Risk perceptions of cannabis- vs. alcohol-impaired driving among Canadian young people

Abstract

Cannabis-impaired driving (CID) is associated with an increased risk of motor vehicle accidents. A number of studies have reported on the prevalence of CID and/or riding in a vehicle with a cannabis-impaired driver (RCID), which appears to have increased in certain jurisdictions. However, there is little evidence on beliefs and perceptions of risk associated with CID vs. alcohol-impaired driving (AID). This study examined perceptions of CID and AID, prevalence of CID, and associations with cannabis use status. Respondents aged 16–30?years in Canada (n?=?870) were recruited via a commercial panel and completed an online survey in October 2017. Perceptions of risk for CID were significantly lower than those for AID (p?<?.001). Cannabis use status predicted past CID, RCID, and low perceived risk of motor vehicle accidents (p?≤?.01). CID behaviors were prevalent among young people in Canada: over 40% of respondents reported RCID, and 17% reported CID – including over a third of past-year cannabis users. Respondents also reported a lower willingness to intervene (p?<?.001) and reduced likelihood of legal consequences (p?<?.001) of CID compared to AID. These perceptions may be important barriers to reducing CID and should be prioritized in public education campaigns targeting both youth and young adults.     

Psychological Risk Factors for Alcohol,Cannabis, and Various Tobacco Use among Young Adults: A Longitudinal Analysis

Background: Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing. Objectives: This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors. Methods: Data from a 2-year longitudinal study of 2,397?US college students (aged 18–25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist. Results: Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.     

Profiles of alcohol- and marijuana-impaired adolescent drivers

The aim of the study was to identify risk factors that distinguish alcohol-impaired and marijuana-impaired drivers from non-impaired drivers, among adolescents with a history of using these substances. An anonymous questionnaire was administered to 6594 seventh- to twelfth-grade students in nine Ohio public school districts. Data analyses were conducted on the 11th to 12th grade sub-sample that had prior experience of alcohol (n?=?1378) and/or marijuana use (n?=?678). Logistic regression analyses confirmed that the involvements in alcohol-impaired and marijuana-impaired driving were both associated with higher levels of use of these two drugs. However, the profiles of these two risk behaviors were relatively distinct. Boyfriend/girlfriend alcohol use, hours spent at a job, race, family structure, and academic performance also had significant, independent relationships with the two driving practices. To effectively deter impaired driving among adolescents, prevention efforts must address the social context of adolescent alcohol and marijuana use.     

Is Major Depression Linked to Alcohol-Impaired Driving?

Background: Alcohol-impaired driving causes a substantial proportion of motor vehicle accidents. Depression is a prevalent psychiatric disorder among drinker-drivers. Few previous studies have investigated the relationship between major depression and alcohol-impaired driving. Objectives: We investigated whether depression has a positive relationship with the probability of alcohol-impaired driving after controlling for the co-occurrence of binge drinking and alcohol dependence. Methods: Our data consisted of drinkers aged 21–64 years from two waves of the National Epidemiologic Survey of Alcohol and Related Conditions. Cross-sectional analysis investigated whether depression is an independent risk factor for drinking-driving. Longitudinal analysis distinguished the relationship of depression onset, continuance, and recovery with changes in drinking-driving behaviors between the waves. These dual approaches allowed comparisons with previous studies. Results: Major depression was a small but statistically significant predictor of changes in alcohol-impaired driving behaviors among males but not females. Binge drinking and alcohol dependence were comparatively stronger predictors. Conclusions/Importance: There is limited empirical support that treating depression reduces drinking and driving in males who do not exhibit symptoms of alcohol use disorders. For persons with co-occurring depression and alcohol use disorders, depression treatment should be part of a strategy for treating alcohol use disorders which are highly related to drinking and driving.     

