Non medical use and abuse of psychoactive substances among university students in health-related courses 261

ORIGINAL ARTICLE

Non medical use and abuse of psychoactive substances

among university students in health-related courses
Experimentação, uso e abuso de substâncias psicoativas
entre universitários da área da saúde
Clesio Nepomuceno1, Ana Paula de Carvalho2, Valéria Aparecida de Paula3,
Viviane Cristina de Souza4, Dorisdaia Carvalho de Humerez5

ABSTRACT
Objective: To understand the pattern of consumption of legal and
illicit drugs among students of health-related courses and, if there
are users among the participants in the survey, and find out whether
they wish to participate in prevention and treatment programs.
Methods: Quantitative and descriptive study performed using a
self-applicable questionnaire. The study population consisted of
students at a private university in the city of Sao Paulo who
answered a questionnaire on research objectives. Anonymity was
assured, and all of them signed an informed consent form. Results:
Five hundred and eighty-three students participated in the study,
82% female and 18% male. Most students (75.45%) were aged 20-
35 years. The average family income ranged from 5 to 15 minimum
wages. Among the legal substances, alcohol was most frequently
mentioned as used occasionally, frequently or daily (47.33%),
followed by tobacco (36.02%). As to illicit drugs, Cannabis sativa
was more often mentioned for experimental and occasional use
(12.86%) and 2.83% of students reported dependence. It was
followed by inhaled substances and cocaine. Crack, heroin in the
form of medication (Dolantin), “mushroom tea” and other
medications were also mentioned as tried by the participants.
Conclusion: These data were similar to those of other studies
performed with university students and showed the need to create
educational programs in order to broaden the complexity of the
circle involving drug use and abuse.
RESUMO
Objetivo: Conhecer o padrão de consumo de drogas lícitas e ilícitas
entre os alunos dos cursos na área de Saúde e identificar, se houver
usuários entre os participantes da pesquisa, o desejo de fazer parte de
programas de prevenção e tratamento. Métodos: Estudo quantitativo
e descritivo realizado por meio de questionário auto-aplicado. A
população de estudo foi constituída por estudantes de uma Instituição
de Ensino Particular no Município de São Paulo, que responderam a
um questionário que atendia aos objetivos da pesquisa. Foi garantido
o anonimato e todos assinaram o termo de consentimento. Resultados:
Participaram da pesquisa 583 universitários, sendo 82% do sexo
feminino e 18% do sexo masculino. A maioria dos alunos (75,45%)
tinha idade entre 20 e 35 anos. A renda média familiar variou de cinco
a 15 salários mínimos. Entre as substâncias lícitas, o álcool foi o mais
citado como de uso ocasional, freqüente ou diário (47,33%), seguido
pelo uso do tabaco (36,02%). Quanto às drogas ilícitas, a mais citada
como experimentação e uso ocasional foi a Cannabis sativa (12,86%)
e 2,83% relataram dependência. Em seqüência tivemos uso de
inalantes e de cocaína. O crack, a heroína sob a forma de medicamento
(Dolantina), “chá de cogumelo” e outros medicamentos também foram
mencionados como de experimentação pelos participantes.
Conclusão: Estes dados revelaram uma aproximação com outros
estudos realizados com universitários e demonstraram a necessidade
de se estabelecer programas educativos visando ampliar a
complexidade do círculo que envolve o uso e o abuso de drogas.

Keywords: Dependence; Alcoholism; Tobacco; Cannabis; Descritores: Dependência; Alcoolismo; Tabaco; Cannabis;
Narcotics; Amphetamines; Cocaine; Nursing students Narcóticos; Anfetaminas; Cocaína; Estudantes de enfermagem

Study carried out at Faculdade de Enfermagem do Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU, Centro - UniFMU, São Paulo (SP), Brazil.
1
Master’s degree in Intensive Care Therapy, Faculdade de Enfermagem do Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU, São Paulo (SP), Brazil.
2
Nursing student at Faculdade de Enfermagem do Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU, São Paulo (SP), Brazil.
3
Nursing student at Faculdade de Enfermagem do Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU, São Paulo (SP), Brazil.
4
Nursing student at Faculdade de Enfermagem do Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU, São Paulo (SP), Brazil.
5
Lecturer at the Centro Universitário das Faculdades Metropolitanas Unidas - UniFMU. Ph.D. in Psychiatric Nursing from the Escola de Enfermagem da Universidade de São Paulo - USP and Escola de
Enfermagem da Universidade de São Paulo, São Paulo (SP), Brazil.
Corresponding author: Clesio Nepomuceno - Av. Corifeu de Azevedo Marques 4989 - ap.103 - Vila Lageado - CEP 05340-002 - São Paulo (SP), Brasil - Tel.: 37190235 - e-mail: clesionepomuceno@uol.com.br
Received on May 19, 2005 - Accepted on August 20, 2005

