research on drug abuse in ghana

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• Published: 29 February 2024

Prevalence, correlates, and reasons for substance use among adolescents aged 10–17 in Ghana: a cross-sectional convergent parallel mixed-method study

• Sylvester Kyei-Gyamfi 1 ,
• Frank Kyei-Arthur 2 ,
• Nurudeen Alhassan 3 ,
• Martin Wiredu Agyekum 4 ,
• Prince Boamah Abrah 5 &
• Nuworza Kugbey 2 , 6  

Substance Abuse Treatment, Prevention, and Policy volume  19 , Article number:  17 ( 2024 ) Cite this article

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Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10–17 in Ghana.

Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8–17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children’s rights and wellbeing. Overall, 4144 adolescents aged 10–17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson’s chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.

The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10–13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.

Conclusions

There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

Adolescence is a developmental phase associated with a greater risk of experimenting and using substances such as alcohol, cannabis and tobacco [ 1 ]. Substance use among adolescents is of major public health concern because of the short-and long-term effects on their health and safety as well as the broader negative social consequences [ 2 , 3 , 4 ]. Specifically, substance use is associated with an increased risk of road traffic accidents, violence, sexual risk-taking (such as unprotected sex), mental health disorders (including learning disorders) and suicide. While substance use among adolescents is not new in Ghana, there is evidence of the rising prevalence of some substances and the use of ‘new substances’ (such as tramadol), which have greater intoxicating effects [ 5 ]. According to Kyei-Gyamfi et al. [ 5 ], about 7% of children aged 8–17 in Ghana are lifetime users of alcohol.

In Ghana, multiple laws forbid and govern the use and sale of substances to individuals under 18. For instance, the sale of tobacco products to individuals under the age of 18 is regulated by the Tobacco Control Regulations 2016 (L. I. 2247) [ 6 ] and the Public Health Act, 2012 (Act 851) [ 7 ]. Specifically, the Public Health Act, 2012 (Act 851) forbids smoking tobacco products in public places and advertisements on tobacco products. In Ghana, anti-smoking campaigns, such as the SKY Girls campaign, employed diverse channels, including school and community activities, films, and social media, to dissuade adolescents from smoking [ 8 , 9 ]. The Food and Drugs Authority guidelines for the advertisement of foods [ 10 ] stipulate that advertisements for alcoholic beverages should not appeal to or target individuals under 18. Consequently, the Food and Drugs Authority is responsible for examining and authorising all advertisements related to alcoholic beverages. In addition, alcoholic beverage companies are prohibited from selling or providing their products as prizes for sponsorship programmes at educational institutions.

Also, the Liquor Licensing Act 1970 (Act 331) [ 11 ] regulates the sale of alcoholic beverages to individuals under 18. Act 331 also stipulates that individuals under 18 should not be permitted to enter or be found in any premises where alcoholic beverages are sold. Furthermore, the Narcotic Drugs (Control, enforcement and Sanctions) Act, 1990 (P.N.D.C.L. 236) [ 12 ] forbids the utilisation of narcotic drugs by any individual without legal authorization, including children.

While a body of research exists on substance use in Ghana, it is essential to acknowledge some limitations associated with these studies. First, these studies have mainly used a type of substance to measure substance use (e.g., alcohol use, tobacco use, and shisha use) [ 2 , 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. For instance, Kugbey’s [ 2 ] study measured substance use among adolescents using alcohol use, amphetamine use, and marijuana use. Similarly, Asante and Nefale [ 18 ] estimated substance use using alcohol use, cigarette use, marijuana use, glue, heroin, and amphetamine. To the best of our knowledge, no study in Ghana has used varieties of substance use as a composite variable to measure substance use. Second, most studies have focused on in-school adolescents [ 2 , 13 , 14 , 15 , 16 ]. Third, few studies have interrogated the various sources and outlets where adolescents procure substances [ 5 ]. Therefore, this study examined the prevalence, correlates and reasons for substance use as well as the outlets where such substances are procured among adolescents aged 10–17 in Ghana.

Data and sample

The study employed secondary data as the primary source of information. The data was acquired from the Department of Children within the Ministry of Gender, Children, and Social Protection in Ghana, which employed a cross-sectional convergent parallel mixed-method technique to collect quantitative and qualitative data from children aged 8–17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children rights and wellbeing. A convergent parallel mixed-method technique enables the simultaneous gathering and examination of quantitative and qualitative data [ 20 ]. The secondary data cover several topics, including children’s rights, substance use, employment, and sexual and reproductive health. This study focused on substance use.

The quantitative data in this study was obtained using a multi-stage sampling procedure to select respondents. In 2018, a sample of 20% of the total 216 districts in Ghana was chosen, with the selection criteria focusing on child welfare issues, such as child rights and child protection. As a consequence, a total of 43 districts were chosen. Furthermore, 645 enumeration areas were selected by choosing 15 enumeration areas in each of the selected 43 districts. Moreover, the study involved the selection of children between the ages of 8 and 17 residing in households within each enumeration area. In each household, it was ensured that just one child between the ages of 8 and 17 was selected for the interview. However, this study focused on adolescents aged 10–17. Overall, 4144 adolescents aged 10–17 were interviewed for the study. Figure  1 is an organisational flow of the multi-stage sampling procedure for the quantitative data collection. The inclusion criteria for children to participate in the study were: they must be aged 8–17, be a member of eligible households in selected EAs, must consent and be willing to participate, and parents/legal guardians must consent for them to participate in the study.

Multi-stage sampling procedure for the quantitative data collection

In order to gather qualitative data, ten focus group discussions (FGDs) were carried out with adolescents aged 10 to 17 years at locations convenient for them. Each FGD consisted of 8–10 participants, encompassing male and female adolescents across various age groups. Overall, 92 adolescents aged 10–17 participated in the ten FGDs. Topics covered in the FGDs included the types of substances adolescents use, where adolescents get substances to use, and the reasons for the use of substances.

The study was approved by the National Child Protection Committee of the Department of Children of the Ministry of Gender, Children, and Social Protection. Adolescents gave their written informed consent before trained research assistants interviewed them. Also, research assistants received written informed consent from parents or legal guardians of eligible adolescents before interviewing them. Experienced research assistants proficient in mixed-method data collection were enlisted and underwent a comprehensive training session on the data collection tools, as well as the objectives and significance of the study. Further information regarding the sampling process might be obtained in prior studies [ 21 ].

Study variables

Dependent variable.

Substance use was the dependent variable for this study. It was a composite variable computed using two questions, “Have you ever taken alcohol?” and “Have you ever taken drugs?”. Respondents who responded “Yes” to either or both questions were classified as engaging in substance use.

Independent variables

The independent variables were sex (Male and Female), age (10–13 and 14–17), education (Less than Junior High School (JHS), JHS, and Senior High School (SHS) and higher), marital status (married and not married), religion (Christianity, Islam, and Other), and currently doing any paid work (Yes and No). The region of residence of respondents was recoded into three (3) ecological belts: Coastal ecological belt (Western, Central, Greater Accra, and Volta regions), Middle ecological belt (Eastern, Ashanti and Brong Ahafo regions), and Northern (Northern, Upper East and Upper West regions) ecological belt.

Statistical analyses

The Statistical Package for the Social Sciences (SPSS) version 26 was used to perform the statistical analyses for the quantitative data. Descriptive statistics was used to describe the socio-demographic characteristics of respondents and the types of substances respondents use. Pearson’s chi-square test was used to examine the association between substance use and socio-demographic characteristics of respondents. A multivariable binary logistic regression was performed to examine the correlates of substance use. All variables in the quantitative data were determined to be statistically significant at p-value ≤ 0.05.

QSR NVivo version 10 software was used to analyse the qualitative data thematically. The researchers examined all transcripts to gain insights into respondents’ viewpoints regarding substance use among adolescents. Subsequently, the transcripts were thoroughly examined, and utterances pertaining to the substance usage of the adolescents were systematically categorised using codes. Sub-themes were identified from the identification and grouping of similar codes found within the transcripts. Moreover, the process involved clustering comparable sub-themes to generate overarching themes.

Socio-demographic characteristics of respondents

The socio-demographic characteristics of respondents are displayed in Table  1 . A little more than half of the respondents (50.7%) were males, while most were Christians (76.4%). Most respondents were unmarried (98.9%) and currently not engaged in any paid work (95.2%). Among those currently working, a higher proportion were males (68.3%) than females (31.7%) (See Table S1 in the supplementary material).

More than half of respondents (53.0) were aged 15–17. Also, 3 out of 10 respondents (30.5%) had attained less than JHS education, and about two-fifths (39.6%) resided in the Middle ecological belt.

Prevalence of substance use

The prevalence of substance use was 12.3% (95% CI = 11.34 − 13.37%) (Table  1 ). In terms of sex, a greater proportion of males (15.8%) engaged in substance use than females (8.8%, p  ≤ 0.001). More respondents aged 15–17 (18.1%) engaged in substance use than those aged 10–13 (5.9%, p  ≤ 0.001). It can be observed that respondents’ education was positively associated with the prevalence of substance use ( p  ≤ 0.001). Most respondents with SHS and higher education (19.2%) engaged in substance use, followed by those with JHS (12.0%) and less than JHS (5.7%) education. Also, most respondents who resided in the Coastal ecological belt (16.6%, p  ≤ 0.001) and those who are currently doing paid work (28.1%, p  ≤ 0.001) engaged in substance use.

Regarding the type of substance respondents use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances (Table  2 ). About 7% of respondents (6.5%) used tramadol, and 4.8% used marijuana. Other substances respondents used include codeine (1.7%), cocaine (1.5%), shisha (1.2%), and heroin (1.0%).

Generally, more male adolescents used all types of substances than female adolescents. For instance, of those adolescents who used codeine, 90% were male, and of those who used tramadol, 86.8% were male. Similarly, older adolescents (14–17 years) generally used all types of substances than younger adolescents (10–13 years), except heroin. For instance, about 9 out of 10 older adolescents (89.5%) used tramadol, while 88.3% used cigarettes. However, more younger adolescents (66.7%) used heroin than older adolescents (33.3%).

Correlates of substance use

From Table  3 , males (AOR = 2.117, 95% C.I. = 1.731–2.589, p  ≤ 0.001) and respondents who are currently working (AOR = 1.821, 95% C.I. = 1.295–2.560, p  = 0.001) were more likely to engage in substance use. However, respondents aged 10–13 (AOR = 0.333, 95% C.I. = 0.232–0.478, p  ≤ 0.001) and residing in the Middle (AOR = 0.510, 95% C.I. = 0.409–0.636, p  ≤ 0.001) and Northern (AOR = 0.597, 95% C.I. = 0.451–0.790, p  ≤ 0.001) ecological belts were less likely to engage in substance use.

Where respondents get substance

During the FGD with respondents, issues were discussed regarding where children get their substance. Four themes emerged: (a) supplies from their peers, (b) household members who also use substances, (c) purchasing from drug stores, and (d) purchasing from drug peddlers.

(A) supplies from peers

Respondents explained that friends with connections can provide access to illicit substances. They explained that most adolescents who engage in substance use are extremely cautious when searching for their drug of choice, as they are aware that the simplest act of irresponsibility will get them in trouble. As a result, they rely on their peers who also engage in substance use since they can trust them.

Most drug-using young people only associate with peers who also use drugs. Through this, they can establish a network, gain each other’s trust, and obtain supplies, as suppliers find it convenient to give substances to trustworthy individuals. Once a member obtains supplies, they may distribute them within their respective circles. (FGD 1)

(B) household members who use substances

Household members who engage in substance use also serve as suppliers of substances. It was found that some adolescents obtain substances from their siblings, uncles, and other household members who also use substances. One participant explained this phenomenon:

”My first taste of whisky came from my older brother’s room. Since I frequently observe him drinking before meals, I decided to try it one day, and it has since become my primary source of alcohol. Some of my smoking acquaintances obtain their supplies from their brothers, too. (FGD 2)”.

(C) purchasing from drug stores

The FGDs with adolescents revealed that some adolescents acquire tramadol from small medicinal retail outlets known as ‘drug stores’. Adolescents explained that acquiring such medications from a pharmacy is risky due to the possibility of being tracked down for drug use. A participant explained:

When customers enter small drugstores in densely populated communities, they are rarely asked what they intend to use the medication for. Not so with pharmacies, which are well-established and staffed by licenced pharmacists. Due to this, some adolescents purchase codeine and tramadol from them to avoid getting caught. (FGD 3)

(D) purchasing from gangs

Adolescents’ narratives highlighted that they purchase substances from gangs, who often get their supplies from drug peddlers. However, the gangs only sell to individuals they know and can vouch that they may not expose them to the police. Adolescents explained that one must be known to be a reliable client before buying from a gang. These gangs are not at specific locations but operate in areas noted for substance use.

Drug peddlers who occasionally offer marijuana do not sell to adolescents. Typically, an adult member of a gang buys it and distributes it around the groups, usually on the basis that he receives a free supply, while adolescents or underage members provide monies for the purchase of the marijuana. (FGD 4)

Reasons for substance use

Adolescents narrated varied reasons for using substances. Five themes emerged: (a) substance use is fun, (b) use of substances as an aphrodisiac, (c) boosts confidence to approach the opposite sex, (d) forgetting anxieties, and (e) substance use makes one popular and being perceived as the finest.

(A) substance use is fun

For some adolescents, substance use is fun. Occasionally, meeting friends, drinking, and smoking add spice to the entertainment of adolescents. One of the adolescents described how he has enjoyed drinking with his neighbourhood friends over the years:

The greatest time of my life is when my friends and I assemble at drinking places [pubs], listen to music, dance to some songs, consume alcohol, smoke, and party. Life is great when unwinding with friends. (FGD 5)

(B) use of substances as an aphrodisiac

During the FGD, it emerged that the use of tramadol, also known as ‘Tramol’, has become widespread among many adolescents in the country’s urban communities since it serves as an aphrodisiac, which enhances their sexual performance. One adolescent stated:

Boys who use Tramol in my area claim that it allows them to have long-lasting sexual intercourse with their partners whenever they have sex. As a result, many adolescents use Tramol as an aphrodisiac. (FGD 6)

(C) boosts confidence to approach the opposite sex

Some adolescents believe that when they use substances, it boosts their confidence to approach the opposite sex. They use substances to overcome their shyness to approach the opposite sex. Below is the narrative of a respondent:

Some of the boys drink alcohol or even smoke marijuana because they may lack the confidence to approach a girl they are interested in. However, they firmly believe that by using drugs, they will become high and be better positioned to accomplish their goal of flirting with the girls. (FGD 7)

(D) forgetting anxieties

The FGD with adolescents revealed that some adolescents use substances to help them forget about their anxieties about the lack of employment opportunities, educational opportunities, and other family issues. One participant explained why he has been drinking:

I finished Polytechnic and have been home for two years without a job. Most of my peers are in similar situations, so when we get together, those of us with money purchase drinks and split them amongst ourselves so we can commiserate and console ourselves about our jobless situations. (FGD 8)

(E) substance use makes one popular and being perceived as the finest

Adolescents revealed that some adolescents have the misconception that engaging in substance use makes them popular and perceived as the ‘finest’ [best] in their peer group. The following were the sentiments expressed:

Most children who smoke cigarettes and marijuana believe they become popular with their peers and are highly regarded as the finest guys in their group when they smoke. Many boys and girls of my age group are influenced to indulge in substance use due to the widespread prevalence of these misconceptions. (FGD 9)

Although there have been many studies conducted on substance use in Ghana, only a limited number of these studies have utilised multiple types of substances to assess substance use. Moreover, most of these studies have concentrated on adolescents attending school. At the same time, only a limited number of studies have examined the diverse channels and locations through which adolescents obtain substances. To close this disparity in knowledge, this study examined the prevalence, correlates and reasons for substance use as well as the outlets where such substances are procured among adolescents aged 10–17 in Ghana. The findings of this study would contribute to the literature on substance use, and it would help to inform policymakers in providing programmatic responses to address substance use among adolescents, which has long-term health implications for their lives.

We found that the prevalence of substance use among adolescents was 12.3%. The prevalence of substance use in this study is higher than that of 6.6% found in 7.2% in Uganda [ 22 ] and 11.3% in sub-Saharan Africa [ 2 ]. In contrast, the prevalence of substance use in this study is lower than 16.0% in India [ 23 ], 17.1% in Southern Brazil [ 24 ], 32.9% in Nigeria [ 25 ], and 48% in South Africa [ 26 ]. A study in Northern Tanzania reported a lifetime and current prevalence of substance use of 19.7% and 12.8%, respectively [ 27 ]. The variation in the prevalence of this study and other studies could be attributed to the sample size of adolescents, socio-cultural factors, demographic characteristics, age of adolescents and the types of substance use that were considered in each study. For instance, Mavura et al. [ 27 ] considered alcohol, cigarette smoking, marijuana, khat, and recreational drugs (cocaine, heroin) in their study, while in this study, we considered alcohol, smoking and drugs (Marijuana, heroin, cocaine, codeine and tramadol). In addition, the differences in the age of adolescents could account for the variations in the prevalence of substance use among adolescents. In this study, we considered adolescents aged 10–17. However, Kugbey’s [ 2 ] study participants were aged 11–18, while Mmereki et al.’s [ 26 ] study participants were aged 13–21.

The results of this study show that alcohol was the most common substance used among adolescents, followed by smoking (cigarettes), tramadol, marijuana, codeine, cocaine, shisha and heroine. The findings of this study are similar to a study by Mavura et al. [ 27 ], who reported alcohol as the common substance use by adolescents in Tanzania. Similar findings were found by Anyanwu et al. [ 25 ] in Nigeria, Birhanu et al. [ 28 ] in Northwest Ethiopia, and Olawole-Isaac et al. [ 29 ] in Sub-Saharan Africa. The probable reason for the high prevalence of alcohol use may be attributed to the visibility and advertisement of alcohol in Ghana, which may entice adolescents to drink. Akesse-Brempong and Cudjoe [ 30 ] argued that there is a pervasive and robust advertising campaign promoting the consumption of alcoholic beverages in Ghana, which has the potential to influence adolescents to consume alcohol. Aside from the advertisement, there are more drinking spots where adolescents can easily access any alcoholic beverage. Hormenu et al. [ 14 ] reported that in Ghana, about 42.3% of adolescents have ever consumed alcohol. It is, therefore, not surprising that alcohol was the major substance used by adolescents in this study. In addition, studies have identified smoking cigarettes as the second substance adolescents use [ 25 , 27 , 28 ]. In contrast, Srivastava et al. [ 23 ] found the use of tobacco to be higher in India than alcohol.

The findings of the study show that males were more likely to engage in substance use than females, similar to other studies [ 2 , 5 , 28 , 31 ]. The higher use of substances among males may be attributed to gender roles, peer influence and sensation-seeking behaviour, which sometimes forces males to use substances to enable them to behave as they desire [ 28 ]. Iwamoto et al. [ 32 ] reported that substance use, such as alcohol and drugs, shows masculinity, whereas men who do not take alcohol or drugs are considered weak. Men conform to these masculine norms or beliefs, such as “playboy” and “risk-taking and self-reliance”, which increase their risk of substance use. In contrast, engaging in substance use among females is sometimes seen as shameful, and society frowns on it [ 2 ]. Due to this, there could be a situation of underreporting of substance use among adolescent females.

The study results show that adolescents aged 10–13 years were less likely to engage in substance use than those aged 14–17 years. The finding of this study is similar to other studies that reported substance use practice among older adolescents than younger adolescents [ 25 , 26 ]. The probable reason could be that as adolescents grow, they begin to live independent lives by making their own decisions, and this sometimes leads them to engage in unhealthy lifestyles such as drinking alcohol and taking drugs. Older adolescents become susceptible to experimentation with different things, such as drugs and alcohol. Sometimes, this is done out of curiosity or peer pressure from friends as they age [ 25 , 33 ]. However, older adolescents may lack the knowledge and consequences of using these substances, and their continuous use may lead to addiction.

In addition, we found that adolescents who were currently working were more likely to engage in substance use than those who were not working. Adolescents who are working may have the financial resources to purchase substances to use than those who are not working. This finding is similar to previous studies, which found that respondents who were working as vulnerable groups that engaged in substance use [ 23 , 34 , 35 ]. However, this finding is contrary to Masferrer et al. [ 36 ] study, which found substance use is more likely among respondents who are not working.

Furthermore, adolescents residing in the Coastal ecological belt are more likely to engage in substance use than those living in the Middle and Northern ecological belts. Previous studies have found the use of alcohol among persons residing in Coastal areas in Ghana [ 37 ]. Also, the use of tramadol has been documented to be more prevalent in the Greater Accra, Volta, and Western regions, which are found in the Coastal ecological belt [ 38 ]. Kyei-Gyamfi and Kyei-Arthur’s [ 19 ] study on substance smoking in Ghana found cigarette smoking to be more prevalent in the Coastal ecological belt than in the Middle and Northern belts of Ghana. These factors may explain why adolescents living in the Coastal ecological belt are more likely to use substances than those in the Middle and Northern ecological belts.