Substance Use in Young Swiss Men: The Interplay of Perceived Social Support and Dispositional Characteristics

Background: Social environment plays a central role in substance use behaviors. However, it is not clear whether its role varies as a function of individual dispositional characteristics. Objectives: To investigate the interaction between dispositional characteristics (i.e. sensation seeking, anxiety/neuroticism) and social environment (i.e. perceived social support [PSS]) in association with substance use. Methods: A representative sample of 5,377 young Swiss males completed a questionnaire assessing substance use, sensation seeking, anxiety/neuroticism, and PSS from friends and from a significant other. Results: Sensation seeking and anxiety/neuroticism were positively related to most substance use outcomes. PSS from friends was significantly and positively related to most alcohol and cannabis use outcomes, and significantly and negatively associated with the use of hard drugs. PSS from a significant other was significantly and negatively associated with most alcohol and cannabis use outcomes. The associations of sensation seeking with drinking volume, alcohol use disorder and the use of illicit drugs other than cannabis were stronger in individuals reporting high levels of PSS from friends than those with low levels. The associations of sensation seeking with risky single-occasion drinking and the use of hard drugs were weaker in participants reporting high levels of PSS from a significant other than in those with low levels. Conclusions: Sensation seeking and anxiety/neuroticism may constitute risk factors for substance use and misuse. PSS from friends may amplify the risk for alcohol and illicit drug use (other than cannabis) associated with high sensation seeking, whereas the PSS from a significant other may reduce it.     

The Role of Acculturation and Alcohol Problems on Frequency of Cannabis Use Among Latinas at Risk of an Alcohol-Exposed Pregnancy

Background: Along with alcohol, cannabis is one of the most commonly used substances among women of childbearing age. Recent studies indicate detrimental effects of prenatal cannabis use. Because many women use these substances before realizing they are pregnant, these serious health consequences for women and their offspring are of great concern. Despite the recent upsurge in cannabis use, little is known about individual and sociocultural factors that may contribute to risk of a cannabis-exposed pregnancy, particularly among Latinas of child-bearing age also at risk of an alcohol-exposed pregnancy (AEP). Objectives: Examine the relationships of acculturation, alcohol use, alcohol problems, and psychological distress with frequency of cannabis use among adult Latinas at risk of an AEP. Methods: The hypothesized model included 76 Latinas and was analyzed using path analysis. The study used baseline data from a randomized controlled trial of an intervention targeting risky drinking and tobacco use among women at risk of an AEP in primary care clinics. Results: Greater acculturation was associated with more frequent cannabis use and greater psychological distress. There was a positive indirect relationship between acculturation and alcohol use and alcohol problems through psychological distress. Greater alcohol problems were associated with more frequent cannabis use. Greater psychological distress and alcohol use were indirectly related to more frequent cannabis use through alcohol problems. Conclusions: Findings underscore the critical role of acculturation and alcohol-related problems in cannabis use frequency and have relevant implications for preventive efforts addressing cannabis use among Latinas at risk of an AEP.     

PTSD Symptom Severity,Cannabis, and Gender: A Zero-Inflated Negative Binomial Regression Model

Introduction: In the general population, significant relations have been shown between experienced trauma and cannabis use. Approximately three out of four college students report experiencing at least one-lifetime traumatic event, putting them at greater risk for developing substance use disorder (SUD), and college students report using cannabis to cope with negative effect and stress. However, PTSD symptom severity predicting cannabis use in the college population has not been investigated. Methods: This cross-sectional survey study investigated the relation between PTSD symptom severity and cannabis use, and explored the moderating effect of gender on this relation, using a non-directional, exploratory analysis, in a sample of college students (N?=?536; 68% female). Due to excessive zero values in the primary outcome, a zero-inflated negative binomial regression model was used. Results: Gender predicted number of cannabis using days [incidence rate ratio (IRR) = 2.17; 95%CI = 1.41, 3.35; p < .001]. The probability of being a cannabis user was moderated by gender [odds ratio (OR) = 0.96; 95%CI= 0.93, 0.99; p?=?.026], such that for males, as PTSD symptom severity increased, likelihood of being a cannabis user increased. This relation was not supported in females, however. Conclusion/Implication: Discussion includes the potential role of the endocannabinoid system, social norms, and motives in gender differences in PTSD-related cannabis use, and explores the self-medication hypothesis in this context.     