einstein. 2005; 3(4):261-267

262 Nepomucemo C, Carvalho AP, Paula VA, Souza VC, Humerez DC
INTRODUCTION
Drug use is a very ancient phenomenon in the history
of mankind, and is a serious public health problem
leading to severe personal and social consequences(1).
Drug addiction is a symptom rather than a disease,
since individuals often cannot bear the stresses of an
unsatisfactory solution to the basic anxieties of life(2).
The use of psychoactive substances is one of the ways
of expressing human problems and, as times and values
change so do the external forms of human problems(3).
The Expert Committee on Drug Dependence of the
World Health Organization (WHO) considers a drug
to be any substance that when introduced in the body
can modify one or more of its psychological, physical
and social functions. According to the Committee,
psychoactive substances cause dependence, which
means a psychological and often also physical state
resulting from interaction between the body and the
drug. Psychological dependence is characterized by
behavioral responses involving a compulsion to use the
substance, continuously or periodically, in order to feel
its pleasurable effects or, at least, to interrupt the
discomfort resulting from withdrawal. This compulsion
is the main factor that may lead to chronic intoxication
with any drug, and this could be the single factor for
the condition of abuse (4). Physical dependence is a
pathological state that is a consequence of the repeated
administration of a substance leading to the onset of a
characteristic and specific group of symptoms called
withdrawal syndrome, when drug use is discontinued
or significantly reduced. The drug must be taken
continuously when the withdrawal syndrome occurs.
Physical dependence is the powerful factor that
reinforces the user to continue drug use or to go back
to using it after stopping. The resistance acquired by
the user’s body is called tolerance, and it compels a
person to take increasingly large amounts in order to
produce the same effects as obtained previously at
lower doses. Tolerance and physical dependence
generally develop concurrently(5).
Among the psychoactive substances are tobacco,
alcohol and a few medications (barbiturates, hypnotics
and others). Others, such as Cannabis sativa
(marijuana), cocaine, crack, lysergic acid (LSD),
Methylene Diox Methamphetamine (MDMA), known
as Ecstasy, opiates, and others, are considered illicit.
According to WHO, approximately five million
individuals die every year worldwide from complications
related to smoking and two hundred billion dollars are
spent or lost in the world, per year, due to this habit(6).
In Brazil, a study performed in ten capital cities
showed that roughly 11% of students had their first
contact with cigarettes at the age of 10 to 12 years(7). It
einstein. 2005; 3(4):261-267
is not definitely known how many people use tobacco
in Brazil, but in households in the State of Sao Paulo,
9.3% of people interviewed are dependent, and a much
larger number uses it continuously(8).
Ethyl alcohol is considered the oldest anxiolytic used
by man. In one way or another, all cultures learned to
produce alcohol, and its use and abuse are disseminated
worldwide. The Ministry of Health of Brazil(9) considers
ethanol a psychoactive substance that can produce
changes in the functioning of the central nervous system
and modify the behavior of individuals that take it.
Inhalants or solvents are volatile substances,
obtained legally and used by addicted individuals.
Among the most common inhalants are plastic glue or
“shoemaker glue”, paint solvent, petrol, ether,
acetone, lança-perfume (perfume sprays containing
ether used at Carnival balls), varnish, etc. The risk of
sudden death caused by aerosol aspiration is very high,
because it interferes directly in breathing causing
irregular heartbeat and asphyxia, reducing oxygen to
the brain. There is an increased risk of death when the
dependent aspirates using a plastic bag to concentrate
the fumes. The inhalation of volatile substances such
as drugs that lead to abuse may also cause alterations
in many systems including the central and peripheral
nervous, gastrointestinal, cardiovascular and renal
systems, and blood, among others(10).
The use of Cannabis sativa by man goes back thousands
of years and it is one of the most commonly used illicit
drugs. It is very likely that the use of cannabis is related
to development or exacerbation of psychoses or other
mental diseases(11). In 1937, it was considered a narcotic
and a law forbade planting it anywhere in Brazil(12).
Cocaine is the alkaloid extracted from the dried
coca leaf. The natives of the Andes chew coca leaves
with some alkaline substance in order to diminish their
feeling of hunger. Coca tea is obtained by making an
infusion of the coca leaf. On the other hand, cocaine
is the coca substance refined by an extremely complex
process. It is used by addicts by aspiration or direct
application on mouth, nose or genitals, or by
subcutaneous or intravenous injections. Cocaine use
is currently a serious public health problem(13).
With the cocaine leftovers, associated with other
solvents, the users obtain rough stones that are also
used as crack and merla (cocaine paste, bazooka). Crack
use is associated with violent crimes and riots in
communities(14).
Amphetamines are substances used as anorectics,
but abusive use may be found as drug dependence,
becoming a significant health risk. They act on the
cardiovascular and neurological systems, besides causing
hyperthermia and hyponatremia(15).
 Non medical use and abuse of psychoactive substances among university students in health-related courses 263

