in danger to the well being of society and whole the nation at large.

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