Consistent with other studies [ 39 , 40 ], the findings of this study revealed various reasons for substance use, such as for fun, as an aphrodisiac, to boost confidence to approach the opposite sex, forgetting anxieties, making one popular and being perceived as the finest. The probable reason for this could be that most adolescents are sometimes shy of approaching the opposite sex. Therefore, they use substances to boost their confidence to approach them. In addition, due to youthful exuberances, adolescents are involved in risky sexual behaviour and, therefore, use various substances as aphrodisiacs to please their partners during sex [ 41 ]. In Ghana, Attila et al. [ 42 ] reported that substance use among adolescents is due to curiosity, which is similar to the findings of this study.

The study found that adolescents obtained their substances from peers, household members who engage in substance use, drug stress and gangs. Similar findings of this study have been reported by other studies [ 43 , 44 ]. For instance, Lopez-Mayan & Nicodemo [ 43 ] reported that peers significantly influence adolescent substance use in Spain. These adolescents get the substances from their peers in schools, thereby impacting their use. Schuler et al.’s [ 44 ] study in Southern California reported that adolescents acquire the substance they use from their friends and family members. Similarly, Srivastava et al.’s [ 23 ] study in India found that the probability of an adolescent engaging in substance use is heightened when they have a family member who also engages in substance use. Thus, peers and family members who use substances may influence adolescents to also use substances.

Limitations

There are some limitations to this study. First, substance use was defined as the lifetime use of a substance, and it was measured by a single question, which was not a robust measure of substance use. Second, children were asked if they had ever used substances. Since substance use is regarded as a deviant behaviour and unlawful, children might fail to disclose their use. Third, there may also be recall bias because children must recollect when they used a substance, which may lead to under reporting of their experiences. Fourth, because this is a cross-sectional study, we are unable to establish causal links between the dependent and independent variables. Despite these limitations, the data’s national representativeness would allow policymakers and researchers to tackle substance use among adolescents across the country.

This study revealed a relatively high prevalence of substance use (12.3%) among adolescents, and alcohol and cigarettes were the main substances used by adolescents. Adolescents obtain the substances they consume from their peers and household members who are substance users, as well as from drug stores and drug peddlers. The study highlighted adolescent’s age, sex, ecological zone of residence and working status as significant correlates of substance use.

Furthermore, it emerged that adolescents use substances because they want to boost their self-confidence to approach the opposite sex, forget their anxieties, and it served as a form of aphrodisiac. Other adolescents use substances since they perceive them as fun, and the use of substances makes their peers perceive them as famous.

Though the study found that only a little over one-tenth of adolescents (12.3%) used substances, substance use is detrimental to the health and wellbeing of adolescents. Consequently, there is a need for muti-sectoral collaborations between institutions mandated to enhance the wellbeing of adolescents and implement substance use laws and regulations, such as the Narcotic Control Authority, the Ministry of Gender, Children, and Social Protection, and other child protection partners, to help reduce adolescent substance use. Also, there is a need to provide risk-behaviour counselling to adolescents and to strengthen parent control to help curb adolescent substance use in Ghana.

Data availability

The raw data for the findings of this study are freely available from the corresponding author upon request.

Abbreviations

Adjusted Odds Ratio

Confidence Interval

Focus Group Discussions

Junior High School

Ministry of Gender, Children and Social Protection

Reference Category

Senior High School

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Acknowledgements

We thank all respondents who made this study possible and the Department of Children, Ministry of Gender, Children and Social Protection for granting us access to this dataset.

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Kyei-Gyamfi, S., Kyei-Arthur, F., Alhassan, N. et al. Prevalence, correlates, and reasons for substance use among adolescents aged 10–17 in Ghana: a cross-sectional convergent parallel mixed-method study. Subst Abuse Treat Prev Policy 19 , 17 (2024). https://doi.org/10.1186/s13011-024-00600-2

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DOI : https://doi.org/10.1186/s13011-024-00600-2

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Newspaper Coverage of Substance Misuse and Other Drug-Related Behaviors in Ghana: A Content Analysis of Health Communication

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• Christina Barnett   ORCID: orcid.org/0000-0002-5283-8097 1 ,
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• Hortance Houngbeke 4 &
• Samuel Hanu 5  

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Six Ghanaian newspapers with the widest readership and distributions were selected for analysis to examine health communication themes and strategies related to alcohol and/or substance misuse and other drug-related behaviors in Ghana. Newspapers were manually searched using relevant keywords. We used thematic analysis to examine 90 articles that were identified. Content themes included (1) legal consequences, (2) adverse effects, (3) change motivation, and (4) help and support. Communication strategies included (1) articles about high-profile individuals or events, (2) narratives, (3) use of rhetoric, and (4) sensationalism. The legal consequences of misusing substances and using illicit substances were the most prevalent themes. Sensationalism was the most prevalent communication strategy. We address the benefits and limitations of the ways in which Ghanaian print media shapes the narrative about substance misuse.

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Virginia Commonwealth University, Richmond, VA, USA

Christina Barnett & Vivian Dzokoto

Fayetteville State University, Fayetteville, NC, USA

Viviette Allen

University of Ghana, Accra, Ghana

Annabella Osei-Tutu

Arlington Health Department, Arlington, VA, USA

Hortance Houngbeke

Mental Health Authority Ghana, Accra, Ghana

Samuel Hanu

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Corresponding author

Correspondence to Christina Barnett .

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This study did not involve human subjects. As such, ethical approval was not required.

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Barnett, C., Dzokoto, V., Allen, V. et al. Newspaper Coverage of Substance Misuse and Other Drug-Related Behaviors in Ghana: A Content Analysis of Health Communication. Int J Ment Health Addiction 20 , 1768–1792 (2022). https://doi.org/10.1007/s11469-020-00479-7

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DOI : https://doi.org/10.1007/s11469-020-00479-7

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Drivers of Substance Use and Related Disorders Among Young People in a Peri-urban District of Ghana

Vida Kasore, Enoch Acheampong, Frances Emily Owusu-Ansah, Mark Owusu, and 2 more

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https://doi.org/ 10.21203/rs.3.rs-989406/v1

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Background: Substance use-related disorders have become a major psychiatric issue globally. The energetic youth who contribute meaningfully to national development are the most affected population by this social menace. This study aimed to examine the knowledge and perception of the youth on substance use-related disorders and the perceived effects on their lives.

Methods: The study used a qualitative approach to explore the perceptions of substance use-related disorders in the Kwabre-East Municipality of the Ashanti Region of Ghana. The purposive technique was used to select 35 participants based on a set of inclusion and exclusion criteria. The data were gathered through focus group discussions and interviews in the Twi language and audio-recorded. Data were transcribed from Twi to English in a written form. The data were categorized into themes based on similarities and differences. Thematic analysis was used to analyze the data. The emerged themes have been presented as main findings, which are supported by quotations from the participants.

Results: The study identified that substances commonly abused by the youth were alcohol, tramadol, gasoline product, glue, and marijuana. Again, it was found that peer influence, poor parental control, and loss of a job (poverty), perceived academic enhancement, and imitation of role models were factors that caused substance abuse among the youth. In addition, the following were identified in terms of the effects: mental illness, cardiovascular conditions, family exclusion, insecurity, and stigmatization.

Conclusion: The initiation and implementation of drug preventive interventions by relevant stakeholders are crucial in preventing the commencement of any undesirable behaviour among the youth as far as substance abuse is concerned. 

Other Public Policy

Health Economics & Outcomes Research

Substance abuse

Effects on the Youth

Rehabilitation intervention

Introduction

Substance addiction is one of the most common social problems faced by many nations worldwide [ 1 ]. Alcohol and illicit drug use have harmful effects on the life of the individual, family, and the nation as a whole in terms of health and livelihood [ 1 ]. Aside from socioeconomic effects, individuals with substance addiction are prone to criminal conduct, homicide and suicide, family and marital issues, cardiovascular diseases, and other impairment conditions [ 2 ]. There are several reasons for which a person can abuse substances. Biological and hormonal changes can induce adventurous risk-taking behaviors [ 3 ]. The desire for independence from parental authority or values in the youth can precipitate substance use [ 4 ]. Others have found that living in abject poverty or social isolation, bereavement, and job loss can also increase the desire for alcohol and other drug use [ 5 , 6 ].

According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), [ 7 ] substance abuse is a maladaptive pattern of substance use characterized by recurrent and significant threats related to prolonged use of substances. This revised manual introduced a single diagnostic category termed ''substance use disorders’’ which combines the former two categories (substance abuse and substance dependence) in the previous edition (DSM-IV). The criteria for diagnosing substance use disorders are primarily based on cravings, relapse, and withdrawal symptoms [ 7 , 8 ]. There is a plethora of evidence in the literature that emphasizes the deleterious effects of substance abuse. Preventable injuries and disabilities are sustained, and many lives are lost due to alcohol or drug abuse [ 9 , 10 ]. An opioid, for example, is responsible for two-thirds of 585,000 people who died due to drug use in 2017 [ 10 ]. In addition, millions of persons who become addicted to substance use or contract diseases, as a result, do not all receive needed treatment [ 11 ]. Unfortunately, the vulnerable or at-risk group is the youth and young adults between the ages of 18-30, a clear 'waste' of most productive years [ 12 ]. The report also suggested that Substance Use Disorders (SUDs) have heavy economic implications, costing billions annually [ 13 , 14 ].

The situation is not different in Africa. It is estimated that 7.7% (38 million) of the African population abuse cannabis annually, which is far higher than the 3.8% of cannabis users among the global population [ 15 ]. In 2014, Benin recorded about 45% of drug abuse cases whiles Cameroon recorded 75–80% of abuse cases, with the youth being the predominant group in both countries [ 16 ]. In 2019, it was also reported that about 14.4% of Nigerians used drugs in the last couple of years, and this is more than twice the global average of 5.6 [ 11 ].

The same situation is mirrored in Ghana, where substance abuse is the third highest cause of psychiatric cases at the Komfo Anokye Teaching Hospital (KATH) and close to 90% of the psychiatric cases are substance use related [ 17 ]. Drug abuse and drug dependence have become the leading cause of mental impairment in the country among the youth and some of them choke the few psychiatric hospitals, rehabilitation centres, prayer camps, or end up on the streets [ 18 ]. Many who need appropriate interventions for addiction do not receive it because of limited state-funded care facilities and unaffordable private rehabilitation centres [ 11 , 18 ]. This situation impedes national development.

Appropriate context-specific interventions must be evidence-based. Yet, there is a paucity of research on alcohol or drug abuse and related disorders in Ghana due to limited research, lack of opportunities for publication, and poor record-keeping in remote areas [ 19 ]. Admittedly there has been considerable research in the last three decades on alcohol or drug abuse in some African countries though in small sample sizes. Resource constraints and documentation challenges regarding the true patterns of substance abuse and related risks or implication have hampered research in the area, making reliance on secondary sources a practice [ 19 ]. Yet, secondary sources fail to examine the knowledge and perception of the abusers on drug abuse and the disorders associated. This study sought to bridge this gap. From the perspective of the youth, in-depth information on the subject could help design programs that deter them from engaging in indiscriminate substance abuse.

Over the last two years, a number of the youth in the Kwabre-East Municipality within the Ashanti region have been involved in a riot and criminal behaviours due to abuse of illicit drugs, which even led to the closure of one Senior High School [ 20 ]. However, in the reports that followed, it appeared that the investigators failed to examine what led to the abuse of the drugs. Therefore, this study examined the perception of the youth on substance abuse-related disorders and the effects on the lives of the youth in the Kwabre East Municipality of the Ashanti Region of Ghana.

The study employed a descriptive, qualitative design. In-depth understanding and description of the phenomenon understudy was facilitated by this approach [ 21 ].

Purposive and snowball sampling techniques were used to recruit people between the ages of 15 and 35 living in the Kwabre-East Municipality and who could provide detailed information on the questions of interest in the study. In addition, the researchers were assisted by a participant who was a recovering substance abuser and who led them to others he knew who were substance abusers. It was necessary because, given the sensitivity of the subject under study, it was difficult to penetrate the community.

The inclusion criterion was that participants should have abused drugs or know others who have or who are abusing drugs. In addition, they must live in the district and be within the desired age category. The researchers initially contacted the participants at their homes and workplaces. They explained the purpose of the study to them before scheduling a date for the interviews and focus group discussions. Participants gave their informed consent before participating in this study. Based on the ‘Principle of Saturation’ [ 22 ], a total of 35 participants (22 males and 13 females) participated in the study. Nine participants completed one-on-one interviews, whilst the remaining 26 participants were divided into two separate focus groups.

The data were collected in the local language (Twi) through face-to-face interviews and focus group discussions. The interview guide focused on the following areas: knowledge of commonly abused drugs , perceptions on substance abuse, factors that influence substance use , abuse and dependence , social and health effects of substance abuse , and the interventions for substance abuse .

Principal investigators trained research assistants before data collection commenced to ensure consistency of procedure. The data was recorded with an audio recorder. Each interview and the focus group discussions lasted approximately 40 and 90 minutes, respectively. The interview took place in 6 communities within the district. Each interview or Focus Group Discussion was audiotaped and transcribed verbatim, after which the data were coded and analyzed based on themes, using thematic analyses.

Data curation, once collected, included reading through the transcripts, highlighting codes that represented specific terms used by the participants to ascribe meaning to their thoughts, opinions, or actions, and spell checking to avoid misinterpretation of data. Five main themes emerged. Sub-themes were developed and linked together. Some of these sub-themes have been cited as quotations to support the findings.

Socio-Demographic Characteristics and substance abuse

The data from table 1 revealed that people who abuse drugs start at an early age, between 14 and 18 years of age. The data further revealed that about 80% of males abuse substances as against 20% of females. Most of the drugs are illegal, and it takes people who are brave to use them. Men are considered as risk-takers in Ghanaian societies, while women are considered vulnerable besides, it is very shameful for a woman to use drugs in public [23]. The data revealed that most of the women who abuse drugs hide doing it, and they use the drugs to be able to manage certain disorders. Some participants also shared that a person's religious background can deter them from abusing drugs. In addition, a person's marital and employment status can either deter or influence their drug use.

“… madam, I started using drugs when I was unemployed; I became frustrated, especially whenever my parents insult me and tell me to find a job to do. I started to use drugs to forget my frustrations…”  (Male participant individual interview).

“…all the guys in my area who do drugs are single, and they have no meaningful job. I only see a few guys who are married and still do drugs…”  (Male participant, focus group discussion).

“… I and my squad take drugs sometimes to prove who is a guy... when you cough it means you are a woman…’’ (Male participant, individual interview).

“…women feel shy to smoke or drink outside… they usually send their children to buy alcohol for them to gain an appetite for food…”  (Male participant, focus group discussion).

Types of substances abused by the youth

Most participants identified the following as drugs commonly abused by the youth: ''wee'' (Marijuana), '' Akpeteshie’’ (alcohol), cigarette, cocaine, pethidine, heroin, diazepam, tramadol, super glue, dried faeces, and gasoline products. Almost all the male participants agreed they had used one or more of the above drugs before. In addition, all the participants claimed that they know people who constantly abuse at least one of the above drugs.

“..I have smoked wee before, and I know many people who mix alcohol with wee, tramadol… they drink all the time; some also inhale the gas and dried faeces.”  (Male participant, individual interview).

“… my father will kill me if I ever use any drug; I know some guys in my area who sniff cocaine, and I have heard that some also inject pethidine whiles others inhale super glue …”  (Male participant, individual interview).

Substance abuse affects the individual’s dressing and composure. The majority of the participants perceived substance abusers as ''mad'' people who have lost self-control and meaning in life. They openly admitted that they would not associate with substance abusers for fear that they may end up being like them. However, some of the participants who were substance abusers had a different opinion about themselves.

“ …as for me, I cannot befriend someone who is a drug addict…they can easily hurt you besides my parents will not even approve our relationship if we should fall in love” (Female participant, focus group discussion).

“ ...sis! What are they saying…I have been taking tramadol and marijuana for years now, look at me, am I shabbily dressed?” (Male participant, focus group discussion).

“I know a lot of people who abuse substances, yet they're perfectly okay when you are not told you won't notice it…” (Male participant, focus group discussion).

Causes of  Substance Use and Abuse among the youth

The findings revealed that the use and abuse of drugs among the youth stem from social and economic factors. These factors are categorized under poor parental support, bereavement, peer influence and curiosity, strenuous work, job loss, unemployment issues, academic performance enhancement, overcoming stage fright, and imitating role models and health or medical reasons.

Poor parental support

The findings revealed that most parents lack basic parenting skills. Therefore there is little or no bond between them and their children, especially when the care of the child becomes one parent's responsibility due to divorce.

“…sister, it's not easy to be separated from your parents… I and my senior brother were brought up by our stepmother, who doesn't care about our movements, and as a result, my brother joined bad friends. My brother cannot live a day without wee, and I know it's because of my parents' separation” (Female participant, individual interview).

“……Most young people join friends to abuse tramadol and other drugs because their parents don't check their movement and besides there is no good relationship between them and their children” (Female participant, focus group discussion). 

Bereavement

The participants shared that the bereavement of a loved one increases the desire for alcohol and other drug use, and dependence becomes a coping mechanism.

“I … know a young guy who lost his family through a motor accident and he could not bear the pain and started drinking alcohol to forget his pain, and now he abuses alcohol, wee, and tramadol”  (Female participant, individual interview).

“ I … lost my mom almost two years ago, and during that time … I couldn't accept she was gone like that, I thought of taking my life whenever I was alone and I started drinking alcohol to forget my pain.”  ( Male participant, individual interview).

Peer influence and curiosity to implement

The findings further revealed that some of the youth join their peers to abuse drugs to fit in whilst others just want to experiment with dazedness. Some people also abuse drugs out of frustration. 

“… I started smoking marijuana out of curiosity. I had often heard people say that the weed can make you feel high, and I wanted to experience that…” (Male participant, focus group discussion)

“… l know some guys who are doing drugs because their friends introduced them, and  there are others too once you join their squad you will have to smoke wee and drink  alcohol by all means” (Female participant, focus group discussion).

Strenuous work

Some of the participants revealed that some physical activities are very demanding and therefore many people turn to use different types of drugs to carry out the activities. Carving, Construction work, Sexual activity, Galampsey (manual mining), and Weaving are all examples of physical activities in which many people need drugs to boost their stamina. The following cites indicate participants shared opinions:

“ …I once took quick action tablet to gain more energy to sit for a long time to weave many pieces of kente but I noticed I was becoming addicted and so I stopped, but some of my colleagues mix it with tramadol and other substances”  (Male participant, individual interview).

“…some of us take tramadol and alcoholic drinks to gain stamina and to enhance sexual activities.”  (Male participant, focus group discussion).

Loss of job and unemployment issues

The findings also revealed that some youth who have either lost their job or are unemployed get frustrated and join other substance abusers in ghettos to run away from responsibilities and avoid family members who constantly remind them to look for a job.  

“…my uncle was laid off permanently and after a while he became frustrated. He could no longer take care of his family. He spends most of the time smoking weed with his friends in ghettos and eventually his wife divorced him…”  (Female participant, individual interview).

Enhancement of academic performance

The majority of the participants revealed that they abused substances to enhance academic performance. They were of the view that substances like stimulants make them feel more alert and confident. It also helps them in long hours of studies without feeling tired. However, some of them also shared that drugs can make students go mad and end up performing poorly.

“… I have been smoking marijuana since Junior High School. and I cannot study without a puff… it helps me to study”  (Male participant, focus group discussion).

“…in school, I had a friend who could take 3 bottles of energy drinks mixed with marijuana at a time to stay active and study overnight… his Cumulative Weighted Averate dropped at the end and he started saying weird things and had to defer the course for treatment…”  (Male participant, focus group discussion).

Overcoming Stage Fright and Imitating Role Models

The majority of the participants admitted that stage fright and role modelling lead to substance use and abuse. They explained that some celebrities cannot perform on stage without taking drugs. Some of these celebrities whom the youth look up to consistently post pictures of themselves drinking and getting high on various social media platforms. The youth who have some of these celebrities as their role models turn to abuse drugs intending to be like them (their role models). That notwithstanding, some also believe that certain advertisements on social media can lead to substance abuse among the youth. However, other participants did not see anything wrong with alcohol and drugs advertisement because it involves celebrities.

“… most of our upcoming celebrities are shy in nature and cannot take shows without taking drugs… some of the youth copy them blindly…” (Female participant, focus group discussion).

“Sister, as for me I can’t stand the sight of beer advert on Television oo, especially when they pour it into the glass I start salivating…”  (Male participant, focus group discussion).

“ If alcoholic drinks are bad why do celebrities advertise on Television …it means it’s good and I can’t stop drinking it.”  (Male participant, focus group discussion) .

Health or Medical Reasons

Some participants also revealed that some people with disorders such as anxiety, depression, and sickle cell use drugs intending to alleviate psychiatric symptoms and pain; however, they end up abusing the drug due to its constant use. They further indicated that when one takes a particular drug for some time, the body becomes immune to it, and the individual increases the dosage to have the same effect. 

“…some of my colleagues with sickle cell have been spending all their salaries injecting pethidine and at times they steal that of other patients’ because they have become addicted.”  (Female participant, focus group discussion).

Effects of Substance Abuse

The data revealed that substance abuse has several effects ranging from health, social, and economic with dire implications on the individual, their family, and society as a whole.