Multisubstance Use Among Treatment-Seeking Smokers: Synergistic Effects of Coping Motives for Cannabis and Alcohol Use and Social Anxiety/Depressive Symptoms

Objective: This study examined the impact of coping motives for cannabis and alcohol use on the relation between social anxiety/depressive symptoms and severity of substance use for alcohol, tobacco, and cannabis among treatment-seeking smokers who also use cannabis and alcohol. Methods: The sample included 197 daily cigarette smokers (M_Age 34.81 years, SD = 13.43) who reported using cannabis and alcohol. Results: Hierarchical multiple regression analyses were conducted wherein separate models were constructed for each dependent variable. Among individuals with higher social anxiety, alcohol coping motives were associated with heavier drinking, and this was more pronounced among those low in depressive symptoms. Similarly, those at greater risk for nicotine dependence were anxious individuals with lower depressive symptoms who endorse coping-oriented motives for using cannabis. Further, among those with higher social anxiety, cannabis coping motives were associated with marginally greater drinking, particularly for those high in depressive symptoms. Conclusions: The present findings support the perspective that among multisubstance users, the interplay between social anxiety, depressive symptoms, and coping-oriented motives for using one substance (e.g., cannabis or alcohol) may pose difficulties in refraining from other substances (e.g., tobacco). This observation highlights the importance of tailoring multisubstance treatments to specific needs of multiusers for whom single-substance interventions may be less effective. Findings also support previous work exploring the benefits of concurrently treating co-occurring substance use and lend credence to the perspective that motivation to use substances for coping reasons is of central theoretical and clinical relevance.     

Interpersonal Guilt and Substance Use in College Students

Background: The college years are a time for developing independence and separating from one's family, and they are also a time in which substance use often escalates. This study examined the relationships between use of substances and interpersonal guilt, an emotion that can arise from feelings about separation among college students. Methods: In total, 1865 college students completed a survey evaluating substance use and interpersonal guilt. Regular users of alcohol, cigarettes, cannabis, and other illicit drugs were compared with nonregular users of each substance. Sequential linear regression, controlling for confounding variables, examined relationships between regular use of each substance and scores on a guilt index. Results: Risky drinkers and daily smokers had significantly more interpersonal guilt than their peers who did not regularly use these substances. In contrast, regular cannabis users had significantly less guilt than nonregular cannabis users. Conclusions: These data suggest that substance use among college students may be related to interpersonal guilt and family separation issues, and this relationship may vary across substances.     

Cannabis-Related Problems and Social Anxiety: The Mediational Role of Post-Event Processing

Background: Cannabis is the most commonly used illicit drug in the US, and is associated with a range of psychological, social, and physical health-related problems. Individuals who endorse elevated levels of social anxiety are especially at risk for experiencing cannabis-related problems, including cannabis use disorder, despite not using cannabis more often than those with more normative social anxiety. Identification of mechanisms that underlie the relationship between social anxiety and cannabis-related problems may inform treatment and prevention efforts. Post-event processing (PEP, i.e., cognitively reviewing past social interactions/performances) is a social anxiety-related phenomenon that may be one such mechanism. Objectives: The current study sought to test PEP as a mediator of the relationship between social anxiety and cannabis-related problems, adjusting for cannabis use frequency. Method: Cannabis-using (past 3-month) undergraduate students recruited in 2015 (N = 244; 76.2% female; 74.2% Non-Hispanic Caucasian) completed an online survey of cannabis use, cannabis-related problems, social anxiety, and PEP. Results: Bootstrap estimate of the indirect effect of social anxiety through PEP was significant, suggesting PEP is a mediator of the social anxiety–cannabis-related problems relationship. Conclusions/Importance: Treatment and prevention efforts may benefit from targeting PEP among individuals with elevated social anxiety and cannabis-related problems.     