Morphine is the main alkaloid of opium and it is informed consent term regarding their participation.
used as an analgesic. The drug is used for dependence Anonymity was guaranteed and the participants were told
when heroin is scarce on the market. It is known as data would only be used to provide further information
opium and contains more than twenty alkaloids or active for research and to establish preventive programs.
substances. Drug tolerance as well as physical and
psychological dependence may develop within hours,
days or weeks(16). RESULTS
Heroin is the most commonly used illicit opiate, Five hundred and eighty-three students answered the
but there are also morphine and codeine, used as questionnaire and females predominated (82% versus
medication but causing drug dependence(17). 18%), as shown in figure 1. As to age, 28.98% were
WHO(4) recommends the following classification for aged 21-25 years, 26.75% were 26-30 years and 19.72%
people who use psychoactive substances: non-user, a were 31-35 years (figure 2).
person who has never used them; experimental user, a
person who only experiments with one or more drugs,
but whose contact with drugs does not go beyond the
first experiments; occasional user, who uses one or several
substances, but with no breakdown in affective,
professional or social relations; habitual user, who often
takes drugs and in whom signs of breakdown have already
been observed, even if they function socially; and the
dependent user, who has already broken some social ties Figure 1. Distribution of participants per sex
and may present physical and moral decadence.
This study is based on the above mentioned issues. Its
purpose was to diagnose patterns of psychoactive
substance consumption to create primary and secondary
care programs for the university students in health-related
courses and help them as well as their future clientele.

OBJECTIVES
1. To understand the pattern of legal and illicit drug
consumption among students of health-related
courses;
2. To identify whether among the students who
answered the questionnaire there were drug users
who wished to participate in prevention and
treatment programs.
Figure 2. Age range of 583 students who answered the questionnaire

METHODS
As an indicator of the socioeconomic level it was
The participants in this study were students in health- found that the monthly family income ranged from
related courses at a private university in the city of Sao five to fifteen current minimum wages. Concerning
Paulo. The study included all students who accepted marital status, 384 (66%) were single, 183 (31%) married
to take part in the survey. and 16 (3%) separated or widowed (figure 3).
The instrument used to collect data was a self-
applicable questionnaire concerning the research
objectives. In order to apply the questionnaires, the
researchers initially carried out a pilot test before the
field study. This study followed the research ethical
principles according to Resolution 196/96, to ensure
its legitimacy and protect the participants. The students
were informed about the research objectives and invited
to participate, and those who accepted signed an Figure 3. Distribution of students per marital status