Individual-level health effects of substance abuse

The majority of the participants revealed that constant use of drugs could lead to loss of appetite for food, trembling, addiction, mental illness, and lung and liver diseases. Again, some participants added that alcohol abuse could lead to making bad decisions such as drunk driving, resulting in serious motor vehicle accidents. Some of the drugs also make people lose self-control and engage in unprotected sex, which could lead to the spread of sexually transmitted diseases.

“I work in a hospital, and I know that most of the psychiatric cases we record are due to drug injection because it goes straight into the bloodstream and it can collapse the vein…”  (Female participant, focus group discussion).

“…. My brother abuses alcohol, and most of the time he doesn't eat; he is always shaking…” (Female participant, individual interview).

Health effects of substance abuse on the family and the society

Some participants added that the abuse of drugs could equally affect the abusers' families and society at large. For example, some families suffer from depression because of the stigma associated with addiction. Society also feels insecure because most substance abusers are perpetrators of violence. In addition, they engage in theft and robbery to be able to afford their drugs. Below are some of the quotes describing some of the participants' opinions on the health implications of substance abuse:

“My elderly sister died of lung cancer because she abused alcohol and cigarette for a long time. My mother, who was a trader, spent her entire fortune treating her…my mother became depressed when she lost everything and finally died of stroke” (Female participant, individual interview).

“It is not easy to have a substance abuser in your family. We are from a wealthy family and my cousin abuses tramadol and marijuana… he is always at the station trying to load passengers for coins. Sometimes I wish he is not living…” (Female participant, individual interview).

“… some wee smokers in our vicinity have been stealing people’s property…your heart is always on fire when you step out; for fear that they will come and break your door open…” (Female participant,   individual interview).

“… it is very cheap to sleep with women in the ghetto… I and my friends sometimes do sex gala (competition)…”  (Male participant, focus group discussion).

Socioeconomic Effect of Substance Abuse

The abusers experience family exclusion or rejection. Most substance abusers are not invited during family gatherings or deliberations, and even when they happen to be around, their opinions are not considered because they are seen as 'mad'.

“my family does not invite me when they’re discussing family issues…even when I am around, my views are not considered because they think that I’m under the influence of alcohol…” (Male participant, individual interview).

The data further revealed that drug abuse could lead to depletion of the users' income which, in effect, result in a lack of care for families and other responsibilities. Other participants also added that substance abuse leads to loss of jobs and unemployment due to the stigma associated with addiction.

“… my father spends all his money on alcohol…I have 3 siblings, and none of us was able to complete S.H.S.” (Female participant, individual interview).

“I used to work as a sales personnel in a certain company, but now I am jobless because I have been taking alcohol and my boss fired me…”  (Male participant, individual interview).

The data also revealed that the abuse of substances among the youth could lead to low productivity in the country; because the abusers' performance at work is usually compromised by hangovers, health complications, and lack of focus. Moreover, the cost of treating SUDs is very high, and drug abuse also increases pressure on state owed rehabilitation facilities. Therefore, families are compelled to send them to private rehabilitation centres, which are usually very expensive. Aside from spending huge sums of money on SUDs treatment, the family also spends huge sums of money on settling crime issues.

“… the youth are the future leaders of its nation, and therefore losing them to addiction implies that the nation has no future…” (Male participant).

Intervention for Substance Abuse

Some of the participants indicated that the ultimate intervention for drug addiction is in-patient rehabilitation. They also indicated that drug abuse and addiction are well managed with psychosocial therapies in rehab centres; however, they are inadequate in the district. Other participants also added that even though rehabilitation is the best intervention for substance abuse, people in the rehab centres are usually labelled as ''abnormal,'' which impedes rehabilitation progress and deters other people from seeking help.

“I did my NSS in a rehab centre, and I learned that psychiatric cases are different from substance abuse… counselling is used to manage drug issues…unlike psychiatric issues which are managed with medicine…” (Male participant)

“ … I have been taking tramadol and wee, but I know it's not good for me. I want to stop, but I can't go for rehabilitation because people will start looking at me in some way…”   (Male participant).

“…both substance abusers and people with mental illness are the same… they have all lost their mind and need to seek asylum…the treatment centres are very few that is why a lot of mad people are on the streets”  (Male participant).

The condition in which people find themselves could have some influence on their drug use, understanding, and perception about substance abuse and their related disorders. This finding confirmed that the possibility of a man becoming a substance user is three times that of a woman [ 25 ]. In addition, gender roles can influence substance use and abuse. Culturally, adventurous roles are reserved for men, and, therefore, they initiate and take in more drugs to prove how strong and brave they are. On the other hand, women are considered in society as faint-hearted and vulnerable. Consequently, shame and stigma are attached to their use or abuse of alcohol and drugs, and therefore it was not surprising that substance use and abuse are prevalent among men than women. However, the fact that the findings further confirmed the National Institute of Drug Abuse [ 25 ] that most women hide using drugs to cope with pain, sleeping, and eating disorders means that substance use is also gradually becoming a growing problem among females. If care is not taken, the effect can be very dangerous as it could lead to fetal alcohol syndrome, birth defects and developmental disabilities in pregnant women.

Most substance users initiate the use between 14-18 years of age [ 12 , 26 ]. The participants were very much aware of the different types of drugs that are abused daily. The study revealed that aside from alcohol, cigarette, and marijuana, most of the youth also abuse opioid medication such as tramadol, diazepam, and pethidine and volatile substances, including glue and gasoline products. This confirms that marijuana is the major drug commonly abused among the youth in Ghana [ 28 ]. However, it was also evident that tramadol and other volatile substance use have also gained popularity among the youth. Substance abuse is inherently linked to mental illness and the introduction of new drugs into society will increase mental illness and consequently bring pressure on public psychiatric hospitals [ 18 ]. It was not surprising that Equal [ 17 ] reported that about 90% of the psychiatric cases recorded at Komfo Anokye Teaching Hospital were substance use-related disorders. Since the government subsidizes psychiatric treatment, the increase in psychiatric cases will increase government expenditure. Resources that could have been invested in developmental projects to benefit the entire populace are spent on a minute population. This is a wake-up call for the Ministry of Health, Ghana Health Services, Narcotic and Drug Control Board, and other stakeholders who are interested in addressing substance abuse to come together and fight this social canker.

There are several reasons for which people abuse drugs. The findings affirm Alberta Alcohol and Drug Abuse Commission, [ 25 , 28 , 29 ] that people with chronic health conditions such as depression and other psychiatric conditions use prescribed opioid pain relievers to alleviate their pain and the psychiatric symptoms which end up worsening their condition in the long run and consequently increase their risk of developing an addiction. The prolonged use of the drugs can also trigger certain mental conditions and make the individual develop dual diagnoses since substance abuse co-exists with mental conditions. The study further revealed that peer pressure and poor parental care are the most predominant factors for substance use and abuse among the youth. The study revealed that most of the youth who abuse drugs are lured into it by their friends though few of the youth on their own, experiment with the use of drugs ‘’ to feel high’’ because of the temporal euphoria associated with the use of these drugs [ 25 ]. This calls for appropriate parental supervision and control in the areas of discipline and constant monitoring of behaviours.

The findings confirm Clark, Thatcher & Maisto, [ 30 ] that poor parental supervision leads to adolescents' substance use and abuse. Similarly, the findings showed that parental supervision becomes a problem when the care of the child becomes the sole responsibility of one parent due to divorce. Therefore, the ministry of gender, children, and social protection, and other human rights activists must also come together to ensure that the care of children becomes a corrective responsibility.

Another major factor leading to substance abuse among the youth is overcoming stage fright and imitating role models. The findings showed that what the youth see on social media makes them susceptible to drug use and abuse [ 31 ]. Consistently, Hilliard finds that some celebrities consistently post pictures of themselves drinking and getting high on various social media platforms giving their followers, who are mostly the youth, the wrong impression that it is appropriate to do the same [ 31 , 32 ]. Although Food and Drugs Authority (FDA) has banned celebrities from endorsing alcoholic drinks, some famous media presenters continue to endorse alcoholic drinks on their shows, and most youth look up to some of these personalities. It is a pity that the Food and Drugs Authority and Advertisement Regulatory bodies in the country are silent. There is no doubt whatsoever that the alcoholic industry can be a source of revenue for the government and help reduce the country's unemployment rate. Nevertheless, that is not worth the resources government spends in treating alcohol and drug-related diseases.

Moreover, the study results showed that the youth use substances to increase stamina and relieve stress. Some of these stressors which predispose the youth to drug use include loss of a loved one, unemployment, and loss of a job which usually results in poverty. These results from the study support what Amoakwa-Fordjour, and Appiah identified that living in poverty or social isolation, bereavement, being unemployed or highly stressed in work increase the desire for alcohol and other drug use especially among the youth and subsequently addiction becomes a coping mechanism [ 5 , 6 ]. The use of drugs will not completely take away the above stressors, and the repeated use of the drugs will only result in addiction and other chronic mental conditions. Besides, the resources that the family members and the government will have to spend in treating the individual are not worth the money that was used to buy the drugs. Family members, friends, and society have to support the youth to manage stress positively. Lastly, it was evident in the findings that the youth abuse substances to enhance academic performance. There is a clear line between long hours of study and concentration. Some drugs can stimulate a person to spend long hours studying without feeling tired, but that cannot be taken for concentration in studies. The repeated use of drugs can affect how the brain functions [ 32 ]. This is more likely to lead to substance use-related disorders, which can also lead to theft, poor academic performance, and dropping out, as was evident in the findings.

The findings revealed that substance abuse is associated with a wide range of long-term and short-term health effects on the individual abuser. The effects of substance abuse do not only rest in the individual abuser but also the family and society suffer from it. The substance being chemicals can affect the individual's body and brain function depending on the type of drug, the quantity, and frequency of use. The effect of substances on the body includes mental illness, addiction, and sexually transmitted diseases since most substance abusers engage in unprotected sex and share the needle. This means that family members, friends, and people in society are at a higher risk of contracting infectious diseases. In effect, the rate of HIV/AIDS will escalate in the country, and the government will have to spend huge sums of money on managing it. Everyone in the country will be affected in one way or the other. Therefore the Government, Ministry of Health, Public Health Officials, and other stakeholders must come together to fight this drug issue. The socioeconomic effects of substance abuse on the individual abuser, their family, and society cannot be overemphasized. The findings revealed that most substance abusers usually lose their job due to poor performance, and they rely on their families, and the public for support whilst others end up on the streets and engage in theft and robbery to afford the drugs and also to survive. Some also experience societal exclusion, rejection by family members and friends. Substance abuse or addiction leads to a breakdown of family relationships and brings shame and disgrace to the family members due to the stigma associated with addiction. The findings also showed that addiction increases the crime rate in society. This means that the very existence and survival of society are threatened. This calls for serious collective efforts of all stakeholders who are working together to reduce the menace of drug use among the youth.

Many researchers have consistently shown that substance abuse is a public health concern [ 19 , 23 ]. However, they failed to look at proper ways to manage the condition, and this study fills that gap. Every human being has struggles and needs help in one way or the other. The findings revealed that the best way to deal with SUDs is to go for rehabilitation which includes psychosocial therapy and pharmacotherapy, which are usually undertaken in a residential facility. However, limited rehabilitation services in the country and the stigma associated with addiction make it very challenging. Therefore, it is not surprising that 1 in 7 individuals receive treatment for SUDs each year [ 11 ]. Unlike the recent pandemic (coronavirus), cancer, and other health conditions, it is pathetic that little attention is given to substance abuse and addiction, which can claim many lives. It is, therefore, necessary for the government, the Ministry of Health, and Public Health Officials to come together to sensitize the general public on the seriousness of substance abuse to deter people, especially the youth, from alcohol and drug use.

Limitations

The study was carried out in a single region and district, and hence the findings may not be a true reflection of what pertains to the entire youth population. Therefore it is recommended that researchers who are interested in conducting a similar study should at least consider more than half of the regions in Ghana.

The findings of the study confirmed that the gender and culture of a person could make one susceptible to substance use. Substance abuse is regarded as a risky activity. The findings also showed that there is a high awareness among the youth about different types of substances available and their general effects on the individual, family, and the nation. Therefore, such knowledge can be capitalized to serve as a protective factor against experimental substance use. Mass media campaigns can also be used to change norms regarding substance use. The study further revealed that poor parental supervision and peer influence are the main cause of substance use and abuse. It was also evident that HIV/AIDS, low productivity, insecurity, and humiliation remain the dominant effect of substance abuse. Moreover, the study showed that Rehabilitation remains the ultimate intervention for SUDs; however, limited rehabilitation facilities and stigma associated with SUDs interfere with treatment. The rate at which the youth is getting into substance use and abuse is becoming abhorring. It is, therefore, necessary for stakeholders such as Ghana Education Services, Ghana Health Services, Social Welfare Department, Parents, etc. to come together and set up home and school-based drug prevention units to educate the youth at a very tender age about substance abuse and its related disorders as well as the devastating consequences on the individual, family and the society as a whole.

Again, stakeholders interested in addressing substance abuse and its related disorders can also come together and use the media to reframe SUDs as a public health issue, enabling the government to allocate more funding towards substance use rehabilitation.

Finally, the study recommends that the Ministry of Health, Ghana Health Services, and other stakeholders should consider establishing rehabilitation support in communities to help substance abusers. The value of fines and prison sentences for civil penalties outlined in the Narcotics Commission Bill is not enough to deter people from drug use or reform prisoners who are convicted for drug use. It is, therefore, necessary for the government to set up affordable and effective residential rehabilitation facilities to offer focused-rehab programs or ongoing addiction support.

List Of Abbreviations

Abbreviations Meaning

DSM-V Diagnostic and Statistical Manual of Mental Disorders

SUDs Substance Use Disorders

KATH Komfo Anokye Teaching Hospital

Declarations

Acknowledgements

We wish to thank the people of Kwabre for their involvement in this study

Authors’ contributions

VK and EA conceptualized and prepared the study design and carried out the data collection exercise. FEO, MO, AG, and AUW did the analysis. All the authors took part in the preparation and of this manuscript.

There is no funding to report as this study received no funding support, and the authors funded the study through their individual contributions.

Availability of data and materials

The full data is available at the research repository of the Department of Health Promotion and Disability Studies, KNUST-Ghana.

Ethics approval and consent to participate

The participants were fully informed about the procedures and risks or benefits involved in the research. They gave their consent to participate in the study by signing a consent form. They had the opportunity to withdraw or cease their participation without any coercion. Anonymity was ensured as no identifying information was attached to their responses.

Consent for publication

Participants have consented to publication.

Competing interest statement

The authors do not have any competing interests as far as this submission is concerned.

Data Availability

The complete data can be accessed from the research repository of the department of health promotion and Disability Studies, KNUST.

• Adzrago D. Doku DT. Adu-Gyamfi AB. Experiences of Individuals with Alcohol and Drug Addiction at Rehabilitation Centres in Ghana . J Addict Res Ther 2018:9: 363. doi:10.4172/2155-6105.1000363.
• National Institute on Drug Abuse, Cigarettes and Other Tobacco Products. 2016:1–6.
• Feinstein EC. Richter L. Foster SE. Addressing the critical health problem of adolescent substance use through health care, research, and public policy. Journal of Adolescent Health, 2012: 50 (5), 431–436. http://doi.org/10.1016/j.jadohealth.2011.12.033 .
• Mason MJ. Mennis J. Schmidt CD. A social operational model of urban adolescents’ tobacco and substance use: A mediational analysis. Journal of Adolescence, 2011: 34 (5), 1055–1063. http://doi.org/10.1016/j.adolescence.2010.11.002
• Amoakwa-Fordjour G. The breakdown of Ghana’s mental healthcare .2013 .
• Appiah R, Boakye KE, Ndaa P, Aziato L. “Tougher than ever”: An exploration of relapse prevention strategies among patients recovering from poly-substance use disorders in Ghana. Drugs: Education, Prevention and Policy. 2018 Nov 2; 25(6):467-74
• American Psychiatric Association. Diagnostic and statistical manual of mental Disorders   (5th ed., Text Revision). Washington, DC: American Psychiatric Association. 2013
• American Society of Addiction Medicine. ‘ Opioid Addiction Disease’: 2015 Facts & Figures, 2015, 1–2. http://doi.org/10.2105/AJPH.2005.071647?journalCode=ajph.
• World Health Organisation. Management of substance abuse. World Health Organisation. 2014:23(4), 1. http://doi.org/11/01/16. 
• United Nations Office on Drugs and Crime, World Drug Report (ISBN: 978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6) 2017
• United Nations Office on Drugs and Crime: 35 million people worldwide suffer from drug use disorders and only 1 in 7 people receive treatment https://www.unodc.org/unodc/en/frontpage/2019/June/world-drug-report-2019_-35-million-people-worldwide-suffer-from-drug-use-disorders-while-only-1-in-7-people-receive-treatment.html [Accessed on 29th July 2021]
• Substance Abuse and Mental Health Services Administration, Centre for Behavioural Health Statistics and Quality. (July 17, 2014). The TEDS Report: Age of Substance Use Initiation United States Department of Justice. Among Treatment Admissions Aged 18 to 30. Rockville, MD
• National Drug Intelligence Centre The Economic Impact of Illicit Drug Use on American Society. Washington D.C.: 2011
• Canadian Centre on Substance Use and Addiction: Canadian Substance Use Costs and Harms 2015–2017
• UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1)
• International Narcotics Control Board. Report of the International Narcotics Control Board for 2014.
• Equal A. (Substance abuse is 3rd highest cause of psychiatric cases at KATH. 2015 https://www.myjoyonline.com/substance-abuse-is-3rd-highest-cause-of-psychiatric-cases-at-kath/ [Accessed on March 30, 2021].
• Lucia B. Domestic Drug Consumption in Ghana: An under-reported phenomenon.   [Online] Geneva, Global Initiative against Transnational Organized Crime. 2019. Available from: http://www.Globalinitiative.net CH-1211[Accessed on 10 th November 2020].
• Acuda   W.   Caleb JO. Anne O. Ilana BC.‘The Epidemiology of Addiction in Sub-Saharan Africa: A Synthesis of Reports, Reviews, and Original Articles’. Journal on Addictions [online] 2011:DOI: 10.1111/j.1521-'0391.2010.00111.x [Accessed on 17December, 2019].
• Nyabor Jonas. (Tramadol abuse responsible for student rioting – GES reveals. 2018 https://citinewsroom.com/2018/06/tramadol-abuse-responsible-for-student-rioting-ges-reveals
• Bryman A. The research question in social research: what is its role? International journal of social research methodology. 2007 Feb 1; 10(1):5-20.
• Lipworth W, Taylor N, Braithwaite J. Can the theoretical domains framework account for the implementation of clinical quality interventions?. BMC health services research. 2013 Dec;13(1):1-3.
• Mensah, EA. Substance Use among Students of a Second Cycle Institution in Accra. 2018
• UNODC. World Drug Report finds drug use stable, access to drug & HIV treatment still low, 0–2. (2015a).
• NIDA. Is abuse of prescription medications as dangerous as other forms of illegal drug use? [Retrieved from https://www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide/frequently-asked-questions/abuse-prescription-medications-dangerous-other-forms-illegal-drug-use.2020 [Accessed on 2021, March 30]
• King KM. Chassin L. A prospective study of the effects of age of initiation of alcohol and drug use on young adult substance dependence. Journal of Studies on Alcohol and Drugs, 2007:68(2), 256-265
• Adu-Mireku S. The Prevalence of Alcohol, Cigarette, and Marijuana Use Among Ghanaian Senior Secondary Students in an Urban Setting . Journal of Ethnicity in Substance Abuse , 2003; 2 (1), 53–65. http://doi.org/10.1300/J233v02n01_05
• Alberta Health Services; AADAC."The ABCs - Codeine and Other Opioid Painkillers". Alberta Alcohol and Drug Abuse Commission. 2007.  
• Barclay, R .4 Illegal Drugs That Might Be Medicines https://www.healthline.com/health-news/mental-four-illegal-drugs-with-medicinal-qualities-2014:113013 [Accessed on 29th March 2021].
• Clark DB. Thatcher DL. Maisto S. Supervisory neglect and adolescent alcohol use disorders: Effects on AUD onset and treatment outcome. Addict Behav. 2005:30:1737–1750.
• Hilliard J. The Influence of Social Media on Teen Drug Use. 2019 https://www.addictioncenter.com/community/social-media-teen-drug-use [Accessed on March 30, 2021].
• United Nations Office on Drugs and Crime (2016) World drug report 2016. New York: United Nations.

Table 1 showing the Demographic characteristics of participants.

Source: fieldwork, 2020

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Ghana designs National Drug Control Master Plan to address drug abuse

Accra, April 27, GNA- The Narcotic Control Commission with support from the ECOWAS Commission has designed a new National Drug Control Master Plan (NDCMP) to address drug abuse and trafficking in Ghana.

The blueprint document renews and advances Ghana’s efforts to counter the substance abuse threat that continues to blight the nation, crushing lives and resources.

Mr Ambrose Dery, Minister of the Interior, speaking at a validation workshop on the Master Plan, commended the ECOWAS Commission for their support.

The National Drug Control Master Plan will serve as a strategic document, providing a coherent framework for more comprehensive national drug prevention and control measures.

The Plan will provide the necessary evidence-based guidance to address drug abuse, illicit drug trafficking and related crimes in Ghana.

