Psychoactive Substance Use among Psychiatric Outpatients of a Tertiary Hospital in Nigeria.
ABSTRACT
Psychoactive substances and mental illness is a common comorbidity with poor treatment outcome on patients in some parts of the world. In Nigeria, there is dearth of information on the use of psychoactive substance in mentally-ill patients and their effects.
This study investigated the influence of socio-demographic factors, prevalence and types of psychoactive substance use and the effect of these substances on adherence to prescribed medication among psychiatric out-patients of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria.
For this descriptive cross-sectional study, all adult patients (18 years and above) who had previously attended the clinic at least1 year prior to the data collection period of 4 months were used.
A sample size of 207 obtained from an estimated population of 450 regular attendees expected to visit the clinic was calculated. From the routine clinic follow-up, each consecutive 4th patient eligible for the study was interviewed until the sample size was attained.
The selected respondents were made to complete a socio-demographic and drug use questionnaires and were then administered the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).
The data generated from these instruments was analysed by means of descriptive statistics using the statistical package for social sciences (SPSS), version 16. Chi square and t-tests were used to test for differences in proportion for categorical and continuous variables respectively.
A total of 208 respondents were interviewed (52.9% males and 47.1% females). Although respondents in the age bracket of 21 to 40 used the substances more, this difference was not statistically significant (p=0.83).
The sex, marital status, highest level of education and occupation of the respondents were found to be significant predictors of substance use.
From this study, males, those who were married, those with higher level of education and the unemployed were found to use psychoactive substances more. The prevalence for the use of at least one psychoactive substance was 29.3%, while that for the use of multiple substances was 17.7%.
The most commonly used substances were alcohol, cannabis and tobacco and they were also the ones used in combination with one or the other. Other substances used to a lesser extent included anxiolytics, solvents and opioids.
The SCAN identified 10.1% of the respondents with psychoactive substance use disorder of one type or the other. No statistically significant relationship between substance use and adherence.
This use of psychoactive substance is common among psychiatric outpatients of the ABUTH and adherence behaviour is influenced by substance use.
Further studies using larger sample size are therefore needed to evaluate the relationship between substance use and medication adherence and other effects such as poor response to medication in mentally-ill patients.
TABLE OF CONTENTS
Title page i
Declaration iii
Certification iv
Dedication v
Acknowledgement vi
Abstract vii
Table of contents ix
List of tables xiii
List of figures xiv
List of Appendices xv
Glossaries of symbols xvi
CHAPTER ONE (INTRODUCTION)
1.1 Statement of the problem 1
1.2 Significance of the study 4
1.3 Aim of the study 5
1.4 Specific objectives of the study 6
1.5 Research Questions 6
1.6 Hypothesis 6
CHAPTER TWO (LITERATURE REVIEW)
2.1 History of psychoactive substances 7
2.2 Global Psychoactive Substance Use Statistics 10
2.3 Burden of Disease and Prevalence 12 10
2.4 Classification of Psychoactive Substances 14
2.5 The mechanistic classification of psychoactive substances 15
2.6 Psychoactive Substance Use Disorders 16
2.7 Neurobiology, Neuropharmacological and Bio-behavioural basis of psychoactive substance use 17
2.8 Psychoactive substance use and mental illness 21
2.8.1 Psychoactive substance use and mental illness sharing similar neurobiological Basis 24
2.8.2 Psychoactive substance use and mental illness: Self medication hypothesis 25
2.9 Medication adherence 26
2.10 Under-diagnosis of psychoactive substance use 27
2.11 Treatment of Psychoactive Substance Use Disorders 28
CHAPTER THREE (METHODS)
3.1 Description of the study area 30
3.2 Study population 31
3.3 Study design 31
3.4 Sample size estimation 31
3.5 Respondents 33
3.6 Eligibility 33
3.7.1 Socio-Demographic and Drug Use Questionnaire 34
3.7.2 Schedule for Clinical Assessment in Neuropsychiatry (SCAN) 34
3.7.3 Translation of the instruments 35
3.8 Research assistant 35
3.9 Approval 36
3.10 Ethical Consideration 36 11
3.11 Pilot Test of Instruments 36
3.12.1 Procedure 36
3.13 Data Analysis 37
3.14 Data presentation 38
CHAPTER FOUR (RESULTS)
4.1 Socio-demographic characteristics of respondents 39
4.2 Socio-demographic profile of respondents with and without substance use 41
4.2.1 Age 41
4.2.2 Sex 42
4.2.3 Marital status 42
4.2.4 Religion 43
4.2.5 Highest level of education attained 43
4.2.6 Occupational status 44
4.3 Socio-demographic risk factors for psychoactive substance use 45
4.4 Non substance use psychiatric diagnoses of the respondents 46
4.5 Psychoactive substance use and the psychotropic drugs respondents were Receiving 47
4.6 Medication adherence 50
4.7 Underdiagnosis of substance use in the respondents 54
CHAPTER FIVE (DISCUSSION)
5.1 Socio-demographic profile of the respondents 53
5.1.1 Age 55
5.1.2 Sex 56
5.1.3 Marital status 57 12
5.1.4 Religion 58
5.1.5 Highest level of education 59
5.1.6 Occupational status 60
5.2 Socio-demographic predictors of psychoactive substance use 62
5.3 Home living arrangement 62
5.4 The non-substance use psychiatric diagnosis 62
5.5 Psychoactive substance use distribution 63
5.6 Prevalence of psychoactive substance use 64
5.7 Medication adherence 67
5.8 Underdiagnosis of substance use in the patients 70
CHAPTER SIX (SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
6.1 Summary 71
6.2 Conclusion 72
6.3 Limitations 73
6.4 Recommendations 73
REFERENCES 74
APPENDICES 85
INTRODUCTION
1.1 Statement of the Problem
Mental disorders includes a heterogeneous group of conditions which have been traditionally put into groups as organic brain disorders, psychotic disorders, affective disorders, neurotic disorders, behavioral disorder, childhood disorders etc.
These conditions essentially affect thought, emotional, behavioral and perceptual processes, often resulting in an enduring pattern of deviation from what is considered normal. Mental disorders are known to afflict humans from childhood to adulthood.
However, some of these disorders are more common to some age group and sex. In addition, some mental illnesses show some sub-culturally based modification and expression of symptoms.
The psychotic disorder which is one of the most severe and dramatic form of the mental disorders can often be a persistent illness.
A common type is schizophrenia which according to current thinking arises from a hypothetical hyperdopaminergic activity in the limbic system.
Schizophrenia exerts a great deal of loss and damage to the sufferer and has the capacity to interfere with his or her life expectations. It can result in deterioration of the individual‘s overall life achievements and performance especially if it goes untreated or coexist with psychoactive substance use.
REFERENCES
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