Social anxiety and alcohol use: The role of alcohol expectancies about social outcomes

Though social anxiety disorder and alcohol use disorders commonly co-occur, the mechanisms involved in social anxiety and hazardous drinking among college students are not well understood. The current study contributes to the emerging literature on social anxiety and college drinking as the first known study to test how positive (e.g. “I would feel at ease in social situations”) and negative (e.g. “I would make a fool out of myself”) alcohol outcome expectancies (AOE) specific to social situations (social AOE) impact the association between social anxiety and hazardous alcohol use among 718 undergraduates (61% women; M_age?=?19.50, SD?=?1.45; 85% White). Results supported the mediation, but not the moderation models. There were positive indirect effects of social anxiety through positive social AOE and negative indirect effects of social anxiety through negative social AOE on both hazardous drinking outcomes (i.e. alcohol consumption and alcohol problems). Findings suggest that there could be competing pathways for increasing (positive social AOE) and decreasing (negative AOE) risk for hazardous alcohol use in socially anxious college students.     

Book Review of The United States and International Drug Control, 1909–1997. By David R. Bewley-Taylor London & New York: Continuum International Publishing Group, 250 pp. £25.00. ISBN 0 8264 5813 0

Cannabis use is increasingly prevalent among young adults in Canada. Due to cannabis’ impairment effects, driving under the influence of cannabis has recently developed into a traffic-safety concern, yet little is known about the specific circumstances and factors characterizing this behavior among young people. In this study, we interviewed a sample of university students (n?=?45; age 18–28 years) in Toronto who had driven a car after cannabis use in the past year. The study collected information on respondents’ sociodemographic characteristics, cannabis and other drug use, cannabis use and driving (CUD) experiences, law enforcement and accident exposure, perceptions of cannabis and alcohol impairment effects as well as future anticipated substance use and driving behaviors. Results indicated that: CUD originated primarily from social settings; that impairment risks from cannabis were perceived to be low; and that the level of anticipated future CUD was high. Furthermore, high frequency of CUD in the past year was associated with high frequency of cannabis use. Interventions aiming at CUD among young people need to be anchored in the specific sociocultural settings of this behavior; targeted information needs to address cannabis’ impairment potential for driving; possibilities for harm-reduction measures for CUD need to be considered.     

Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity

Background: Harmful alcohol use is associated with disease and mortality. Identifying new determinants of harmful drinking may aid the 16.3 million adults who have alcohol use disorders. Childhood adversity is associated with alcohol use, but is not amenable to change. Attachment insecurity (anxiety and avoidance) may be associated with alcohol use and may be a target for modification or used to personalize interventions. Objectives: This study aims to (a) identify the association between attachment insecurity and harmful drinking, (b) determine if attachment insecurity may mediate between childhood adversity and harmful drinking, and (c) test sex as a moderator between attachment insecurity and harmful drinking in the mediation relationship. Methods: Adult primary care patients (N = 348, 60% women) completed a cross-sectional survey study using validated measures in 2012. Statistical analyses were performed using Hayes's PROCESS macro in SPSS. Results: Childhood adversity was reported by 61% of the cohort and 18% endorsed harmful drinking. Attachment anxiety was associated with harmful drinking (p >.001), but attachment avoidance was not (p =.11). Attachment anxiety may mediate between childhood adversity and harmful drinking (95% CI:.03–.14). Sex did not moderate the relationships between attachment anxiety and harmful drinking in the mediation relationship (women: 95% CI:.031–.179; men: 95% CI:.003.–.182). Conclusions/Importance: Attachment anxiety may mediate between childhood adversity and harmful drinking in both men and women. Attachment anxiety may be a potential therapeutic target for people with a history of childhood adversity.     