He said the validation could not have come at a better time to complement efforts of the Government in putting in place measures to deal with drug abuse and illicit drug trafficking. 

The Minister said he was aware that as part of ECOWAS Commission Strategic Plan, between 2018 and 2021, the Commission in collaboration with its development partners supported 12 Member States to complete their National Drug Control Master Plan. 

“Ghana, Liberia and Burkina Faso are the three remaining countries yet to complete their National Master Plan,” he said. 

He said the draft Master Plan had been carefully put together with the recognition of other national policies developed. 

Mr Dery said the Narcotics Control Commission Act, 2020 (Act 1019) provided for offences related to narcotic drugs and plants cultivated for narcotic purposes and for related matters. 

He said the validation workshop would support Ghana to review and validate its draft drug control plans to address drug abuse, illicit trafficking and related crimes.

The Minister said experts from Health, drug demand reduction, drug law enforcement agencies, departments in charge of corruption, money laundering and terrorism financing would have the opportunity to contribute to the Plan.

The Plan will be published after validation and disseminated to relevant agencies, Civil Society Organisations and development partners.

He said the Master Plan would improve public health and security for everyone living in Ghana by ensuring that both Drug Demand Reduction and Supply Reduction strategies went hand in hand with sustainable development strategies.

Mr Dery said drug abuse and illicit drug trafficking was a transnational organized crime which required resolute efforts from all stakeholders both local and international to deal with.

Madam Aba Jacqueline Opoku, Chief Staff Officer, Economic and Organised Crime,, said illicit drug trade continued to hold back economic and social development, while extremely impacting on the most vulnerable and marginalised people in society. 

She said the canker constituted a fundamental threat to security and stability to all nations. 

“Drug abuse is one of the major problems facing the whole world and it is destroying lives, families and communities and our country Ghana has never been spared in this drug menace,” she added.

Madam Opoku, who represented the Board Chairman of the Commission, said as illicit drug trafficking and use continued to threaten health and security of the communities, the situation called for a more pragmatic,  efficient and effective actions to stem the tide.

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The correlates of substance use among older adults in Ghana during the COVID-19 pandemic

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Evidence suggests that substance use remains one of the negative consequences of the coronavirus (COVID-19) pandemic among older adults. However, not much is known about the prevalence and associated factors of substance use during the COVID-19 pandemic in Ghana.

Using data from a survey on coronavirus-related health literacy conducted in the Ashanti Region of Ghana among 474 older adults aged 50 years or above, we performed multivariable logistic regression analysis to assess demographic, socio-economic and health-related correlates of alcohol and tobacco use.

We recorded a prevalence of 11.4% alcohol use and 6.8% of tobacco smoking, in addition to 16% prevalence of tobacco smoking and/or alcohol intake during the pandemic. After adjusting for the demographic and socio-economic factors, male participants had higher odds of substance use than their female counterparts. Older adults with tertiary education and those who rated their wealth status as poor had a lower odds of substance use than their counterparts.

Conclusions

Our findings have implications for designing programs and policies to limit substance use among older adults during the COVID-19 pandemic and possible future disease outbreaks.

Globally, the Coronavirus (COVID-19) pandemic has emerged as a public health challenge that health systems are grappling with. Existing evidence shows that the pandemic has resulted in significant health, economic and political crisis. 1 Various global, regional and local reports have demonstrated that COVID-19 has placed an additional burden on the health systems providing care for patients infected with the virus. 2 , 3 The pandemic has also caused the diversion of health resources from other healthcare needs and services to COVID-19 control and treatment. 2 , 4 , 5 Since the declaration of COVID-19 as a pandemic on 11 March 2020 by the World Health Organisation, countries around the world have implemented a host of policies and stringent measures, including lockdowns, wearing of face masks, closure of national borders and limitations on public gathering to control the spread of the pandemic. 6

The pandemic and its accompanied mitigating measures have several policy implications, especially in older population health and wellbeing. Evidence suggests that older populations are at a higher risk of being infected or dying from the disease, either directly by exposure to the virus or indirectly by measures taken to mitigate the virus’ health and economic effects on the aged population. 7 Indeed, the lockdown and social-distancing measures have severely impacted older adults’ health through isolation, loneliness and depression. 8 , 9 As Satre et al. 10 noted, “older people already are vulnerable to the detrimental effects of isolation and face disproportionate adverse consequences from social distancing and shelter-in-place guidelines, which may trigger or worsen anxiety, depression, substance use, and other psychiatric disorders”.

In the face of the pandemic and associated restrictions, various studies have reported that many older adults have resorted to substance use, especially alcohol and tobacco, to relieve anxiety and other personal burdens. 11–13 Notwithstanding, inappropriate use of substances, particularly alcohol and tobacco, leads to chronic health conditions, including medical, functional and psychiatric problems for older adults. 10 , 14 For example, several studies have shown that excessive drinking is associated with cancers, cardiovascular disease, cirrhosis, pancreatitis and gastrointestinal disorders. 15–20

In Ghana, substance use such as alcohol and cigarettes among older adults remains moderately high with an alcohol per capita of 10 L, especially the locally brewed beverages. 21 In a recent large scale study using data among 3533 Ghanaians aged 50 years and older from the Study on global ageing and adult health (SAGE), the prevalence of lifetime alcohol consumption (history of ever consuming alcohol) was 22.8%. Of these, 93.7% had consumed alcohol within seven days and 100% within 30 days before the study. Among current drinkers, the prevalence of hazardous drinking was 6.2%, and non-hazardous drinking was 93.8%. The prevalence of lifetime alcohol use was significantly higher in men than women. 21 In another study using nationally representative data from the SAGE study, the overall prevalence of current daily smokers among older adults in Ghana was 7.6%. Tobacco use (i.e. ever used tobacco) was associated with older males, older adults residing in rural locations, and older adults who used alcohol. 22 The study also reported that regional differences existed in tobacco use; the three northern regions (Upper East, Northern and Upper West) had higher proportions of tobacco use among older adults in Ghana. 22

Compared to the general population in Ghana and older adults in some middle and high-income countries, studies suggest that the prevalence of substance use among older adults in Ghana is relatively low. 23–28 However, this trend of substance use among older adults in Ghana is worrying, especially during this current pandemic period. This is because studies suggest that alcohol and tobacco use remain one of the common coping strategies for stress, anxiety and depression associated with the pandemic. 10–12 , 29 , 30 It was argued that the disproportionately high rates of COVID-19 health complications and mortality among older adults prompted negative responses such as excessive alcohol drinking and tobacco smoking. 30 Moreover, older people are already vulnerable to the detrimental effects of the COVID-19 response, such as social distancing and shelter-in-place guidelines, which may inadvertently trigger or worsen stress, social isolation, loneliness and depression, which are directly associated with harmful health behaviours as substance use. 11 , 31–33 For example, a recent survey of adults across Canada found that stress was a major contributing factor among those who reported increased alcohol use during the pandemic. 34

In line with the preceding evidence, older adults in Ghana may also tend to use drugs, alcohol and tobacco and, in some instances, abuse its use, which has consequences for their health. However, the prevalence and correlates of substance use among the older population during the COVID-19 pandemic remain unknown in Ghana. Drawing on a cross-sectional survey in Ghana, we examine substance use prevalence and its correlations among older adults during the COVID-19 pandemic. This study adds to the growing body of evidence seeking to inform healthcare providers and social workers on how best to provide support services and programmes for older adults to adopt a positive response to the pandemic. This would go a long way in preparing healthcare providers and other key stakeholders who seek to improve the health of older populations to develop evidence-based programmes against substance use to relieve stress, depression and anxiety during and post-COVID-19 pandemic.

Sample and data

This paper was generated from a larger study on coronavirus-related health literacy (CHL) conducted between 12 September 2020 and 15 October 2020 in the Ashanti Region of Ghana. The CHL survey was carried out in the Ashanti Region because the region houses the highest percentage (17.5%) of older adults in Ghana coupled with their diverse cultural, social and economic characteristics. 35 The CHL survey employed a cross-sectional design to determine CHL among older adults from the Ashanti Region of Ghana. Considering the World Health Organization’s (WHO) study on Global Ageing and Adult Health in five developing countries, including Ghana, we conceptualize an older person as an individual who has attained a minimum of 50 years. 36 Before the actual data collection, we conducted a pilot study to test the survey questions. Participants who took part in the pilot study were not part of the original survey participants. The outcome from the pilot study was used to modify the survey questions and outline.

This study presents part of a larger study that examined CHL among older adults during the COVID-19 pandemic in Ghana. Cluster and simple random sampling techniques were used to select the participants from five communities in the Ashanti Region of Ghana. We used a conservative prevalence of 40% (because the actual prevalence of CHL was unknown in Ghana/or the study areas) among older adults in Ghana. Employing Lwanga and Lemeshow 37 formula for sample size calculation for health research with an alpha value of 0.05, a minimum sample size of 369 was determined but considering a 35% nonresponse rate, the final sample size was approximately 498. Out of the 498 participants targeted, 487 met the inclusion criteria. Of these eligible respondents, 13(2.67%) declined to participate in the study yielding a sample size of 474, representing a response rate of 97.33%.

The data collection instrument used for the study was a questionnaire. The questionnaire was developed in English and later read in the local language (Twi) to ensure better understanding and quality control. We translated the questionnaire into Twi by considering the World Health Organization guidelines for assessments of data collection instruments. 38 We established the validity of the questionnaire by undertaking a detailed review of related literature on the subject matter to check for language clarity, simplicity, and consulting experts in health literacy, financial support, and substance use, which is consistent with previous studies. 38 , 39

Five research assistants from the Department of Planning at the Kwame Nkrumah University of Science and Technology (KNUST) of Ghana were recruited and trained to assist in the data collection process. The training of the research assistants lasted a day. The data collection exercise was monitored and supervised to ensure quality control. The administration of each questionnaire lasted between 25 and 30 minutes.

Given that the research was conducted to assist welfare institutions and health authorities in improving older adults’ health during the COVID-19 pandemic, ethical issues were considered. First, the study was approved by the various municipal health directorates in which the study was conducted. In line with the ethical principles, after going through the research proposal and survey instruments, the Municipal Health Research Team granted permission for data collection in the study setting. Secondly, the research participants were briefed on the purpose of the study and their informed consent (oral and written) was obtained. The research participation was voluntary; therefore, the study participants were free to opt-out of the study when they deemed necessary. Confidentiality was also ensured throughout the entire research process. Very importantly, the research was conducted to provide empirical evidence to assist policymakers and planners in improving the wellbeing and welfare of older adults during the COVID-19 pandemic as there is not much data on substance use during the COVID-19. However, to conduct further analysis of the data to determine the factors associated with substance use among older adults during the pandemic, approval was granted by the Municipal Health directorates.

Outcome variable

In this study, substance use during the COVID-19 pandemic was defined as “started using and/or has increased in the frequency and quantity of alcohol and/or tobacco since the emergence of COVID-19 in Ghana”. Thus, substance use was the dependent variable in this study. Substance use was measured as a dichotomous variable indicating "Not started using and/or increased in alcohol and/or tobacco =0) or “started using and/or increased alcohol and/or tobacco use =1)” during the COVID-19 pandemic.

Exposure variables

The predictor variables were age (years) (1=50-69 years, 2= 70-79, 3= 80 or above), gender (1=female, 2= male ), marital status ( 1=married, 2=single), education ( 1=none, 2= basic, 3=secondary, 4=tertiary), wealth status (1=average, 2= poor, 3= rich), employment status (1=yes, 0= no), religion ( 1=Christian, 2= non-Christian), ethnicity (1= Akan, 2= non-Akan), health status ( 1=good, 2= poor), income (GH¢) (1= ≤ 500, 2= ˃500) and chronic non-communicable diseases (1=yes, 0=no). Details about the measurement, conceptualization and justification of the study variables have been reported elsewhere. 39–46 Gender, marital status, employment status, chronic non-communicable diseases, ethnicity, religion, health status and income were measured as dichotomous variables. Age was measured as ranked variable, wealth status and education were measured as nominal variables.

Analytical framework

Descriptive and inferential statistics were used to analyze the data. Descriptive statistics such as percentages and frequencies were used to describe the background characteristics and prevalence of substance use during the COVID-19 pandemic among older adults. We used inferential statistics such as binary logistic regression embedded in the Statistical Package for the Social Sciences (version 20) software to estimate demographic, socio-economic and health-related factors associated with substance use among older adults during the COVID-19 pandemic in Ghana. We performed multivariable logistic regression analysis to investigate the demographic, socio-economic and health-related factors associated with substance use during the COVID-19 pandemic.

Using one model, we estimated the factors associated with substance use among older adults during the COVID-19 pandemic. Previous studies used the omnibus chi-square tests of model coefficients, Hosmer and Lemeshow Test, and proportion of correction classification to measure the model fitness. 39 , 40 , 46 The robustness of the models was measured, and the outcomes are as follows. The homogeneity outcome ( P >0.05) of the Hosmer and Lemeshow test shows that the model fits the data well. The Omnibus Tests of Model Coefficients shows a significant difference between the based model (without explanatory variables) and the current model with explanatory variables ( P <0.05) having 84% proportion of correct classification. All tests were considered significant at a p-value of 0.05 or less.

Socio-demographic and medical characteristics of the respondents

The participants’ demographic, socio-economic, and medical characteristics are shown in Table 1 . We found that 80.8% of the participants were aged 50-59 years. The majority of the participants (66.7%) were females, 58% were married, and 44.1% had basic education. Most of the participants (61.6%) rated their wealth status as average; 87% earned a monthly income of ˃GH¢500, 67.7% were employed, 83.1% were Christians, and 87.8% were Akans. In addition, about 86% of the participants rated their health status as good, and 32.3% had been diagnosed with chronic non-communicable diseases (NCDs) ( Table 1 ).

Prevalence of Substance Use among older adults during COVID-19 pandemic

We estimated the prevalence of substance use among older adults during the COVID-19 pandemic. We found that 6.8% of the participants consumed tobacco products (Tawa, cigarettes, cigars, pipes, chewing tobacco, or snuff powder) during the COVID-19 pandemic. Also, 11.4% of the participants consumed alcohol during the COVID-19 pandemic. The study revealed that 16% consumed alcohol and/or tobacco (substance use) during the COVID-19 pandemic ( Table 2 ).

Predictors of substance use among older adults during COVID-19 pandemic

The study found that gender, education and wealth status were significantly associated with substance use among the participants. After adjusting for the demographic and socio-economic factors, male participants were 1.1 times more likely to use substances than female counterparts (adjusted odds ratio, AOR=1.11, 95% confidence interval, 95% CI=0.16-.1.20, P <0.05). Older adults with tertiary education were 0.239 times less likely to use substances than their counterparts (AOR=0.24, 95% CI=0.07-0.79, P =0.019). Similarly, older adults who rated their wealth status as poor were 0.380 times less likely to use substances than their counterparts (AOR=0.38, 95% CI=0.18-0.79, P =0.010) ( Table 3 ).

Italic values indicate significance of P value ( P < 0.05) CI= Confidence Interval; AOR= Adjusted Odd Ratio * P < 0.05.

Key findings

In this cross-sectional study involving 474 participants, we aimed to examine the prevalence of substance use and associated factors among older adults amid the ongoing COVID-19 pandemic in Ghana. The results showed a relatively moderate prevalence of substance use – consumed alcohol and/or tobacco (16%) among older adults during the COVID-19 pandemic in Ghana. The results also showed that demographic and socio-economic factors, particularly gender, education and wealth status, were associated with substance use. Males were likely to report the use of alcohol and/or tobacco compared to females. Older adults with tertiary education and within poor wealth status were less likely to consume alcohol and/or smoke tobacco than their counterparts with primary and secondary education and within average and rich wealth quintile.

Possible interpretation in relation to previous studies

Our study offers evidence that the pandemic directly affects the risk of substance use, particularly alcohol drinking and tobacco smoking among older populations. 12 , 46 , 47 This finding is consistent with a representative panel survey of 5,412 adults in the USA in which 13.3% of the participants had started or increased substance use during the COVID-19 pandemic. 48 Moreover, in an anonymously-completed online self-report survey among 13,829 adults in Australia, Tran et al 49 found that about one in five adults had been drinking more alcohol since the emergence of the pandemic than they used to do. In another study of 1684 Australians aged 18–65 years, participants had increased both their frequency and quantity of alcohol consumption during the pandemic. 50

Several reports from the media and other sources suggest that sales and consumption of alcohol and tobacco increased in some parts of Canada and the USA at the beginning of the pandemic. 51–53 Despite these results, the studies were not conducted in sub-Saharan Africa (SSA). These results cannot be compared to our study because the settings have distinct cultural, social and economic situations that either promote or hinder substance use. Thus, the current findings may not provide a complete understanding of substance use during the pandemic. To the best of our knowledge, this is the first study to establish the prevalence of substance use and associated factors among older adults during the COVID-19 pandemic in SSA specifically Ghana.

Alcohol and tobacco use remain common coping strategies for stress, anxiety and depression associated with the pandemic. 10–12 , 29 , 50 Macdonald et al. 29 argued that the disproportionately high rates of COVID-19 health complications and mortality among older adults prompted negative responses such as excessive alcohol drinking and tobacco smoking. More senior people already are vulnerable to the detrimental effects of the COVID-19 response, such as social distancing and shelter-in-place guidelines, which may inadvertently trigger or worsen stress, social isolation, loneliness and depression, which are directly associated with harmful health behaviours such as substance use. 11 , 30–32 For example, a recent survey of adults across Canada found that stress was a major contributing factor among those who reported increased alcohol use during the pandemic. 33

However, alcohol and tobacco use are associated with several chronic medical conditions common in older adults, such as liver disease. 54 Furthermore, growing evidence suggests that substance use puts older adults at a greater risk of COVID-19 related symptoms since severe alcohol consumption and tobacco use associated with reduced immunity to viral infections. 55 For example, data from China, where the COVID-19 first emerged, show that 32% of Chinese COVID-19 patients with a history of smoking (smokers and ex-smokers) had a severe form of COVID-19 pneumonia at the time of hospitalization compared to 15% of non-smokers. 56 In addition, 16% of smokers required hospitalization in intensive care units, compared to 5% of non-smokers. 56 In another study from China on patients diagnosed with COVID-19-associated pneumonia, 27% of smokers’ health worsened (including death) within two weeks of hospitalization, compared to 3% of non-smokers. 57 The conclusion is that since alcohol and tobacco-related immune system impairment increases susceptibility to pneumonia and other infectious diseases, minimizing alcohol and tobacco consumption is critical for older adults during the pandemic. 10 , 58

Our findings show that socio-demographic and economic factors are important in alcohol and tobacco use among older adults during the pandemic. Males experienced a significantly greater risk of substance use than their female counterparts. In contrast, older adults with tertiary education and within the poor wealth category who experienced significantly lesser risk of the substance may not appear as a surprise but has policy implications. The gender difference may relate well to how males and females respond differently to challenging situations. It is known that men consume alcohol and tobacco more than women, 44 and excessive substance use among men is believed to increase as a response to stress, especially in times of economic crisis. 50 , 58

Moreover, the reduced income and financial support for older males may influence them to resort to alcohol and/or tobacco to manage their financial stress. 31 Consistent with our findings, previous studies have also found an association between wealth status and risk of substance use during the pandemic. 11 , 12 Older adults with higher income are more likely to consume more alcohol and tobacco during the pandemic than those who are poor. On the other hand, older adults with tertiary education are less likely to use a substance during the pandemic. This could be attributed to the fact that they are more likely to know the adverse effects of substance use on both their physical and mental health.

Implications for policy and research

The findings of the study have several implications for policy formulation and research. First, our results that 16% of the older adults included in the study used alcohol and/or cigarette during the COVID-19 pandemic in Ghana suggests that many older adults in Ghana are likely to consume alcohol and/or tobacco to cope with the stress and burdens associated with the pandemic. Given that excessive substance use can affect older adults’ psychological and physical health, our study offers health authorities and other stakeholders evidence on the prevalence of substance use among older adults in Ghana. Having access to this evidence can aid the development of evidence-informed programmes and measures by health authorities and other stakeholders to support older adults who are resorting to substance use during the current pandemic.

Secondly, this study provides essential findings to community-based organizations that offer different programmes involving medication and behavioural therapy to older adults during the COVID-19 pandemic. Our study has revealed the socio-demographic and economic characteristics of older adults who are more and/or less likely to use a substance during the COVID-19 pandemic in Ghana. This study provides evidence to show that older adults who are males with limited education and high income were more likely to increase substance use. This finding implies that measures and programmes to support older adults in Ghana to reduce or stop substance use should particularly target older adults with these demographic and economic characteristics.

This study also provides findings that can inform stakeholders and appropriate authorities to promote education and awareness of substance use among older adults during the COVID-19 pandemic. Our findings can indicate the general situation of substance use among older adults during the COVID-19 pandemic in Ghana.

In addition, this study contributes to literature and discussion on substance use among older adults. Our findings also imply that a nationally-representative study on substance use during the COVID-19 pandemic in Ghana is required to provide national data and evidence to inform and guide policies and programmes.