einstein. 2005; 3(4):261-267

264 Nepomucemo C, Carvalho AP, Paula VA, Souza VC, Humerez DC
Four-hundred and eighty (82%) participants lived
with their families and 103 (18%) did not live with their
families, showing that most of them maintain family
ties (figure 4). Concerning the productive process, 518
(89%) students worked and studied and 65 (11%) only
studied (figure 5).
Figure 4. Distribution of students per family ties
Figure 5. Distribution of students per productive process insertion
As to experimenting with tobacco and alcohol, 83.35%
of the participants had tried them at some time. Among the
participants, 47.33% mentioned that they used alcohol,
43.05% used it occasionally and 4.28% were heavy users
according to the World Health Organization criteria, and
only 0.51% of these declared themselves to be addicted.
Regarding tobacco, 5.83% of respondents reported to be
addicted. Alcohol use or abuse was found without any
distinction of age and sex among the students. The data
concerning occasional, frequent/daily use or addiction to
alcohol and/or tobacco are shown in figure 6.
Figure 6. Occasional, frequent/daily use and abuse of alcohol and tobacco
among participants
einstein. 2005; 3(4):261-267
Considering the illicit substances, Cannabis sativa
was the drug most frequently experimented (some time
during life) (12.86%; in that, 2.83% reported
dependence). It was followed by cocaine (3.6%),
amphetamine with no medical prescription (3.25%);
inhalants and solvents (2.4%), opiates (1.71%), crack
(0.51%) and others (0.34%), including heroin used as
medication (Dolantin), LSD, Ecstasy, mushroom tea,
etc. Figure 7 displays these data.
Figure 7. Illegal drug experimenting among students
The subjects who informed the use of heavy drugs,
such as crack and cocaine, were multiple users and
combined several psychoactive substances simultaneously.
It was also observed that those who consume illicit
substances tend to also use the so-called legal drugs.
As to sex, experimentation, use and abuse of heavy
drugs (cocaine and crack) were greater among males, and
improper use of amphetamines was greater among females.
The participants who used drugs and considered
themselves addicted mentioned their wish to participate
in prevention programs.
DISCUSSION
In a previous study,(18) the majority of undergraduate
students of health-related courses at public and private
schools, on being asked about cigarette use, answered
that they did not use them, and only a few confirmed
they smoked. Among the smokers, most mentioned that
they did this daily, and few of them sporadically. Such
study revealed that the motivation to smoke cigarettes
is based on words such as: pleasure, addiction,
dependence, desire, stress, anxiety, nervousness,
relaxation and social life. Among the smokers, some
classified themselves as occasional users, others as
constant users and most of them as dependent. It may
be inferred that the use of this psychoactive substance
among students of health-related courses is relatively
high, and that half of the smokers considered themselves
 Non medical use and abuse of psychoactive substances among university students in health-related courses
dependent. Most of them had no intention to stop
this dependence, and the longer the time of use, the
more difficult it is to quit smoking(18). It is known that
young people are highly attracted to smoking since it
represents interests that range from curiosity about
discovering new feelings/emotions to dealing with
models established by the social group(19).
A study of female smokers showed the difficulty faced
by addicts in maintaining abstinence and the great
suffering caused by the nicotine withdrawal syndrome(20).
It has been proved that the use of tobacco causes
physical, emotional or psychological and social harm
to humans. It is a habit that has led to many losses,
from health to life itself, often very early, costing great
suffering and also economic damage. Five million
smokers die every year from tobacco-related diseases.
Smoking is the main cause of morbidity and mortality
in many countries(6).
Nicotine dependence is alarming and smokers wish
to give up the habit, but few manage to do it by
themselves. The view of smoking behavior as drug
dependence caused a real revolution in the way smokers
are understood and treated. Cigarettes and other forms
of tobacco generate nicotine dependence and the
pharmacological and behavioral processes that
determine this dependence are similar to those that
determine addiction to other psychoactive substances
such as heroin and cocaine(21).
Thus, cigarette dependence was no longer seen as
simply a “psychological habit”, but as a physical
addiction that should be treated as a medical illness,
along the same lines of treatment as other addiction-
forming substances.
Based on this vision, a therapeutic armamentarium was
developed to relieve the symptoms of the nicotine withdrawal
syndrome, or to reduce the anxiety it causes(22).
In 2005, Galduróz et al. performed a survey in 107
Brazilian cities with over 200,000 inhabitants showing
that 41.1% of subjects used tobacco at least once in
their life (23). In the present study, the daily use of
tobacco was more prevalent than alcohol use, and was
close to that mentioned by Galduróz et al.(23) contrasting
with occasional use, in which alcohol had a higher
prevalence than tobacco. A higher percentage of
tobacco users considered themselves addicted as
compared to alcohol users.
Alcoholism is a very frequent disease worldwide,
affecting different areas of an individual’s life. Alcohol
has major pharmacological and toxic effects on almost
all organs of the body and the results of treatment do
not fully reach the expected goals. Therefore,
alcoholism is a social problem due to the high rate of
criminal behavior, traffic and labor accidents, violence,
265
mortality and family problems it causes, among other evils.
The drinking pattern is different in men and women:
impairment associated with alcohol abuse by women is
actually much greater than usually admitted(24-25).
In our study we found alcohol use or abuse had no
distinction of age and sex among students. The majority
of participants in the present study was female and the
onset of alcohol use and abuse among women was a
phenomenon that caused concern. According to many
studies, alcohol is more harmful to females than to males(26).