Population-Based Associations Among Cannabis Use,Anxiety, and Depression in Norwegian Adolescents

Objective: The aim of the study was to explore the use of cannabis among Norwegian adolescents and examine associations with self-reported symptoms of anxiety and depression, age, and dose/frequency of use. Methods: A total of 36,714 Norwegian adolescents between the ages of 13 and 17 completed a cross-sectional national survey. Results: Cannabis users reported significantly more symptoms of anxiety and depression compared to non-users. There were no significant differences on anxiety and depression scores between those who had tried the drug once and those who had tried it six times or more. Both cannabis use and the prevalence of symptoms of anxiety and depression were found to increase with age. Girls reported less use of cannabis and slightly more symptoms of anxiety and depression compared to boys. Conclusions: The present study contributes to the existing knowledge about important associations between cannabis use and symptoms of anxiety and depression in adolescents. Future research should focus on longitudinal methods in order to better understand the role of environmental and neurobiological explanatory factors.     

Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis,Tobacco, and Other Drug Use?

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n?=?4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.     

Posttraumatic Symptomatology and Alcohol Misuse Among Black College Students: Examining the Influence of Anxiety Sensitivity

Objective: Posttraumatic stress symptoms (PTSS) have been found to be associated with alcohol (mis)use among college students. Anxiety sensitivity has been theoretically and empirically linked to both PTSS and alcohol (mis)use. The goal of the present study was to extend research by examining the relations among PTSS, anxiety sensitivity, and alcohol misuse within a sample of trauma-exposed Black college students. Methods: Participants were 121 Black undergraduate college students who endorsed exposure to a traumatic event (M age = 22.98, 77.7% female). Results: Correlational findings provide support for significant positive relations between PTSS and both anxiety sensitivity and alcohol misuse. Further, analyses revealed a significant indirect effect of anxiety sensitivity on alcohol misuse through PTSS. Specifically, greater anxiety sensitivity was associated with higher levels of PTSS, which, in turn, were associated with higher levels of alcohol misuse. Conclusions: These findings suggest that the assessment of anxiety sensitivity may be useful in identifying trauma-exposed Black individuals who are likely to experience alcohol misuse and the clinical utility of addressing PTSS in this population reporting anxiety sensitivity to possibly prevent alcohol misuse and related negative consequences.     

Alcohol and cannabis use among college students: Substitutes or complements?

AimsEconomists debate whether changes in availability of alcohol or cannabis are positively or negatively related to changes in use of the other substance. Implicit in these arguments are two competing, individual-level hypotheses—that people use alcohol and cannabis either as complements or substitutes for one another. This is the first study to test these hypotheses using micro-longitudinal data on individuals' alcohol and cannabis use on a given evening.MethodsUnited States college students who use alcohol and cannabis (n = 876) were selected from a larger sample who participated in a 30-day online daily diary study. At baseline, students reported their proclivity to use alcohol/drugs to cope with stress. Each day students reported their level of alcohol use from the prior evening as well as whether they had used cannabis.ResultsEvening levels of alcohol use and mean levels of alcohol use positively predicted the likelihood of evening cannabis use, results indicative of complementary use. This relation, however, was moderated by coping style, such that students who were more likely to use alcohol/drugs to cope were less likely to use cannabis as their evening or mean alcohol use levels increased, results indicative of substitution.ConclusionsSubstance-using college students showed evidence for complementary alcohol and cannabis use at both the within- and between-person levels. Students with a proclivity toward using alcohol/drugs to cope, however, showed evidence of substitution. These findings suggest that studies based on economic theories of substance use should take into account individual differences in substance use motives.     