Limitations

Regardless of the strengths of this study, some limitations need to be remarked. The first limitation of the study is the sampling strategy. The data are self-report and not diagnostic, which means recall and social desirability bias may occur. Previous studies conducted in the same and similar settings have noted measurement bias due to social desirability. Most people like to present themselves in a favourable light and do not respond honestly in surveys. 35 , 36 , 39

Also, given the study’s cross-sectional nature, the data can only estimate associations and not causal relationships. These and other limitations may affect the veracity of the findings that limit the representation and generalizability of the results. However, we controlled for major confounders, including socio-demographic factors in the analysis, though residual confounding remains challenging that may be common to all observational studies.

CONCLUSIONS

This study offers insights into alcohol consumption and tobacco use among older adults during the COVID-19 pandemic in Ghana. Our study provides evidence that some older adults have resorted to alcohol and/or tobacco as a response to the pandemic. Demographic and socio-economic factors, particularly gender, education and wealth status, played a role in substance use among older adults during the pandemic. Although the prevalence of substance use among older Ghanaian adults was relatively moderate, our findings reveal that the COVID-19 pandemic had contributed to older Ghanaian adults’ use of substances such as alcohol, with potentially harmful implications for their physical and psychological health. Consequently, social assistance and kindship care provided to older adults should be intensified to avert any potential health implications.

Acknowledgements

We thank our research assistants for assisting us in the data collection process. Further, we thank our study participants for providing us with the needed data for the successful completion of the study.

The authors did not receive any specific funding for this work.

Authorship contributions

The authors completed the Unified Competing Interest form at http://www.icmje.org/disclosure-of-interest/ (available upon request from the corresponding author) and declare no conflicts of interest.

Competing interests

Authors declare that they have no competing interests.

Correspondence to:

Shadrack Osei Frimpong, MS, MPH., Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR UK.

Submitted : October 25, 2021 BST

Accepted : December 09, 2021 BST

Substance Abuse among the Youth of Northern Region: The Realities of Our Time

Author(s): Peter Mintir Amadu, Rejoice Enyonam Hoedoafia, Vivian Kapio Abem, Nicholas Danzima Yakubu, Mohammed Imoro, Abass Mohammed Sherif, Abdul Rahaman Abdul Razak.

Article Information

Peter Mintir Amadu 1,2,3 , Rejoice Enyonam Hoedoafia 1,2 , Vivian Kapio Abem 5 ,  Nicholas Danzima Yakubu 4 , Mohammed Imoro 4 , Abass Mohammed Sherif 4, Abdul Rahaman Abdul Razak 4

1 Department of Mental Health, School of Medicine, University for Development Studies, Tamale

2 Department of Internal Medicine, Psychology Unit, Tamale Teaching Hospital, Tamale

3 Total Life Enhancement Centre Ghana (TOLECGH), Tamale

4 University for Development Studies, School of Nursing and Midwifery, Tamale-Ghana

5Unversity for Development Studies - School of Public Health

* Corresponding Author: Peter Mintir Amadu, Department of Mental Health, School of Medicine, University for Development Studies, Ghana, Tamale.

Peter Mintir Amadu https://orcid.org/0000-0001-7501-9804

Received: 21 December 2023; Accepted: 03 January 2024; Published: 22 January 2024

Citation: Peter Mintir Amadu, Rejoice Enyonam Hoedoafia, Vivian Kapio Abem, Nicholas Danzima Yakubu, Mohammed Imoro, Abass Mohammed Sherif, Abdul Rahaman Abdul Razak. Substance Abuse among the Youth of Northern Region: The Realities of Our Time. Journal of Psychiatry and Psychiatric Disorders. 8 (2024): 15-23.

Background: The scourge of drug usage among young people in Ghana has emerged as a significant impediment to the country's sustainable growth. Substance misuse poses a severe challenge, particularly in underdeveloped nations like Ghana, acting as a catalyst for economic woes and exerting a profound impact on the socioeconomic, public health, social, and individual facets of the nation. The alarming rise in the consumption of substances such as shisha, tramadol, alcohol, cannabis, wee (marijuana), as well as the inhalation of glue and other harmful drugs, is becoming a growing concern in northern region of Ghana and Ghana as whole with negative consequences on the world and the achievement of the sustainable development goals (SDGs) and universal health coverage (UHC).

Objective: This study endeavours to gauge the prevalence of adolescent drug abuse, aiming to offer a comprehensive understanding of the issue and subsequently inform the development of effective prevention and treatment strategies within the Northern Region of Ghana.

Methodology: A cross-sectional study design was used. The research employed a meticulously crafted questionnaire featuring both open and closed-ended questions. The incorporation of open-ended questions provided participants with an avenue to articulate their perspectives.

Findings/Results: The findings indicate a disturbing trend of drug abuse among teenagers in schools or students in Tamale Metropolis and Sagnarigu Municipal of the northern region of Ghana, particularly involving substances like shisha and tramadol. Negative peer group influence emerged as a prominent factor leading adolescents into the realm of drug abuse. Inadequate parental supervision, coupled with parental substance use, was identified as significant contributors to adolescents adopting similar habits. Encouragingly, a noteworthy percentage of teenagers in schools or students demonstrated awareness of available resource and help centres for seeking assistance and counselling services against drug abuse. However, sadly mist this greater level of awareness it was surprising to note that a good percentage of the respondents would not seek help for substance use challenges sterming from stigma associated with mental health and limited resources.

Conclusion: To address the burgeoning issue of adolescent drug abuse, it is imperative for the Ghana Education Service to integrate education on drug abuse into the school curriculum. This addition would equip students with a deeper understanding of the causes, effects, and potential solutions to drug abuse. Recognizing the detrimental impact of negative peer influence and insufficient parental supervision on students' susceptibility to drug abuse, it is recommended that government institutions and Civil Society Organizations (CSOs) engage in advocacy and education initiatives targeted at students to mitigate the impact of negative peer pressure and the need for positive parenting.

Drug Abuse, Youth, Adolescents

Drug Abuse articles; Youth articles; Adolescents articles,

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Article Details

1. introduction.

1.1 Background to the study

Drug abuse is the overuse, misuse, or addiction to drugs for purposes other than those prescribed by a physician [1]. Any substance that is used to treat or prevent disease in humans or animals is considered a drug [2]. Drug use affects how the body operates, either favorably or unfavorably, depending on the user's body type, the drug's type, dosage, and whether it is used alone or in conjunction with other drugs [3]. Drug abuse as excessive and persistent self-administration of a drug without regard to the medically or culturally accepted patterns [4]. It could also be viewed as the use of a drug to the extent that it interferes with the health and social function of an individual [5]. Addiction to drugs like heroin, morphine, and prescription painkillers is a severe global issue that has an impact on the social, economic, and physical well-being of all countries [6]. There are an estimated 26.4 million to 36 million drug users globally [7], with an estimated 2.1 million having substance use disorders linked to the prescription of painkillers in 2012 and an estimated 467,000 being heroin addicts [8]. The negative effects of this usage have been severe and are getting worse [9]. For instance, since 1999, there have been more than four times as many unintentional overdose deaths in the United States from prescription painkillers [10]. Globally, men abuse drugs at a higher rate than women [7]. Overall, men are more likely than women to use marijuana, cocaine, and opiates, although non-medical use of opioids and tranquilizers is equally common among men and women [7]. Considering some countries in the African continent such as Kenya, 5.4% of enrolled girls and 11.7% of enrolled boys take drugs [11]. Between 2010 and 2014, 367 substance addiction patients were hospitalized to a university teaching hospital in Nigeria from a cross-sectional research [12]. Those under the age of 31 tended to misuse alcohol, whereas those between the ages of 15 and 30 abused cannabis and amphetamine more frequently than alcohol [5]. According to recent findings in Ghana, out of 50,000 drug users, 35,000 are students in junior/senior high schools and higher education institutions between the ages of 12 and 35. The remaining 15,000 were adults, with 6,000 women and 9,000 men [13]. One of the main factors contributing to mental illness among Ghana's youth and adults is marijuana use [9], with some users finding themselves in psychiatric facilities while others end themselves on the streets or in prayer camps [14]. According to a non-governmental organization called Vision for Alternative Development (VALD), 12.8% of students between the ages of 13 and 15 who participated in Ghana's Junior High Schools' Global Youth Tobacco Survey in 2009 smoked any tobacco product [15]. Cannabis is the least expensive and also the most often misused narcotic in Ghana, according to a VALD study [7]. Herbs, leaves, and other plant materials have been used to treat and prevent disease since ancient times [11]. Medications when used properly will be beneficial and does not themselves pose any risk [16]. Adolescents' physical and psychological development can suffer substantial, and perhaps irreparable consequences from chronic substance use [5]. Drug use may be advantageous or detrimental depending on the method of consumption [2]. A material is considered a drug if its chemical effects have the potential to alter biological function, physiological and psychological process in an individual [6]. It is also regarded as a drug that alters bodily processes like perception, cognition, mood and behaviour [14]. So, they may be viewed as chemical modifications of living tissues that could result in alterations to behaviour and physiological processes [7]. Drug misuse is a significant global public health issue [1]. One of the most alarming health-related trends in Nigeria and other areas of the world is the use and misuse of drugs by teenagers in schools or students [4]. Several teenagers in schools or students who are in school participate in mental health programs, either temporarily or for an extended period of time. Some develop mental illnesses, have trouble adjusting to the environment at school, and eventually quit [2]. Teenagers in schools or students desire to live independently and without adult supervision, which leads them to commit a variety of criminal offenses (such as drug addiction, rape, robbery, cultism, and vandalism) that are harmful to their families, communities, schools, and the country as a whole [13]. Adolescent drug abuse has been associated with moral decay, violence, assault, psychosis, and even murder [16]. Hence the need to conduct a study to assess the prevalence of drug abuse and its associated challenges among teenagers in schools or students of Tamale metropolis and Sagnarigu Municipality in the northern region of Ghana become appropriate following recent documentation and report of it usage in the region.

2.1 Research Design

The abuse of drug among students in the second cycle schools is determined through a cross-sectional survey. This design facilitates data collection from a large number of participants at a specific time point.

The cross-sectional survey design is appropriate for this investigation because it permits the examination of the prevalence, causes, effects and help seeking behaviours among students. The design aides in identifying potential risk factors and support areas for drug abuse challenges, by collecting data from students with varying levels of experience and responsibilities. In general, a cross-sectional survey design is an effective and efficient method for attaining this research study’s objective.

2.2 Study setting

The research was conducted among students in the second cycle school/ senior high schools in the northern region of Ghana. One of Ghana's sixteen administrative regions, the Northern Region is distinguished by its diverse cultural heritage and blend of pastoral and urban areas. The northern region is a viewed as a among the fastest development region with the attended negative implication including substance abuse. By conducting the study at these schools, the results can be extrapolated to other schools in the region.

2.3 Study population

The research targeted Senior High School students in the Northern region of Ghana. The target population included both male and female students. The inclusion criteria in the research was students in Senior High Schools under the Tamale metropolis and Sagnarigu Municipality, both male and female, ability to read and understand properly and of sound mind while the exclusion criteria was persons who are not students or students who are not in Senior High Schools under the Tamale metropolis and Sagnarigu Municipal and people who cannot read and understand.

2.4 Target population

The research was conducted in 10 selected schools in the Tamale metropolis and Sagnarigu Municipality. The respondents of the research constituted both male and female students. One-hundred (100) respondents was randomly selected from each of the 10 Senior High Schools in the Metropolis and Municipality. A total of 1000 respondents was selected for the research. The 10 Senior High Schools, which include; Ghana senior school, Vittin senior high School, St Charles Minor Seminary/Senior High School, Dabokpa senior high/Technical school and Tamale Girls Senior high school in the Tamale metropolis and Tamale Senior High School, Northern School of Business Senior High School, Business Senior High School, Tamale Islamic Science Senior High School and Business College International Senior High School in the Sagnarigu Municipal.

2.5 Sample size and sample size determination

The sample size was determined using the formula for calculating the sample size for a cross-sectional survey design. Assuming a confidence level of 95% and a margin of error of 5%, the required sample size was determined.

The formula for calculating the sample size for a cross-sectional survey design is:

n = (Z^2 * p * (1 - p)) / E^2

n is the required sample size

Z is the z-score corresponding to the desired confidence level

p is the estimated proportion of the population with a particular characteristic

E is the desired margin of error

Given that the population size of the students in the schools was approximately 40000, the estimated proportion of the population (p) can be assumed to be 0.5 to ensure maximum variability, which provides a conservative estimate.

Using a confidence level of 95% and a margin of error of 5% (0.05), the corresponding z-score is approximately 1.96.

n = (1.96^2 * 0.5 * (1 - 0.5)) / (0.05^2)

n = (3.8416 * 0.25) / 0.0025

n = 0.9604 / 0.0025

n = 1000 students

Therefore, the calculated sample size is approximately 1000. Hence, a sample size of 1000 students was deemed appropriate for this study, considering a confidence level of 95% and a margin of error of 5%. This sample size provided a reasonable representation of the target population, allowing for accurate estimation and generalizability of the findings.

2.6 Sampling Techniques

Selection of the schools was based on Senior High Schools that are within the Tamale Metropolis and Sagnarigu Municipal. The top 10 Senior High Schools based on population across the metropolis and Municipality was selected for the research. Student’s selection was done across all departments of each school. A minimum of 20 students was randomly selected from each department until the required number of respondents (100) for each school was reached to respond to the questionnaire to avoid biasness. Respondents were selected using simple random sampling technique in each school. Simple random sampling technique is when every member of the population has an equal chance of being selected. This method of sampling was adopted in order to avoid biasness. Every student of the 10 schools who was available on the day and time of conducting the research was given equal opportunity as long as the targeted number of respondents was not exceeded.

2.7 Sources of Data

The researchers devised a structured questionnaire to assess the level of substance abuse among students in the senior high schools in northern Ghana. Participants were administered the questionnaire in person. Relevant literature on drug abuse stress among students (both published and unpublished) comprised secondary sources of information.

2.8 Data Collection Instrument

The research was conducted through survey and data collected through using a well-structured questionnaire. The questionnaire consisted of 5 parts which include: Demographic Information, Prevalence of Teenage Drug Abuse, Causes of Teenage Drug Abuse, Effects of Teenage Drug Abuse and Seeking Help and Prevention.

2.9 Data Collection Procedure

Participants were administered the structured questionnaire in person. During the data collection process, the participants were informed of the purpose and importance of the study, and their participation was solicited voluntarily. This ensured that participants were aware of the study's goals and were able to make an informed decision regarding their participation.

It was essential that the questionnaire be administered during school working hours at a convenient location within the selected schools to ensure maximal participation and convenience for the students. Collecting data during school working hours caused minimal disruption to the participants' routines and allowed them to complete the questionnaire within their allotted school work schedule. This method increased response rates and decreased the likelihood of non-response bias. By administering the questionnaire in person, the researchers were able to address any questions or concerns the participants may have had, ensuring the accuracy and totality of the data collected.

Moreover, executing the data collection procedure in person enabled a personal connection between the researchers and the participants, which could foster a sense of trust and encourage truthful responses.

2.10 Data Analysis Process

The data collected was subjected to preliminary analysis using Statistical Package for the Social Sciences (SPSS) software version 27. After the data was collected, it was edited to improve its quality for coding. The analysis of the data was done through descriptive statistics which helped the researchers to tabulate data and present it in graphic format. The findings were presented as frequencies and percentages.

2.11 Reliability and Validity of Data

The reliability and validity of the data was ensured by conducting a pre-test of the structured questionnaire on a small sample of students in a similar school within northern region. The pre-test assessed the clarity, comprehensiveness, and consistency of the questionnaire.

2.12 Ethical Consideration

The proposed study followed ethical guidelines and obtain ethical clearance from the Institutional Review Board of the University for Development Studies. Informed consent was obtained from all participants/their guidance and counselling tutor, and confidentiality and anonymity was ensured by using unique identification codes instead of names. Participants were informed about their right to withdraw from the study at any time without penalty.

The present study conducted an analysis on the prevalence of drug abuse among students in second cycle schools in northern region of Ghana. Results are presented below;

The Demographic Features of the Respondents, the results in figure 1 provide an overview of the demographic characteristics of the students participating in the study.

Demographic characteristic of respondents

Figure 1: Gender Distribution of Respondents

(Source: Field Data, 2023)

Table 1: Age Distribution of Respondents

Figure 2: Religion of Respondents

Figure 3: Class of Respondents

Prevalence of Teenage Drug Abuse

Table 2: Response on Abusing Drugs

Figure 4: Types of Abused Drugs

Table 4: Sources of Abused Drugs

Factors contributing to drug abuse/Causes of Teenage Drug Abuse

Table 5: Factors That Causes Teenage Drug Abuse

Table 6: Factors That Motivate Teenagers in schools or students into Drug Abuse

Effects of Teenage Drug Abuse

Table 7: General Effects of Teenage Drug Abuse

Table 8 : Personal Experience on Effects of Teenage Drug Abuse

Table 9: Response on Long Term Effects

Seeking Help and Prevention

Table 10: Respondents Awareness on Support Systems

Table 11: Respondents Willingness to Seek for Help

Table 12: Response on Education Received on Drug Abuse

4. Discussion

The issue of drug abuse among teenagers in schools or students has been a growing concern for societies around the world. Recent research findings shed light on the prevalence and patterns of drug abuse among adolescents. This discussion aims to analyse the findings of a study that questioned respondents about their drug abuse experiences and patterns, as well as to relate these findings to recent articles addressing teenage drug abuse.

4.1 Demographic Features of the Respondents

Ten senior high schools within northern region were chosen for the research, which include; Ghana senior school, Vittin senior high School, St Charles Minor Seminary/Senior High School, Dabokpa senior high/Technical school and Tamale girls Senior high school in the Tamale metropolis and Tamale Senior High School, Northern School of Business Senior High School, Business Senior High School, Tamale Islamic Science Senior High School and Business College International Senior High School in the Sagnarigu Municipal. One-hundred (100) respondents were selected from each school. A total of 1000 respondents across all levels took part in the research. Out of the total 1000 respondents that took part in the research, 650 (65%) were male while 350 (35%) were female. The respondents were Muslims dominated with 822 (82.2%) Muslims and 178 (17.8%) Christians. Majority 750 (75%) of the respondents were between the ages of 16-19 years, 200 (20%) were between 12-15 years while only 50 (5%) were 20 years and above. A total of 450 (45%) of the respondents were first year students, 350 (35%) were second year students and 200 (20%) were final/third year students.

4.2 Prevalence of Teenage Drug Abuse

Respondents were questioned on the prevalence of drug abuse. They were questioned as to whether they have ever abused drugs/alcohol before. Out of 1000 respondents, 584 (58.4%) agreed to have used or abused drugs before while, 416 (41.6%) of them responded not to have ever used/abused drugs before. Considering the 584 respondents who agreed to have abused drugs before, 70 (12%) did so between the ages of 12-14 years, 350 (60%) were between 15-17 years and 164 (28%) were 18 years and above. Moreover, 280 (48%) of the respondents who have abused drugs before did so with shisha, 140 (24%) abused tramadol, 70 (12%) abused alcohol, 48 (8.2%) were abusing marijuana while 22 (3.8%) respondents each abused cocaine and cigarette respectively. Furthermore, the source of the drugs abused were further questioned and 466 (79.8%) of the respondents obtained the abused drugs from friends, 48 (8.2%) obtained them from dealers and 70 (12%) stole them from people possessing them.

The findings of the research indicate that majority 58.4% of the respondents were into drugs or abusing drugs while 41.6% were not. The prevalence of alcohol and marijuana use were relatively low compared to those found among Nigerian adolescent (17) and South Africa youth (11) but similar to those found among Ghanaian teenagers in schools or among students (11). However, the rate of abuse of shisha in this research was similar to that of the youth in Central and Greater Accra regions of Ghana, where it was the most abused drug among the youth. (18)

4.3 Causes of Teenage Drug Abuse

A lot of factors drag teenagers in schools or students into drug abuse ranging from peers group influence, curiosity, boredom, accessibility to drugs, media influence, stress, anxiety, mental health issues among others. Respondents were asked on factors that they believed have contributed to teenage drug abuse, 482 (48.2%) of them believed it is due to lack of parental involvement against drug abuse with their ward, 116 (11.6%) believed it is lack of discipline, 220 (22%) believed it is due to media influence, 66 (6.6%) said it is due to their accessibility to those drugs, 100 (10%) believed it is due to social pressure and 16 (1.6%) associated it with mental health issues. Considering respondents who were engaged in drug abuse, 312 (53.4%) of them were introduced to it by their peers/friends, 227 (38.9%) were into it as a result of being curious, 25 (4.3%) were due to stress or anxiety while 20 (3.4%) were due to boredom.

Regarding causes of drug abuse our study found the following; lack of parental involvement in the fight against teenage drug abuse have been the major cause of it. Media influence has also been another key cause of drug abuse since most teenagers in schools or students see people do it on the media and they tend to practice it. Social pressure such as peer pressure has also contributed to the increase of teenage drug abuse. [19] reported that Peer influence is the main causes of drug abuse among the youth in Kenya which agrees with this research’s findings. Furthermore, (14) conducted a research in the Ankaful Psychiatric hospital in Cape Coast in the central region of Ghana where most of the student/clients associated the cause of their involvement in drug abuse to peers similarly to our findings.