Alcohol dependence in women is a more silent,
discrete phenomenon than in males, due to the negative
stigma and it develops faster than in males(27). There is
less social pressure on women to begin drinking and
greater pressure for them to stop. Women are expected
to be models and in control of their actions. This
difference in roles does not apply only to drinking,
but also to several basic values that are culturally
determined for both sexes.
The prevalence of alcoholism among women,
however, is still significantly lower than among men(27).
All the same, abusive consumption and/or alcohol
dependence are known to have a great number of
negative repercussions on the physical, psychological
and social health of women.
Recent data confirm that, even though alcohol
consumption is really lower among women, its impact
may be greater than among men, evaluated by means
of the report of problems associated with alcohol(28).
The identification of female alcoholism in primary
health care so far appears to be poor and undervalued.
It is therefore important that the present study found
alcohol use and abuse among female students.
There are also extremely high costs involved in
treating alcohol-addicted people and directly or
indirectly related problems.
Dependence means maladjustment between an
individual and the way he/she drinks; there is no clear
line between normal and heavy drinking, since drinking
problems occur in normal, as well as in heavy drinkers(26).
This study also showed that most tobacco or
alcohol-addicted subjects mentioned having tried and
failed to stop smoking or drinking.
The group of students who reported having
experienced drugs should be a matter of concern, since
they may escalate their quantitative and qualitative use,
that is, they could move from experimentation to
occasional consumption, or from this to heavy
consumption, or else from experimenting with drugs
considered “light” to “heavier” ones. In fact, a study
performed with students from several colleges in the
City of Sao Paulo proved that most students had
already experimented Cannabis sativa, and only a few
einstein. 2005; 3(4):261-267
266 Nepomucemo C, Carvalho AP, Paula VA, Souza VC, Humerez DC
of them admitted “heavy” consumption – more than
once a day(29). In the study on drug use conducted in
Brazilian cities, the use of Cannabis at least once in
life was 6.9%(23). In the present study, the use of Cannabis
was most prevalent among illicit drugs, with a higher
frequency than in the other study mentioned.
Discussing the Brazilian situation, surveys performed
in 1992 and 1994 with elementary and secondary students
at public schools belonging to the state government, in
the city of Porto Alegre showed that female students used
more drugs both during their life, i.e., experimental use,
and in the year the survey was conducted. The authors
found that the number of frequent users was similar in
both sexes. As to the type of substance, in the study carried
out in 1994, legal drugs, such as tobacco, anxiolytic,
amphetamines and barbiturates, were most frequently
used by female students, whereas illicit drugs, such as
cannabis and cocaine, were most used by male students.
On the other hand, alcohol, solvents, anticholinergic
agents, opiates and hallucinogens were used at the same
rate by both sexes(7).
Cocaine and crack have been the great media
“stars” among the illicit drugs(13-14). Invariably, there
are newspaper headlines about the frightening,
uncontrolled increased use. This in fact occurs but it is
far from being so dramatic: it is worrying but not a
reason for panic. On the other hand, it should be
recalled that Brazil is one of the main cocaine routes
to Europe and the United States. In the study on drug
use in major Brazilian cities, the use of cocaine at least
once in life was 2.3%(23).
In the present study, cocaine was used much less
than Cannabis, but its frequency was higher than in
the study by Galduróz et al.(23), and closely followed by
amphetamine use.
The presence of drug use among the subjects was
associated with the wish to participate in prevention
programs, which would require organizing voluntary
participation programs for students. It is also necessary
to offer shelter, assistance and specific referrals to
dependent-users who wish it.
We believe that the best way to approach this
problem, which also has the best possible cost/benefit
ratio, is preventing drug abuse. Preventing means
developing programs in the student community at
large, identifying the specific characteristics of each of
them and preparing appropriate strategies in order to
avoid both the beginning of consumption and
progression to disorders resulting from psychoactive
substances related to abuse and dependence. These
programs have long been necessary to effectively deal
with the problem of drug use among students, especially
when we see how many of them wish to take part.
einstein. 2005; 3(4):261-267
As to the use of opiates in general, it is a matter for
great concern, since the students surveyed work in the
field of health care and have easier access to these
substances. In future they could become a group
addicted to pharmaceuticals.
The wish to participate in primary and secondary
prevention programs reflects a satisfactory response.
Those who said that they were addicted declared they
needed assistance and presented phrases that appeared
to be a cry for help.
FINAL REMARKS
Although we acknowledge the limitations of this study
since it is preliminary, there are data indicating a group
with a pattern of consumption that implies a risk of
future impairment of physical or mental health of
college students of health-related courses, although
possibly they do not yet present morbid organic or
psychological effects individually. However, a minimum,
but worrisome percentage of “heavy” users was found,
with a pattern of consumption that could already be
impairing the physical and mental health of future
health care professionals.
CONCLUSIONS
Using this methodology a large group of legal drug
users could be identified among college students in
the health-related courses, as well as another small but
worrisome group of illicit drug users.
Among those who declared themselves as
“dependent”, some expressed the wish to participate
in drug use prevention programs.
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