A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions

The existing literature on the prevalence of drug driving, the effects of drugs on driving performance, risk factors and risk perceptions associated with drug driving was reviewed. The 12-month prevalence of drug driving among the general population is approximately 4%. Drugs are detected commonly among those involved in motor vehicle accidents, with studies reporting up to 25% of accident-involved drivers positive for drugs. Cannabis is generally the most common drug detected in accident-involved drivers, followed by benzodiazepines, cocaine, amphetamines and opioids. Polydrug use is common among accident-involved drivers. Studies of impairment indicate an undeniable association between alcohol and driving impairment. There is also evidence that cannabis and benzodiazepines increase accident risk. The most equivocal evidence surrounds opioids and stimulants. It is apparent that drugs in combination with alcohol, and multiple drugs, present an even greater risk. Demographically, young males are over-represented among drug drivers. Although there is an association between alcohol use problems and drink driving, it is unclear whether such an association exists between drug use problems and drug driving. Evidence surrounding psychosocial factors and driving behaviour is also equivocal at this stage. While most drivers perceive drug driving to be dangerous and unacceptable, there is less concern about impaired driving among drug drivers and drink drivers than from those who have not engaged in impaired driving. Risk perceptions differ according to drug type, with certain drugs (e.g. cannabis) seen as producing less impairment than others (e.g. alcohol). It is concluded that drug driving is a significant problem, both in terms of a general public health issue and as a specific concern for drug users. [Kelly E, Darke S, Ross J. A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions. Drug Alcohol Rev 2004;23:319-344]     

Changes in Drug Use Among Belgian Higher Education Students: A Comparison Between 2005, 2009, and 2013

Background: Most drug users initiate illicit drug use during adolescence and young adulthood. Although in the general population a trend towards a decrease in drug use can be seen, patterns of drug use among students are unclear. Objectives: The objective of the study was to look at drug use patterns among students in higher education in Belgium. Methods: A survey study in Antwerp (Belgium) was conducted on three occasions (2005, 2009, and 2013) at several institutes for higher education. Students (total sample size 24,478; 29,210, and 31,950, respectively) were asked if they had used legal or illicit drugs in the past year. To compare whether drug use differed between the separate years, χ²-tests were performed on past-year drug use for all three time points. If significant, χ²-tests between pairs were performed. Gender and age differences were also analyzed. Results: The use of nondistilled alcohol, spirits, and cannabis decreased during this period but no change in student's use patterns was seen for beer, wine, sedative hypnotics, stimulating medication, XTC, cocaine, or amphetamines. Tobacco use decreased initially, but increased in 2013. More men indicated having used drugs in the past year than women. Only for cannabis did more younger students indicate having used in the past year. Conclusions/Importance: The data from this study could provide valuable insights for academic and governmental bodies and health care professionals into the use of drugs by higher education students since this subgroup shows specific use patterns.     

Drug Use in a Rural Secondary School in Kenya

ABSTRACT

Alcohol abuse and alcohol-related use problems among adolescents are highly prevalent and are a major concern worldwide. This study estimated the prevalence of drug abuse, knowledge about drug abuse and its effect on psychosocial well-being and induced behavioral problems among students of a public rural secondary school that admitted both girls and boys which offered both boarding and day school facilities. The students filled out a self-reporting substance use tool which measures the prevalence, frequency, and general patterns of substance use. Alcohol, tobacco, khat (catha edulis) and bhang (cannabis) were the most commonly reported substance of use, with user prevalence rates of 5.2%, 3.8%, 3.2%, and 1.7%, respectively. Tobacco use was initiated at 10 years, while cannabis, hard drugs, khat, and alcohol were initiated at 11, 12, 13, and 15 years of age, respectively. Among the students 71% were aware that their schoolmates were on drugs and it was known by 49.8%, 41.7%, 37.6%, 44.3%, and 32.4% of these students that using alcohol, tobacco, khat, cannabis, and hard drugs, respectively was a behavioral problem in the school. Three quarters of the students were aware that use of drugs was harmful to their health, with majority (78.6%) indicating that drug users need help to stop the drug use behavior. However most (73.6%) of the students suggested drug users in school should be punished. The drug use behavioral problems included school dropout, poor scholastic attainment, drunken driving, delinquency, and adolescence pregnancy which threaten the stability of the education system, family as an institution (family difficulties) and society at large. Therefore, teachers have an added burden of playing an active role in guidance and counselling the survivors of drug abuse, a pandemic facing teaching institutions apart from instilling knowledge.