4.4 Effects of Teenage Drug Abuse

Drugs abuse generally have several effects on human life and development. A lot of teenagers in schools or students who engages in drug abuse suffers several effects such as physical health problems, mental health problems, poor academic performance, legal problems etc. on their lives and the society. The general effects of drug abuse include physical health problems which 318 (31.8%) of respondents believed abusers would experience, 484 (48.4%) respondents believed they would suffer from mental health problems, 32 (3.2%) believed it has legal effects and 166 (16.6%) believed it has family issues. Regarding respondents who engaged in drug abuse, they were asked on their personal experience on the effects of drug abuse, 292 (50%) of them believed it affects their academic performance, 58 (10%) of them agreed it causes relationship problems, 199 (34%) agreed it has health issues, 29 (5%) agreed it causes financial difficulties and only 6 (1%) of them agreed it has legal consequences. However, 884 (88.4%) of the respondents agreed that the abuse of drugs has long term effects on the lives of the abusers while 116 (11.6%) believed it did not to have any future or long term effects. The effects of drug abuse in this current study points to the fact that abusers mostly suffer from physical and mental health problems and also a decline in academic performance. According to [15] in Egypt, an association between tobacco use and education and also sex was found, which is not consistent with our findings. According to them, lower education level is a significant independent predictor for current smoking in older people, which is also consistent with other studies. According to [20], also revealed that drug users suffer from school- associated outcomes like low-class performance, low attendance, and also school dropout which firmly agrees with our findings.

Our findings also were similar to [1] who stated that despite the fact that health stock depreciates with age, the current study found that Ghanaian male adults have a higher probability to engage in smoking as they age. Our findings found it true because some of the teenagers in schools or students in the senior high school were engaged in smoking.

4.5 Seeking Help and Prevention

Resource centres such as the National Commission on Civic Education (NCCE), Narcotics Control Commission (NCC), both as government institutions/agencies are working towards drug abuse education and support for the young ones in Ghana. Also the Ghana Education Service Guidance and Counselling unit is playing a vital role in our school systems to support teenagers in schools or students with drug related challenges. These state institutions need to continue their effort towards supporting the youth in their development stages. Furthermore, in the civil society space, Total Life Enhancement Centre Ghana (TOLECGH), a psychology-focused institution advocating for mental health and the first private psychological service provider (premier psychology clinic) in the entire northern Ghana based in Tamale has been engaging students from basic to tertiary levels on the concepts of drug abuse and how to overcome it for effective development. TOLECGH operates in six thematic areas mental health advocacy, provision of psychological services, counselling services, emotional intelligence and management, capacity building/livelihood empowerment and mental health research. TOLECGH is a mental health and psychosocial support service (MHPSS) provider with special focus on youth and women. In the northern region of Ghana is Basic Needs Ghana a leading mental health organisation championing mental health in the Northern Region and the entire regions in Ghana and other Civil Societies Organisations (CSOs) are campaigning against drug abuse and are always ready to assist individuals especially teenager to disengage in it. This study found majority of the respondents 584 (58.4%) of respondents were aware of resource centres or support systems available for teenagers in schools or students struggling with drug abuse while 416 (41.6%) were not aware of such support systems. However, only 416 (41.6%) were willing to seek for help for drug abuse, 566 (56.6%) were not willing to seek for help and 18 (1.8%) were not sure of choice to make. It is important to note that these reasons for refusal to seek help could vary from person to person and may be influenced by a combination of personal, societal and systemic factors. These could range from stigma, denial, fear of the consequences, financial barriers, cultural and religious beliefs, lack of trust in the systems, low level of mental health literacy and limited access to mental health resources. it's essential to address these barriers systematically to reduce stigma, increase motivation to seek help to encourage individuals and their families to seek for the help they truely need for mental health and substance abused challenges choice. Respondents’ response on education they have received on drug abuse are as follows: 634 (63.4%) of the respondents got educated on drug abuse through school programs, 166 (16.6%) received their education from community programs, 116 (11.6%) received their education from radio programs while 84 (8.4%)) never had any education at all on n drug abuse. Organizations, agencies, and help centres play a crucial role in the fight against teenage drug abuse in Ghana by providing education, prevention, intervention, treatment, and support services. Counselling and rehabilitation centres can play a significant role in the fight against teenage drug abuse in Ghana by providing essential support, education, and interventions. Majority of the students suggested that parents can be more involved in the quest in preventing the abuse of drugs. Also, parents should expose to their wards the effects of drug abuse. These finding agrees with a report by [16], whose research focused was among the youth in Dansoman Community in the Greater Accra region of Ghana. Again, respondents supported education and information share among parents and children on the effects of drugs as a solution to drug abuse. Furthermore, students also agreed that to prevent drug abuse, students should always be engaged in extracurricular activities.

Stigma related to seeking mental health services in our environment could be the reason why even with high awareness of support services many of the teenagers in schools or students still do not want to seek for help regarding drug abuse.

5. Conclusion

From the study outcomes, the following conclusions can be drawn:

• Taking drugs without a Doctors’ or Physician’s prescription constitutes drug abuse. Also, prescribed drugs that are being taken to overdose, establishes drug abuse.
• A lot of teenagers in schools or students in the Tamale metropolis and Sagnarigu Municipal are into drug abuse especially with shisha and tramadol.
• Negative peer influences mostly lead to drug abuse. Lack of adequate parental supervision and parental drugs usage could lead teenagers to also abuse the drugs.
• Drug abusers can result in immoral behaviours such as stealing, bullying, and school-related outcomes such as poor performance, low attendance, and also dropout.
• Finally, most teenager are aware of the resource centres or help centres to seek for assistance and counselling services against drug abuse. However, even though the awareness is high majority of them did not want to seek help. This could be due to the stigma associated with drug abuse and its mental health related challenges.

6. Recommendations

The following recommendations have been made for adaption and implementation following the findings of our study to relevant stakeholders in the youth Eco space.

• The Ghana Education Service needs to complement education on drug abuse in the school curriculum. This will provide students with more insight in order to understand drug abuse, causes, effects, and solutions available.
• Since negative peer influence and insufficient parental supervision leads to students' drug abuse, it is recommended that the National Commission for Civic Education (NCCE), other governmental agencies and CSOs engage on peer education among students to reduce the influence of negative peer pressure on students.
• Parents should also be educated to intensify their monitoring and supervisory roles in the form of positive parenting.
• Teachers and parents, should intensify their monitoring roles both in school and after school. This will help minimise the rate at which students' abuse drugs.
• Ghana Education Service (GES) to build the capacity of school based counsellors to be well equipped to handle students with drug related challenges.
• The GES to engage more Counselling professionals in the Senior High School to support student with drug abuse challenges.
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A preliminary study of drug abuse and its mental health and health consequences among addicts in Greater Accra, Ghana

Affiliation.

• 1 Department of African American Studies, John Jay College of Criminal Justice, City University of New York, New York 10019, USA.
• PMID: 10681106
• DOI: 10.1080/02791072.1999.10471769

This article represents a preliminary effort to describe drug abuse in Tudu, one of a number of neighborhoods in Accra that serve as drug centers. The problems of such neighborhoods reflect the drug problems that currently beset the rest of Ghana and Accra in particular. There is almost no fundamental current research on this issue. The few works cited comprise virtually the entire body of existing literature on this subject, and they fall far short of providing a comprehensive account of the changes that drugs have made in the social structure of the greater Accra region. This article is based on research done in the drug parlors and alleyways where the Tudu drug trade is conducted, and is a preliminary effort to redress the current lack of information by documenting the changing patterns of drug use in greater Accra. The findings reveal that a shift is underway from traditional marijuana abuse to abuse of crack cocaine and heroin. The article highlights the social relations that characterize this more dangerous drug setting and enhances the understanding of the psychiatric comorbidity of drug abuse, health, and behavior. These conclusions are derived from a multifaceted approach to data collection, taken to enhance the validity of research findings.

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Drug abuse among the youth in ghana, ha brown-acquaye.

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Opinions of Monday, 25 June 2018

Columnist: Kelly Michael Agbesi

Drug abuse in Ghana, causes, effects and solutions

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Obviously, one of the ills plaguing Ghana today is the misuse of drugs specifically "Tramadol" and other forms of substances which are either poorly regulated or banned for use in the country. Like a strike of light to a petrol or a smoker puffing cigarette smoke in the sky, illegal use and abuse of drugs has engulfed our society so much that most of these young men and women are suffocating to death under it's intense canker. It is in the light of this unfortunate situation that I'll carefully examine the menace, causes, effects of using the un-prescribed drugs and suggest ways to ameliorate it. First and foremost, any substance (with the exception of food and water) which, when taken into the body, alters the body’s function either physically and/or psychologically is referred to as drug. (Wikipedia 2018). Drugs may be legal (e.g. alcohol, caffeine and tobacco) or illegal (e.g. cannabis, ecstasy, cocaine and heroin). For the crux of my discussions, tramadol abuse by the youth in recent times has become very important for national and for that matter international attention. What is tramadol? Tramadol (or "Tramol" as called locally) is oral tablet and a prescription drug that is available as an immediate-release and extended-release tablet. Tramadol is a controlled substance. This means it can only be used with a doctor’s close supervision. Why it is used? Tramadol is used to treat moderate to severe pain. This substances can be used as part of a combination therapy. This means you may need to take it with other medications. How it works Tramadol belongs to a "class of drugs" called 'opioid agonists'. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions. It works by changing how your brain senses pain. Tramadol is similar to substances in your brain called "endorphins". Endorphins bind to receptors (parts of cells that receive a certain substance). The receptors then decrease the pain messages that your body sends to your brain. Tramadol works in a similar way to decrease the amount of pain your brain thinks you are having.(https:/www.healthline.com/health/tramadol-oral-tablet). Drug (tramadol) abuse is firmly rooted in the following factors. In other not to "cry the wolf", the limited and difficult access to healthcare delivery in Ghana contribute to the abuse of the substance of play (Tramadol). Young people, especially, those living in the countryside, have no or little access to the various health facilities across the country. The little available ones are are nothing boosts of due to the poor regulation of the facilities and inefficient accessibility by the use of the National Health Insurance Scheme (which is to regulate medical health-care for the citizens in Ghana. These occurrences makes it very difficult for them to have the opportunity to consult a qualified health professional in moments of sickness, trauma or injury. Citizens placed on such happenings would only have to rely on "tramol" or any other substance readily available in their surroundings. After all, if there is no qualified health professional, a quack doctor or a chemist's shop is nearby. What a pity! Added to this is the cost hospital bills which tend to be unaffordable. The lay person walking in the street is incapable of receiving quality health services in the country. No seer to predict the increasing cost of medications and all kinds of health services provided in the country's hospitals. The most disturbing is the embarrassment caused the poor sick person. Though I do not have evidences to prove to the fact that sick people have to pay money before they could see the doctor but I believe this is one of the reasons they stay in the corner and kick the bucket slowly but painfully. Is it any wonder for such poor people to shy from high cost medical care and resort to tramadol or street peddlers or buy from a chemist's shop at a low cost? Quite prominent among the use of tramadol by young people is the desire of most of them to enhance their performances in various fields of human behavior. For instance, these young people use tramol and other un-prescribed substances to enable them do physically challenged activities. Most of them who are students erroneously believe that some 'special' drugs like tramadol would give them required fitness, strength and mental alertness to improve their performances in the tracks, academics and ability to 'last long' in bed. The instreaming of drug itinerants and quack doctors in our streets and at the doorsteps, has orchestrated to a high incidence of drug abuse. It is worthy to note that, not only in our homes and streets that one catches a glimpse of quacks plying their trade, but also in buses and in "troskys". Their ability to entertain an audience, their sheer eloquence and the testimonies given by various people about the efficacy of their drugs are enough to sway a sick person or the young person to buy what they sell. Also, worthy to note is the fact that their drugs are inexpensive and so people cannot help but use them without qualified medical doctor's advice. Another factor responsible for the growing incidence of drugs abuse especially tramadol abuse is peer pressure or peer group influence. In schools especially, students tend to be lured by friends who are into the drug 'businesses'. A young boy addicted to to drugs may convince a colleague to drink alcohol, sniff cocaine, smoke marijuana or misuse tobacco substances in the name of fashion. Some youngsters who are determined not to defile their bodies with drugs are alienated, scolded, and given provocative names like "kolo, john, anti-so", etc. To escape these cat-calls and mockery, some easily give up into the advice of abusing drugs in the nick of time. Interestingly, advertisement has for the past decades have been one of the powerful tools used to lure men to misuse drugs in this country. On the wings of advertisement, young people get carried away by thoughts of fantasy. They begin to feel that they would in no time, beam with smiles, confidence and appear healthy like the smiling confident looking individuals in the advert who have been provident enough to do the right things at the right time. Elegantly dressed and as men of high social standing too, they have almost always, compelled their audience to accept them as role models through the quintessence of eloquence and high sounding catch phrases and slogans like "Marijuana, the heavenly weed that opens the twin doors of wisdom and prosperity!" "Adonko bitters, bitters of the moment!" and etc. Deceptive as their behaviours and speeches are, several thousands of young talented people are influenced into imitating their lifestyles and habits. Curiosity is also one of the factors that accounts for the misuse of drugs. Most young are very curious to find out what is contained in certain types of drugs especially tramadol and other alcoholic substances. They see others happily indulging in drugs. Often times, they find men and women of high social standing smoking and drinking profusely. They irresistibly gross anxious to find out what makes other people indulge in these drugs. Drug abuse has is attendant problems. Most prominent among them is that it usually impairs the health of those who become addicted to the practice. Quite often, habitual users of strong drugs like tramol, cocaine, marijuana and alcohol become emaciated and completely dehumanized. Predictably, this leads to premature deaths. Habitual drug users are noted to be drowsy, lazy and totally unproductive. Though they may eat a lot, they lack the strength and conscience to contribute to the growth of a country's economy. In most situations, the illegal use of drugs leads to mental illness. A drug addict easily breaks down psychologically. The abuse of drugs such as marijuana, alcohol and tramadol provokes acts of violence. Those who misuse such drugs become fearless, aggressive, reckless and prone to acts of inhumanity. This, no doubt, disturbs social order. To combat the drug menace, the following measures should be put in place. There is the need for a nationwide educational campaign, aimed at exposing every citizen to the dangers inherent in using un-prescribed drugs. As much as education is essential, it is equally important for the government to embark on a health revolution. In this respect, hospitals and well-equipped clinics should be established in all towns and villages in the country to give people access to qualified health professionals. As a matter of urgency, hospital fees must be reviewed to make them affordable to the common man. The National Health Insurance Scheme must be regulated enough to cover most hospital bills especially most medicines and laboratory tests which most patients find out very mind-blowing to afford. The government and the security agencies should not delay in waging a relentless war against users and traders of hard drugs like cocaine, tramadol and marijuana. Whenever they are caught, instant punitive measures should be meted to them. In addition, the government is advised to place a ban on the sale of the most commonly abused drugs in the country. Lastly, quack doctors and drug peddlers should be given proper training to enable them conduct their operations more efficiently and effectively. If not, they should be banned from carrying out their operations. I hope the suggestions presented in this piece would be carefully considered to provide a lasting solution to this abuse of drugs especially tramadol (currently trending) in our country. Yours faithfully, ........Signed.....

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CWRU research finds Ozempic may reduce alcohol abuse and other addictive behaviors

Semaglutide drugs such as Ozempic and Wegovy have become commonplace in weight loss treatment, but new research shows the drugs may also be useful in treating substance abuse.

Researchers at Case Western Reserve University's School of Medicine found that semaglutide, or GLP-1 agonists, are linked to reduced incidence and recurrence of alcohol abuse or dependence. Their findings were recently published in the Nature Communications science journal.

The current study started with comments posted in response to a New York Times article on the team's previous findings on the effect of semgalutide on suicidal ideation, said Dr. Rong Xu, professor of biomedical informatics and the study’s lead researcher.

"Some readers left comments about our future studies to say, 'Oh, after I took this medication, I no longer wanted to drink alcohol and my mental status significantly improved,'" Xu said. "So based on the comments left, we conducted a similar study to see semaglutide's association for decreased risk for alcohol drinking."

The study looked at records for nearly 84,000 patients, all of whom were medically obese. Those treated with semaglutide, compared to those treated with other anti-obesity medications showed a 50-56% decrease for both the initiation and recurrence of alcohol-use disorder in the following year.

"So there was a dramatic decrease in new diagnoses of individuals with alcohol use disorder," said Dr. Pamela Davis, study co-author. "That is, there seem to be a lot fewer individuals who were taking on enough alcohol to be diagnosed with a physician for alcohol use disorder."

The researchers then looked at records for nearly 600,000 patients with type 2 diabetes and determined similar results of consistent reductions in alcohol-use disorder diagnoses.

Davis noted that the study merely looked at the data, not the reason why semaglutide appears to reduce alcohol use disorder, but said it likely impacts the brain's reward system.

"The [drugs] have to do with the dopamine system and with the transmission of signals in the dopamine system, which are the reward system in the brain," Davis explained. "People who have alcohol use disorder get an internal brain reward for drinking, and we think that the semaglutide removes at least part of that sense of being rewarded for taking a drink."

Though the research is promising, Xu said it's merely an observational study from clinical trials, meaning more research is needed before her team makes any recommendations for prescribing semaglutide for substance use treatment.

"Hopefully this would provide the evidence for some future community trials," she said.

Researchers have also examined the effects of semaglutide on cannabis use and suicidal ideation in previous studies and found use of semaglutide in patients with obesity also reduced cannabis use disorder and the risks of suicidal ideation.

Now, Xu and her team are continuing their research on the impact of semaglutide on other mental health and substance use disorders, including opioids and nicotine.

"We suspect with semaglutides, probably there's some common mechanism that may involve pocketing the reward system, so they can improve mental health, reduce the desire to have food or other substances," Xu noted.

Xu also said she's hopeful this research can influence pharmaceutical companies like Ozempic manufacturer Novo Nordisk to lower costs for semgalutide. Researchers from Yale, Harvard and King's College determined in a study published to the Journal of the American Medical Association that Ozempic can be manufactured for less than $5 per month, but Novo Nordisk charges nearly $1,000 for a month's supply.

"There are many different pharmaceutical companies working in this field, so hopefully the price will come down significantly," Xu said.

Alcohol use disorder affects nearly 30 million people over the age of 12, according to the National Institute of Alcohol Abuse and Alcoholism. Cases lead to nearly 178,000 deaths in the United States each year, according to the Centers for Disease Control and Prevention.

Social ecological factors affecting substance abuse in Ghana (West Africa) using photovoice

Ahmed Kabore, Evans Afriyie-Gyawu, James Awuah, Andrew Hansen, Ashley Walker, Melissa Hester, Moussa Aziz Wonadé Sié, Jarrett Johnson, Nicolas Meda

Received: 24 May 2017 - Accepted: 09 Dec 2019 - Published: 30 Dec 2019

Domain : Community health,Global health,Health education

Keywords : Substance abuse, illicit drugs, drug addiction, mental health, risk factors, protective factors, West Africa

© Ahmed Kabore et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Ahmed Kabore et al. Social ecological factors affecting substance abuse in Ghana (West Africa) using photovoice. Pan African Medical Journal. 2019;34:214. [ doi : 10.11604/pamj.2019.34.214.12851 ]

Available online at: https://www.panafrican-med-journal.com/content/article/34/214/full

Ahmed Kabore 1,2,3,& , Evans Afriyie-Gyawu 1 , James Awuah 4 , Andrew Hansen 1 , Ashley Walker 1 , Melissa Hester 1 , Moussa Aziz Wonadé Sié 2 , Jarrett Johnson 1 , Nicolas Meda 2,3

1 Jiann-Ping Hsu College of Public Health, Statesboro, Georgia Southern University, Georgia, United States, 2 Centre Muraz, Department of Public Health, Bobo-Dioulasso, Burkina Faso, 3 Joseph Ki-Zerbo University, Department of Public Health, Ouagadougou, Burkina Faso, 4 University of South Dakota, Sanford School of Health Sciences, South Dakota, United States

& Corresponding author Ahmed Kabore, Joseph Ki-Zerbo University, Department of Public Health, Ouagadougou, Burkina Faso

Introduction: substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method.

Methods: this study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse in their communities. They were also given the opportunity to provide narratives of the pictures using pre-identified themes and the different levels of the social-ecological model and participatory action research (PAR).

Results: participants identified at the individual level: ignorance; interpersonal level: family and peer pressure; organizational level: lack of regulation; community level: media, availability of drugs, cost of drugs, urbanization, slum communities and cultural factors; and policy level: lack of regulations and their enforcement. Education and beliefs were cited at the individual level; family at the interpersonal level; religion at the organizational level; organizing youth, media and narcotics anonymous at the community level; and nothing at the policy level.

Conclusion: this is an exploratory study that will add to the limited body of knowledge in the scientific literature with respect to substance abuse in the country and also help develop interventions to address the respective needs of several communities in Ghana.

Drug abuse continues to be a controversial issue around the globe. It leads to enormous loss in life, and its effects spill over into the general society as well, thereby hindering the effective functionality and growth of populations [ 1 ]. In developing countries, for instance, the harm is magnified by the poor economic and living conditions. Government spending on substance abuse treatment is seen as an extra financial burden on an already strained budget. Furthermore, drug addiction can threaten civic safety, given that people under the influence of drugs may have a distorted view of the world around them and are prone to participating in improper behaviors such as armed robbery, traffic violations, and domestic violence [ 2 ]. Such persons can then become a danger to their family, the general public, and the environment [ 3 ]. Substance abuse also increases the risk of spreading infectious diseases such as HIV/AIDS, hepatitis B and C and tuberculosis. Drug abusers tend to share infected needles and cannot make appropriate decisions while under the influence of controlled substances, which can lead to the spread of the above-mentioned infections. Additionally, being under the influence of illicit drugs can also increase the incidence of unprotected sex [ 4 ]. Studies on substance abuse and potential intervention strategies in Africa are extremely limited in the scientific literature, highlighting the need for more research on this subject. Thus, the primary objective of this study was to assess the risk and protective factors pertinent to substance abuse in Ghana, West Africa, using the photovoice methodology.

This current study sought to explore the risk factors regarding substance abuse in Ghana, West Africa. Overall, the participants could identify why people use or abuse drugs from different perspectives, including ignorance at the individual level; family and peer pressure at the interpersonal level; lack of regulation at the organizational level; the availability of drugs, the cost of drugs, the media, urbanization, and slum communities at the community level; and lack of (or inadequate) enforcement and regulations at the policy level. The participants also identified potential protective factors against substance abuse in their communities. As described by participants, drug addiction is not viewed as a disease in Ghana, which makes it difficult to develop interventions. Addiction-related issues receive less attention from the population and at the policy level. Further studies are warranted to help educate the population about the dangers of drugs that are easily accessed on the streets of Ghana. Prevention remains the best option for addressing this issue of substance abuse because of the wide range of available treatment processes.

What is known about this topic

• Literature has addressed the fact that substance abuse was a concern in West Africa;
• Literature has addressed the challenges of addressing the issue in the region.

What this study adds

• Youth in slum communities sell drugs in order to survive which makes drugs such as marijuana and amphetamine available and at low cost;
• Education was highlighted as the most effective way to reach communities;
• The Church and Mosques were chosen as the most effective avenue to educate communities about the danger of substance abuse.

The authors declare no competing interests.

All the authors have read and agreed to the final manuscript.

Table 1 : quotes based on the socio-ecological model Table 2 : risk factors to substance abuse according to participants in recovery Table 3 : protective factors to substance abuse according to participants in recovery Table 4 : action plan proposed by participants to reduce the risk of substance abuse in the community Figure 1 : a photo of shanty towns in Accra illustrates the canal of drug addiction; the slums spread over 5km and the only business they do there is selling drugs Figure 2 : a canoe at the seashore: canoes are used to transport the drugs that come from South America from the high seas to the seashore, with canoes, it is easy to bring the drugs into Accra, Ghana Figure 3 : a photo of a church in Accra illustrates the role of religious groups in the fight against substance abuse in Ghana Figure 4 : an open football field illustrates that youths in Ghana do not need much to practice a sport

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This article authors

• Ahmed Kabore
• Evans Afriyie-Gyawu
• James Awuah
• Andrew Hansen
• Ashley Walker
• Melissa Hester
• Moussa Aziz Wonadé Sié
• Jarrett Johnson
• Nicolas Meda

On Google Scholar

Citation [download], navigate this article.

• Introduction
• Competing interests
• Authors´ contributions
• Acknowledgments

Tables and figures

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• Pubmed Central
• Google Scholar
• Substance abuse
• Illicit drugs
• Drug addiction
• Mental health
• Risk factors
• Protective factors
• West Africa

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Drug discovery research in Ghana, challenges, current efforts, and the way forward

Richard kwamla amewu.

1 Department of Chemistry, University of Ghana, Legon-Accra, Ghana

Patrick Amoateng

2 Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon-Accra, Ghana

Patrick Kobina Arthur

3 Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon- Accra, Ghana

Prince Asare

4 Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

Isaac Asiamah

5 Department of Chemistry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana

Daniel Boamah

6 Department of Microbiology, Centre for Plant Medicine, Mampong-Akuapem, Ghana

Isaac Darko Otchere

Cedric dzidzor amengor.

7 Department of Pharmaceutical Chemistry, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana

Edmund Ekuadzi

8 Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana

Kelly Chibale

9 Holistic Drug Discovery and Development (H3D) Centre at the University of Cape Town (UCT), Rondebosch, South Africa

Susan Jane Farrell

10 Wellcome Centre for Anti-Infectives Research (WCAIR), Division of Biological Chemistry and Drug Discovery, University of Dundee, Dundee, United Kingdom

Regina Appiah-Oppong

11 Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

Dorcas Osei-Safo

Kevin david read, ian hugh gilbert, dorothy yeboah-manu.

We have a long-term vision to develop drug discovery research capacity within Ghana, to tackle unmet medical needs in Ghana and the wider West African region. However, there are several issues and challenges that need to be overcome to enable this vision, including training, human resource, equipment, infrastructure, procurement, and logistics. We discuss these challenges from the context of Ghana in this review. An important development is the universities and research centres within Ghana working together to address some of these challenges. Therefore, while there is a long way to go to fully accomplish our vision, there are encouraging signs.

Introduction

There is limited drug discovery research in sub-Saharan Africa [ 1 ], with the notable exception of Holistic Drug Discovery and Development (H3D), which is based in Cape Town. Hence, we recognized the value in outlining our vision and the progress made in Ghana towards the development of drug discovery research and to highlight some of the challenges that we face. There is a huge need for new drugs for Ghana and across sub-Saharan Africa, particularly in the anti-infective area. Diseases such as malaria, leishmaniasis, schistosomiasis, and tuberculosis (TB) have a massive impact in Ghana, and yet there is inadequate research in drug discovery into these diseases locally. Due to the economics of drug discovery research, there is little commercial gain to be made from drugs for such diseases. Furthermore, for noncommunicable diseases such as cancer, the approaches of diagnosis and management are often very different in countries such as Ghana, from high-income countries, necessitating research in these areas too.

Various efforts are underway in Ghana to increase drug discovery research efforts. In this article, we discuss the status quo and some of the challenges facing drug discovery research in Ghana. Furthermore, we discuss the opportunities going forward with emphasis on the preclinical development stages. Our overall vision is to grow the current infrastructure to enable integrated and professional drug discovery activities: screening of compounds, compound optimisation, and compound characterisation. The eventual aim is to be able to produce preclinical drug candidates.

Developing a drug discovery research infrastructure will address some of the United Nations Strategic Development Goals (SDGs), highlighted in Fig 1 [ 2 ], giving many additional benefits to Ghana. These benefits include education and training across many disciplines to create an environment for Ghanaian researchers to flourish. Furthermore.it offers the potential for generation of “spin-out” companies research groups to generate innovation and economic development. Moreover, building up drug discovery research gives opportunities to strengthen South–South interactions within the West Africa subregion through collaborative research ultimately, we hope this work will lead to the discovery of candidate medicines.

In Ghana, there are a number of key universities and research institutions that have an ambition for drug discovery research ( Fig 2 ). These include the University of Ghana (UG), Accra; Kwame Nkrumah University of Science and Technology (KNUST), Kumasi; University of Cape Coast (UCC), Cape Coast; and the University of Health and Allied Sciences (UHAS), Ho. A constituent part of UG is the Noguchi Memorial Institute of Medical Research (NMIMR), with excellent infrastructure, including Biosafety Level 3 (BSL3) laboratories, an animal experimentation facility for pathogen studies and clinical trials unit. In addition, the Centre for Plant Medicine Research (CPMR), Mampong carries out research on herbal medicines.

*This was determined based on publications in drug discovery and through records of collaborations across the institutions. The base map used for constructing the map as well as the copyright information for use of the base map files are freely available at https://data.humdata.org/dataset/cod-ab-gha . No changes were made to the base map files.

Drug discovery has multiple requirements, many of which have been initiated in Ghana. Pathogen screening has been developed at multiple sites. There is a significant amount of work, trying to take advantage of small molecules from natural sources such as plants, marine invertebrates, fungi, and bacteria. Some of this research is guided by traditional medicine, with the aim of identifying the active constituents. These chemical investigations have yielded many structurally unique compound classes including clerodane diterpenes [ 3 ], flavonoid glycosides [ 4 ], prenylated aryl benzofurans [ 5 ], indole alkaloids, [ 6 ] benzophenanthridines [ 7 ], dichapetalins [ 8 – 10 ], isoflavones [ 11 ], legonmycins [ 12 ], and accramycins [ 13 , 14 ] which have exhibited promising activities following screening in several anti-infective assays. More recently, drug discovery using small synthetic molecules is being developed. Furthermore, there are various research groups, elucidating the underlying mechanisms of diseases as well as identifying and validating targets for therapeutic interventions.

Key challenges

There are several key challenges that we have identified as confronting drug discovery research in Ghana. We anticipate that many of these will be similar to other sub-Saharan African countries and that any knowledge gained should be shared to support research projects in the continent more widely.

Ghana has a well-developed and thriving tertiary education system, which trains people in the basic science disciplines such as chemistry, biochemistry, and microbiology. However, there is a need for training in more specialised aspects in areas such as drug discovery. Firstly, in how to carry out drug discovery research, understanding the different stages and requirements, and how to integrate the basic disciplines. Secondly, other required disciplines are largely absent, such as drug metabolism and pharmacokinetics (DMPK). People need to be trained in these techniques, and relevant assays need to be established in Ghana. It is also important people learn how to interpret and share these data with colleagues working in other disciplines and work together to make decisions on research project progression.

The younger generation, who are quicker to adopt modern technology, need to be trained to complement the efforts of the current scientists. Expertise in the use of robotics, data processing software, and computational chemistry techniques, including machine learning and artificial intelligence, are needed.

There is also a need for training in the use and maintenance of the scientific equipment. Some of the equipment in Ghana is underutilized, obsolete, or in poor working condition owing to an absence of expertise and regular maintenance. The underutilization of working equipment and frequent breakdowns of equipment point to the need to train more technical staff. Training needs to focus on hands-on use and maintenance to ensure maximum and proper utilization of equipment. Focussing the training on technical staff is advantageous as there is usually less turnover in this category of staff, although they manage and operate the equipment. Using bidirectional staff exchange programmes between industry and educational institutions’ technical staff can build the needed capacity at little cost.

Human resource

There is little funding for researchers to carry out studies in Ghana. Most staff at the Principal Investigator level have high teaching and administrative duties, leaving little time for research. Funding for postdoctoral staff from internal university sources is limited, and external funding is often limited to larger, more competitive grant applications. PhD and Master’s students often have to self-fund due to a lack of funding opportunities, leading to many students not continuing in academia as they cannot afford to.

These funding issues lead to a culture of students carrying out placements or entire degrees at institutes outside of Ghana, especially in the drug discovery field since opportunities are limited. Some get the opportunity for further study in South Africa, but many move to Europe or the USA for further degrees. Many pharmaceutical companies and institutions run training schemes for limited periods, which is an excellent way to upskill individuals. However, without sufficient infrastructure and dedicated time for research at their home institution, it can be difficult to put learnings into practice.

All these factors culminate in limited number of individuals working in Ghana on drug discovery. The networking between universities is therefore essential to allow a critical mass of researchers across the country to work together to further drug discovery research.

Most of the critical equipment is in place, albeit not all are located at the same University ( Table 1 ). However, there are still equipment needs, for example, LC-MS-MS equipment and robotic equipment for high-throughput compound screening. Some equipment needs to be duplicated between institutes, to prevent the delays and complexities of transferring samples between institutions.

*FTIR, Fourier transform infrared spectroscopy; GCMS, gas chromatography mass spectrometer; HPLC, high-performance liquid chromatography; LCMS, liquid chromatography mass spectrometer; NMR, nuclear magnetic resonance; qRTPCR, qualitative real-time polymerase chain reaction; UV-VIS, ultraviolet visible spectrometer.

Finding funding to purchase equipment can be problematic. While this is far from unique to Ghana, it is particularly problematic here, as individual universities cannot afford many pieces of equipment and it is very difficult to find external funding opportunities for large equipment grants. None of the major equipment suppliers have bases in West Africa, generally resulting in equipment being brought in, typically from Europe or the USA. When trying to decide on the procurement of large pieces of equipment, it becomes very challenging to demo equipment and ascertain its suitability. Once an item is purchased, installation engineers need to be flown in from abroad, which adds significantly to both cost and time. General servicing and maintenance can also involve flying in specialist engineers again adding to costs and often resulting in large periods where the instruments are not functioning. This whole process can be further hampered by the lack of availability of spare parts. Therefore, when purchasing any new equipment, funding should be identified to maintain them.

Going forward, it will be important to train engineers within Ghana to be able to service and maintain pieces of equipment. It would also be prudent to find a mechanism to supply the more commonly used spare parts within Ghana or at least within West Africa. Local support staff need to be trained in more sophisticated maintenance of the equipment. There also needs to be enhanced staff training in both the use of the equipment and interpretation of the data. Making this cross-institutional would facilitate a critical mass and allow institutions to aid one another. By way of example, at KNUST, a shared laboratory of equipment has been pooled together in the “KNUST Central Laboratory”. This facility allows researchers access to state-of-the-art technologies that would have been too expensive for individual departments to procure and maintain.

Infrastructure

There are some promising signs in terms of infrastructure. The NMIMR has recently moved into a new state-of-the-art facility. The Central Laboratory at KNUST has very good modern laboratories, and there is a new University, the University of Health and Allied Sciences (UHAS), which has just built a new facility. The Science Annex building at UCC is near completion and is expected to provide modern laboratory space and facilities.

However, there is still a need for extra infrastructural development across all the Institutions in Ghana. For instance, there is a need for new chemistry laboratories for synthetic chemistry because the existing buildings are old and were not designed for synthetic chemistry research. In addition, the majority of the laboratory space in the existing building is dedicated to undergraduate teaching. The current chemistry research laboratories have limited space available for research activities. In the medium term, it would be possible to fit additional fume chambers into the existing laboratories to enable synthetic small molecule drug discovery research. However, in the long term, a new building with appropriate facilities for synthetic chemistry is required.

Procurement

This is one of the major challenges facing scientists in Ghana. Quicker access to research items would ensure meeting project timelines and delivery of proposed project goals. However, the process of procurement in Ghana is complex, with many bureaucratic layers. Science research is data-driven and timebound; therefore, delays in getting consumables and supplies are a huge disadvantage for researchers in Ghana. It impacts heavily on making projections and planning future research activities.

Most research items cannot be purchased directly from within Ghana, and they must be imported. The local companies who sell most of these items are third-party agents who themselves must import into the country before selling to prospective end users. Importation is further plagued with additional layers of challenges including complex shipping arrangements. Sometimes shipping can be by air, but other times is required by sea, extending further the time for delivery. These delays and challenges can be problematic with temperature-sensitive goods where a cold chain is required. All these factors can sometimes lead to the actual cost of an item being significantly more expensive than the advertised price by the supplier or the manufacturer.

Another important challenge is the payment process. Often the institutions, and for that matter, the procurement law, demands that payments are made for goods that have been supplied, inspected, and certified by the requisite authorities [ 15 ]. However, the suppliers, particularly the foreign suppliers, demand payment in advance. These bottlenecks compel the researcher to go through a third party (those who subscribe to prefinancing) with the consequence of paying more for the same items. In limited instances where credit is granted, if the payment to the supplier takes longer than stated in the agreements, it can reduce the chance of the researcher benefiting from any future credit from that supplier.

There is willingness to collaborate across institutions, but there is a need to develop structures to enable this. Drug discovery research would involve management of facilities across institutions. For example, management of equipment scheduling; tracking of chemicals, reagents, and samples; and cost recovery for equipment use. To support this, we have compiled a list of all existing core equipment across institutions and their locations. Efforts are underway to develop scheduling management systems to allow researchers at different institutions to book time on core equipment at other institutions. We hope to use IT resources to proficiently handle booking on required equipment ahead of time. Chemical inventories could be integrated to allow researchers across institutions to easily see what is available and can be borrowed from other laboratories, but this would require discussions with management across institutions.

Signs of promise and our vision

Our long-term vision is to develop drug discovery research capabilities in Ghana, to a level where we can produce preclinical candidates and move towards partnership for clinical studies.

A key requirement to realise this vision is for the research-active Universities and research centres to work together to address the challenges highlighted above. While this initiative has been hindered by the Coronavirus Disease 2019 (COVID-19) pandemic, we have now formed working groups to bring together key staff within the different institutions. These are synthetic chemistry, analytical chemistry, pathogen screening, and natural product chemistry. Further working groups are being considered, including DMPK and computational chemistry. In addition, we have put in place a cross-institutional working group, to look at more strategic issues. These working groups have several aims:

• to identify the resources that currently exist within the universities and make sure that this information is shared between the different universities.
• to share learnings among the institutions.
• to identify training requirements and to try and identify how these can be provided.
• to identify opportunities for interaction between the universities, and for joint projects.

By way of examples

• A need for training in the theory and use of liquid chromatography mass spectrometry (LCMS) was identified. An online training programme was developed and run specifically for the users of the instruments, by the WCAIR.
• Often all the equipment and expertise exist within Ghana, but not in the same institution. Thus, there is synthetic chemistry at UG, extensive analytical chemistry capabilities at KNUST, and pathogen screening at the Noguchi Institute, UG. Bringing these groups together provides a more powerful approach. For example, compounds synthesised in the Department of Chemistry UG were tested for antimicrobial activity at NMIMR [ 16 ]. In two separate collaborations, semi-synthesis of a natural product and an isolated plant-derived natural product, both carried out in the Department of Chemistry, UG, were assayed for antitrypanosomal activity at the West African Center for Cell Biology of Infectious Pathogens, UG [ 17 , 18 ]. In another study to access the efficacy some medicinal plants for the treatment of mycobacterial infections, stem back extracts isolated from KNUST were tested at NMIMR for antimicrobial activity and cytotoxicity [ 19 ].
• The University of Ghana is developing a database for their Natural Product work and are expanding this to include KNUST and then the other Universities and Institutions within Ghana.

Our vision is that by working together, we can start to overcome some of the challenges to develop further drug discovery research capabilities within Ghana and more widely within the West African region. Other challenges require infrastructural changes that are beyond our control. However, by coming together, we hope to speak in one voice and highlight these issues to all stakeholders for the desired change.

We are aiming to develop research programmes and to build our drug discovery research expertise and infrastructure around these programmes. Initially, this will be facilitated by interaction with external partners, such as the WCAIR and H3D Centre at the University of Cape Town (UCT) in South Africa, and support of funding agencies such as Medicines for Malaria Venture (MMV). However, as we develop our infrastructure and capabilities, we aim to internalise more of this research within Ghana. An excellent example of this approach is the way that H3D has developed at the UCT in South Africa. They initiated projects with MMV in malaria and developed a preclinical candidate. This was done in collaboration with others, such as the Swiss Tropical and Public Health Institute (SwissTPH). However, they have leveraged their success to eventually develop sophisticated malaria testing capabilities, DMPK, and clinical development experience. Another important aspect is to develop further our South–South interactions, particularly with researchers in the West African region.

We also think that it is important to focus on areas of unmet medical need that are relevant to Ghana and offer solutions that are appropriate to the context within Ghana. There are many infectious diseases that are poorly treated clinically and are of public health importance in Ghana. For example, Ghana is one of the countries with the highest levels of TB endemic countries in the world with an estimated national TB prevalence of 290 cases per 100,000 population and also a low case detection rate, estimated to be 20.7% [ 20 ]. This means that approximately 80% of TB cases go undiagnosed with its concomitant public health implications. Also, Ghana is among the 15 highest countries for malaria endemicity, with 2% of the global malarial cases and 3% deaths [ 21 ].

We have obtained funding from the Academy of Medical Sciences to allow networking within Ghana and to bring together senior representatives of our universities to support our vision. Unfortunately, like many things, this has been affected by the COVID-19 crisis. However, our initial meeting has led to the formation of online focus groups, and we hope to bring together people in person soon.

While developing drug discovery research in Ghana will undoubtably be a long road, we are encouraged by the steps we have taken so far. As we progress, further challenges will be identified but working together as a group of institutions, we hope that we can overcome these to fulfil our vision.

Funding Statement

Funding was received from the Academy of Medical Sciences (D. Y.-M.; I. H.G., GCRFNGR5\1213) and Wellcome for funding the Wellcome Centre for Anti-Infectives Research (203134/Z/16/Z). The funding was to support bringing together funders and scientist involved in Drug Discovery research in Ghana in a networking workshop. The funders had no role in the decision to publish manuscript and in the preparation.

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Portland Tourism Chief to Retire After 19-Year Tenure

Dawit Habtemariam , Skift

June 24th, 2024 at 4:00 PM EDT

Portland is going to need another tourism champion, one who will be an outspoken advocate.

Dawit Habtemariam

Portland is losing a tourism champion. Jeff Miller , who has served for 19 years as CEO and president of Travel Portland , the city’s destination marketing organization, will retire in December, reported Northstar Meetings Group .

Miller oversaw the city’s tourism recovery and led a staff of about 70 full- and part-time employees and an annual budget of about $30 million. He defended Portland’s image against negative media associations with crime and violence. News outlets had repeatedly shown images of the city in a doom loop years after the civil unrest surrounding the murder of George Floyd subsided.

“What the press has reported on Portland has changed dramatically,” Miller told Skift last June . “Now, if we can just get them to stop using pictures from three years ago, we will be fine.”

Portland had to fill the gap left by conventions pulling out amid the unrest. “During the pandemic, with a hundred days of protest and all of the violence and all the reporting, most cities rebooked [conventions] into future years. And we did too, but not to the degree that other cities did,” Miller told Skift in September. 

“Our team has done an amazing job of filling those holes, but there are more to be filled,” he said.

Reversing Negative Suburban Traveler Sentiment

A major objective of Miller was to reignite suburbanite interest in visiting Portland’s downtown.

The share of Portlanders who would recommend the city to out-of-town friends and family fell from 88 percent in 2017 to 61 percent in 2023 , with most of the negative sentiment concentrating in the suburbs, according to Travel Portland.

Miller pointed to the spread of remote work and negative media coverage as the reasons why suburbanite sentiment dropped.

“The reputational damage that Portland suffered certainly extended locally and Portlanders have always been very, very proud of their city,” said Miller. “I think it’s taken a bit of time to get people back into the core to see what’s going on.”

Against Public Drug Abuse

Miller publicly spoke out in support of a ban on public drug use. In November 2020, Oregon approved ballot Measure 110, decriminalizing possession of small amounts of controlled substances.

Miller spoke up on the impact of public drug use on the city’s tourism industry. “Portland’s hospitality crisis is in crisis, and it can be linked to the conditions on our streets with open drug dealing and usage,” he told the city council at a hearing in September .

In that same month, Portland’s city council passed an ordinance that banned the use of controlled substances on public property.

“We need to make major and significant changes, compassionate changes, but we need to find places for these people to get off the street,” Miller told Skift in September.

Miller spoke on-stage at the Skift Global Forum in New York last September.

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LGBTQI+ People and Substance Use

• Research has found that sexual and gender minorities, including lesbian, gay, bisexual, transgender, queer, and intersex people (LGBTQI+), have higher rates of substance misuse and substance use disorders than people who identify as heterosexual. People from these groups are also more likely to enter treatment with more severe disorders.
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F.D.A. Panel Rejects MDMA-Aided Therapy for PTSD

An independent group of experts expressed concerns that the data from clinical trials did not outweigh risks for treatment of post-traumatic stress disorder.

By Andrew Jacobs

An independent advisory panel of the Food and Drug Administration rejected the use of MDMA-assisted therapy for post-traumatic stress disorder on Tuesday, highlighting the unparalleled regulatory challenges of a novel therapy using the drug commonly known as Ecstasy.

Before the vote, members of the panel raised concerns about the designs of the two studies submitted by the drug’s sponsor, Lykos Therapeutics. Many questions focused on the fact that study participants were by and large able to correctly guess whether they had been given MDMA, also known by the names of Ecstasy or molly.

The panel voted 9-2 on whether the MDMA-assisted therapy was effective, and voted 10-1 on whether the proposed treatment’s benefits outweighed its risks.

Other panelists expressed concerns over the drug’s potential cardiovascular effects, and possible bias among the therapists and facilitators who guided the sessions and may have positively influenced patient outcomes. A case of misconduct involving a patient and therapist in the study also weighed on some panelists’ minds.

Many of the committee members said they were especially worried about the failure of Lykos to collect detailed data from participants on the potential for abuse of a drug that generates feelings of bliss and well-being.

“I absolutely agree that we need new and better treatments for PTSD,” said Paul Holtzheimer, deputy director for research at the National Center for PTSD, a panelist who voted no on the question of whether the benefits of MDMA-therapy outweighed the risks.

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Drug discovery research in Ghana, challenges, current efforts, and the way forward

* E-mail: [email protected]

Affiliation Department of Chemistry, University of Ghana, Legon-Accra, Ghana

Affiliation Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon-Accra, Ghana

Affiliation Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon- Accra, Ghana

Affiliation Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

Affiliation Department of Chemistry, School of Physical Sciences, University of Cape Coast, Cape Coast, Ghana

Affiliation Department of Microbiology, Centre for Plant Medicine, Mampong-Akuapem, Ghana

Affiliation Department of Pharmaceutical Chemistry, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana

Affiliation Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana

Affiliation Holistic Drug Discovery and Development (H3D) Centre at the University of Cape Town (UCT), Rondebosch, South Africa

Affiliation Wellcome Centre for Anti-Infectives Research (WCAIR), Division of Biological Chemistry and Drug Discovery, University of Dundee, Dundee, United Kingdom

Affiliation Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana

•  [ ... ],
• [ view all ]
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• Richard Kwamla Amewu, 
• Patrick Amoateng, 
• Patrick Kobina Arthur, 
• Prince Asare, 
• Isaac Asiamah, 
• Daniel Boamah, 
• Isaac Darko Otchere, 
• Cedric Dzidzor Amengor, 
• Edmund Ekuadzi, 

Published: September 15, 2022

• https://doi.org/10.1371/journal.pntd.0010645
• Reader Comments

We have a long-term vision to develop drug discovery research capacity within Ghana, to tackle unmet medical needs in Ghana and the wider West African region. However, there are several issues and challenges that need to be overcome to enable this vision, including training, human resource, equipment, infrastructure, procurement, and logistics. We discuss these challenges from the context of Ghana in this review. An important development is the universities and research centres within Ghana working together to address some of these challenges. Therefore, while there is a long way to go to fully accomplish our vision, there are encouraging signs.

Citation: Amewu RK, Amoateng P, Arthur PK, Asare P, Asiamah I, Boamah D, et al. (2022) Drug discovery research in Ghana, challenges, current efforts, and the way forward. PLoS Negl Trop Dis 16(9): e0010645. https://doi.org/10.1371/journal.pntd.0010645

Editor: Felix Bongomin, Gulu University, UGANDA

Copyright: © 2022 Amewu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: Funding was received from the Academy of Medical Sciences (D. Y.-M.; I. H.G., GCRFNGR5\1213) and Wellcome for funding the Wellcome Centre for Anti-Infectives Research (203134/Z/16/Z). The funding was to support bringing together funders and scientist involved in Drug Discovery research in Ghana in a networking workshop. The funders had no role in the decision to publish manuscript and in the preparation.

Competing interests: The authors have declared that no competing interests exist.

Introduction

There is limited drug discovery research in sub-Saharan Africa [ 1 ], with the notable exception of Holistic Drug Discovery and Development (H3D), which is based in Cape Town. Hence, we recognized the value in outlining our vision and the progress made in Ghana towards the development of drug discovery research and to highlight some of the challenges that we face. There is a huge need for new drugs for Ghana and across sub-Saharan Africa, particularly in the anti-infective area. Diseases such as malaria, leishmaniasis, schistosomiasis, and tuberculosis (TB) have a massive impact in Ghana, and yet there is inadequate research in drug discovery into these diseases locally. Due to the economics of drug discovery research, there is little commercial gain to be made from drugs for such diseases. Furthermore, for noncommunicable diseases such as cancer, the approaches of diagnosis and management are often very different in countries such as Ghana, from high-income countries, necessitating research in these areas too.

Various efforts are underway in Ghana to increase drug discovery research efforts. In this article, we discuss the status quo and some of the challenges facing drug discovery research in Ghana. Furthermore, we discuss the opportunities going forward with emphasis on the preclinical development stages. Our overall vision is to grow the current infrastructure to enable integrated and professional drug discovery activities: screening of compounds, compound optimisation, and compound characterisation. The eventual aim is to be able to produce preclinical drug candidates.

Developing a drug discovery research infrastructure will address some of the United Nations Strategic Development Goals (SDGs), highlighted in Fig 1 [ 2 ], giving many additional benefits to Ghana. These benefits include education and training across many disciplines to create an environment for Ghanaian researchers to flourish. Furthermore.it offers the potential for generation of “spin-out” companies research groups to generate innovation and economic development. Moreover, building up drug discovery research gives opportunities to strengthen South–South interactions within the West Africa subregion through collaborative research ultimately, we hope this work will lead to the discovery of candidate medicines.

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https://doi.org/10.1371/journal.pntd.0010645.g001

In Ghana, there are a number of key universities and research institutions that have an ambition for drug discovery research ( Fig 2 ). These include the University of Ghana (UG), Accra; Kwame Nkrumah University of Science and Technology (KNUST), Kumasi; University of Cape Coast (UCC), Cape Coast; and the University of Health and Allied Sciences (UHAS), Ho. A constituent part of UG is the Noguchi Memorial Institute of Medical Research (NMIMR), with excellent infrastructure, including Biosafety Level 3 (BSL3) laboratories, an animal experimentation facility for pathogen studies and clinical trials unit. In addition, the Centre for Plant Medicine Research (CPMR), Mampong carries out research on herbal medicines.

*This was determined based on publications in drug discovery and through records of collaborations across the institutions. The base map used for constructing the map as well as the copyright information for use of the base map files are freely available at https://data.humdata.org/dataset/cod-ab-gha . No changes were made to the base map files.

https://doi.org/10.1371/journal.pntd.0010645.g002

Drug discovery has multiple requirements, many of which have been initiated in Ghana. Pathogen screening has been developed at multiple sites. There is a significant amount of work, trying to take advantage of small molecules from natural sources such as plants, marine invertebrates, fungi, and bacteria. Some of this research is guided by traditional medicine, with the aim of identifying the active constituents. These chemical investigations have yielded many structurally unique compound classes including clerodane diterpenes [ 3 ], flavonoid glycosides [ 4 ], prenylated aryl benzofurans [ 5 ], indole alkaloids, [ 6 ] benzophenanthridines [ 7 ], dichapetalins [ 8 – 10 ], isoflavones [ 11 ], legonmycins [ 12 ], and accramycins [ 13 , 14 ] which have exhibited promising activities following screening in several anti-infective assays. More recently, drug discovery using small synthetic molecules is being developed. Furthermore, there are various research groups, elucidating the underlying mechanisms of diseases as well as identifying and validating targets for therapeutic interventions.

Key challenges

There are several key challenges that we have identified as confronting drug discovery research in Ghana. We anticipate that many of these will be similar to other sub-Saharan African countries and that any knowledge gained should be shared to support research projects in the continent more widely.

Ghana has a well-developed and thriving tertiary education system, which trains people in the basic science disciplines such as chemistry, biochemistry, and microbiology. However, there is a need for training in more specialised aspects in areas such as drug discovery. Firstly, in how to carry out drug discovery research, understanding the different stages and requirements, and how to integrate the basic disciplines. Secondly, other required disciplines are largely absent, such as drug metabolism and pharmacokinetics (DMPK). People need to be trained in these techniques, and relevant assays need to be established in Ghana. It is also important people learn how to interpret and share these data with colleagues working in other disciplines and work together to make decisions on research project progression.

The younger generation, who are quicker to adopt modern technology, need to be trained to complement the efforts of the current scientists. Expertise in the use of robotics, data processing software, and computational chemistry techniques, including machine learning and artificial intelligence, are needed.

There is also a need for training in the use and maintenance of the scientific equipment. Some of the equipment in Ghana is underutilized, obsolete, or in poor working condition owing to an absence of expertise and regular maintenance. The underutilization of working equipment and frequent breakdowns of equipment point to the need to train more technical staff. Training needs to focus on hands-on use and maintenance to ensure maximum and proper utilization of equipment. Focussing the training on technical staff is advantageous as there is usually less turnover in this category of staff, although they manage and operate the equipment. Using bidirectional staff exchange programmes between industry and educational institutions’ technical staff can build the needed capacity at little cost.

Human resource

There is little funding for researchers to carry out studies in Ghana. Most staff at the Principal Investigator level have high teaching and administrative duties, leaving little time for research. Funding for postdoctoral staff from internal university sources is limited, and external funding is often limited to larger, more competitive grant applications. PhD and Master’s students often have to self-fund due to a lack of funding opportunities, leading to many students not continuing in academia as they cannot afford to.

These funding issues lead to a culture of students carrying out placements or entire degrees at institutes outside of Ghana, especially in the drug discovery field since opportunities are limited. Some get the opportunity for further study in South Africa, but many move to Europe or the USA for further degrees. Many pharmaceutical companies and institutions run training schemes for limited periods, which is an excellent way to upskill individuals. However, without sufficient infrastructure and dedicated time for research at their home institution, it can be difficult to put learnings into practice.

All these factors culminate in limited number of individuals working in Ghana on drug discovery. The networking between universities is therefore essential to allow a critical mass of researchers across the country to work together to further drug discovery research.

Most of the critical equipment is in place, albeit not all are located at the same University ( Table 1 ). However, there are still equipment needs, for example, LC-MS-MS equipment and robotic equipment for high-throughput compound screening. Some equipment needs to be duplicated between institutes, to prevent the delays and complexities of transferring samples between institutions.

https://doi.org/10.1371/journal.pntd.0010645.t001

Finding funding to purchase equipment can be problematic. While this is far from unique to Ghana, it is particularly problematic here, as individual universities cannot afford many pieces of equipment and it is very difficult to find external funding opportunities for large equipment grants. None of the major equipment suppliers have bases in West Africa, generally resulting in equipment being brought in, typically from Europe or the USA. When trying to decide on the procurement of large pieces of equipment, it becomes very challenging to demo equipment and ascertain its suitability. Once an item is purchased, installation engineers need to be flown in from abroad, which adds significantly to both cost and time. General servicing and maintenance can also involve flying in specialist engineers again adding to costs and often resulting in large periods where the instruments are not functioning. This whole process can be further hampered by the lack of availability of spare parts. Therefore, when purchasing any new equipment, funding should be identified to maintain them.

Going forward, it will be important to train engineers within Ghana to be able to service and maintain pieces of equipment. It would also be prudent to find a mechanism to supply the more commonly used spare parts within Ghana or at least within West Africa. Local support staff need to be trained in more sophisticated maintenance of the equipment. There also needs to be enhanced staff training in both the use of the equipment and interpretation of the data. Making this cross-institutional would facilitate a critical mass and allow institutions to aid one another. By way of example, at KNUST, a shared laboratory of equipment has been pooled together in the “KNUST Central Laboratory”. This facility allows researchers access to state-of-the-art technologies that would have been too expensive for individual departments to procure and maintain.

Infrastructure

There are some promising signs in terms of infrastructure. The NMIMR has recently moved into a new state-of-the-art facility. The Central Laboratory at KNUST has very good modern laboratories, and there is a new University, the University of Health and Allied Sciences (UHAS), which has just built a new facility. The Science Annex building at UCC is near completion and is expected to provide modern laboratory space and facilities.

However, there is still a need for extra infrastructural development across all the Institutions in Ghana. For instance, there is a need for new chemistry laboratories for synthetic chemistry because the existing buildings are old and were not designed for synthetic chemistry research. In addition, the majority of the laboratory space in the existing building is dedicated to undergraduate teaching. The current chemistry research laboratories have limited space available for research activities. In the medium term, it would be possible to fit additional fume chambers into the existing laboratories to enable synthetic small molecule drug discovery research. However, in the long term, a new building with appropriate facilities for synthetic chemistry is required.

Procurement

This is one of the major challenges facing scientists in Ghana. Quicker access to research items would ensure meeting project timelines and delivery of proposed project goals. However, the process of procurement in Ghana is complex, with many bureaucratic layers. Science research is data-driven and timebound; therefore, delays in getting consumables and supplies are a huge disadvantage for researchers in Ghana. It impacts heavily on making projections and planning future research activities.

Most research items cannot be purchased directly from within Ghana, and they must be imported. The local companies who sell most of these items are third-party agents who themselves must import into the country before selling to prospective end users. Importation is further plagued with additional layers of challenges including complex shipping arrangements. Sometimes shipping can be by air, but other times is required by sea, extending further the time for delivery. These delays and challenges can be problematic with temperature-sensitive goods where a cold chain is required. All these factors can sometimes lead to the actual cost of an item being significantly more expensive than the advertised price by the supplier or the manufacturer.

Another important challenge is the payment process. Often the institutions, and for that matter, the procurement law, demands that payments are made for goods that have been supplied, inspected, and certified by the requisite authorities [ 15 ]. However, the suppliers, particularly the foreign suppliers, demand payment in advance. These bottlenecks compel the researcher to go through a third party (those who subscribe to prefinancing) with the consequence of paying more for the same items. In limited instances where credit is granted, if the payment to the supplier takes longer than stated in the agreements, it can reduce the chance of the researcher benefiting from any future credit from that supplier.

There is willingness to collaborate across institutions, but there is a need to develop structures to enable this. Drug discovery research would involve management of facilities across institutions. For example, management of equipment scheduling; tracking of chemicals, reagents, and samples; and cost recovery for equipment use. To support this, we have compiled a list of all existing core equipment across institutions and their locations. Efforts are underway to develop scheduling management systems to allow researchers at different institutions to book time on core equipment at other institutions. We hope to use IT resources to proficiently handle booking on required equipment ahead of time. Chemical inventories could be integrated to allow researchers across institutions to easily see what is available and can be borrowed from other laboratories, but this would require discussions with management across institutions.

Signs of promise and our vision

Our long-term vision is to develop drug discovery research capabilities in Ghana, to a level where we can produce preclinical candidates and move towards partnership for clinical studies.

A key requirement to realise this vision is for the research-active Universities and research centres to work together to address the challenges highlighted above. While this initiative has been hindered by the Coronavirus Disease 2019 (COVID-19) pandemic, we have now formed working groups to bring together key staff within the different institutions. These are synthetic chemistry, analytical chemistry, pathogen screening, and natural product chemistry. Further working groups are being considered, including DMPK and computational chemistry. In addition, we have put in place a cross-institutional working group, to look at more strategic issues. These working groups have several aims:

• to identify the resources that currently exist within the universities and make sure that this information is shared between the different universities.
• to share learnings among the institutions.
• to identify training requirements and to try and identify how these can be provided.
• to identify opportunities for interaction between the universities, and for joint projects.

By way of examples

• A need for training in the theory and use of liquid chromatography mass spectrometry (LCMS) was identified. An online training programme was developed and run specifically for the users of the instruments, by the WCAIR.
• Often all the equipment and expertise exist within Ghana, but not in the same institution. Thus, there is synthetic chemistry at UG, extensive analytical chemistry capabilities at KNUST, and pathogen screening at the Noguchi Institute, UG. Bringing these groups together provides a more powerful approach. For example, compounds synthesised in the Department of Chemistry UG were tested for antimicrobial activity at NMIMR [ 16 ]. In two separate collaborations, semi-synthesis of a natural product and an isolated plant-derived natural product, both carried out in the Department of Chemistry, UG, were assayed for antitrypanosomal activity at the West African Center for Cell Biology of Infectious Pathogens, UG [ 17 , 18 ]. In another study to access the efficacy some medicinal plants for the treatment of mycobacterial infections, stem back extracts isolated from KNUST were tested at NMIMR for antimicrobial activity and cytotoxicity [ 19 ].
• The University of Ghana is developing a database for their Natural Product work and are expanding this to include KNUST and then the other Universities and Institutions within Ghana.

Our vision is that by working together, we can start to overcome some of the challenges to develop further drug discovery research capabilities within Ghana and more widely within the West African region. Other challenges require infrastructural changes that are beyond our control. However, by coming together, we hope to speak in one voice and highlight these issues to all stakeholders for the desired change.

We are aiming to develop research programmes and to build our drug discovery research expertise and infrastructure around these programmes. Initially, this will be facilitated by interaction with external partners, such as the WCAIR and H3D Centre at the University of Cape Town (UCT) in South Africa, and support of funding agencies such as Medicines for Malaria Venture (MMV). However, as we develop our infrastructure and capabilities, we aim to internalise more of this research within Ghana. An excellent example of this approach is the way that H3D has developed at the UCT in South Africa. They initiated projects with MMV in malaria and developed a preclinical candidate. This was done in collaboration with others, such as the Swiss Tropical and Public Health Institute (SwissTPH). However, they have leveraged their success to eventually develop sophisticated malaria testing capabilities, DMPK, and clinical development experience. Another important aspect is to develop further our South–South interactions, particularly with researchers in the West African region.

We also think that it is important to focus on areas of unmet medical need that are relevant to Ghana and offer solutions that are appropriate to the context within Ghana. There are many infectious diseases that are poorly treated clinically and are of public health importance in Ghana. For example, Ghana is one of the countries with the highest levels of TB endemic countries in the world with an estimated national TB prevalence of 290 cases per 100,000 population and also a low case detection rate, estimated to be 20.7% [ 20 ]. This means that approximately 80% of TB cases go undiagnosed with its concomitant public health implications. Also, Ghana is among the 15 highest countries for malaria endemicity, with 2% of the global malarial cases and 3% deaths [ 21 ].

We have obtained funding from the Academy of Medical Sciences to allow networking within Ghana and to bring together senior representatives of our universities to support our vision. Unfortunately, like many things, this has been affected by the COVID-19 crisis. However, our initial meeting has led to the formation of online focus groups, and we hope to bring together people in person soon.

While developing drug discovery research in Ghana will undoubtably be a long road, we are encouraged by the steps we have taken so far. As we progress, further challenges will be identified but working together as a group of institutions, we hope that we can overcome these to fulfil our vision.

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• 21. World Health Organization. World Malaria Report 2021. Geneva: World Health Organization; 2021.