A Review of Substance Use among Secondary School Students in Nigeria: Implications for Policies

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A Review of Substance Use among Secondary School Students in Nigeria:

Implications for Policies

Emeka W Dumbili (2015)

Brunel University London ([email protected])

Published in Drugs: Education, Prevention and Policy

Volume 22, Issue 5 pp. 387-399 DOI: 10.3109/09687637.2015.1041455

http://www.tandfonline.com/doi/full/10.3109/09687637.2015.1041455

Abstract

The use and misuse of psychoactive substances among adolescents are increasing in Africa.

While heavy episodic drinking among adolescents in Nigeria is growing, there are no written

alcohol control policies to regulate the production and availability of alcohol. This article

describes the patterns and determinants of alcohol use among Nigerian adolescents in

secondary school. Nineteen quantitative studies published in peer-reviewed English

language-based journals were reviewed. The results reveal more current and lifetime

alcohol use among males than females. The findings also reveal that the motives for using

alcohol include staying awake in order to study at night, drinking to forget one’s problems,

drinking to alleviate anxiety and drinking to enjoy festivals. Similarly, the results reveal that

peer pressure in the form of drinking to satisfy friends or to not be seen as different from

one’s group predicted alcohol use, while multiple substance-related problems were

reported among substance users. Amongst other factors, the non-existence of alcohol

control policies, which increased alcohol availability was associated with alcohol use. This

article discusses the implications of these findings, the possible re-orientation of Nigerian

adolescents, the formulation and implementation of effective alcohol policies and suggested

further research.

Keywords: Alcohol, Policy, Student, Nigeria, Review

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Introduction

The use and misuse of alcohol, especially among young people are growing problems

globally. In many Western countries, it has become increasingly difficult to ignore the fact

that alcohol use among young people is rising, and many of these young drinkers engage in

binge drinking, drinking games, and other hazardous alcohol use practices (Tucker et al.,

2013; Van Tyne, Zamboanga, Ham, Olthuis, & Pole, 2012). Many of those who misuse

alcohol (and other drugs) are students (Kaynak et al., 2013; Pasch, Perry, Stigler, & Komro,

2009). According to Piacentini & Banister (2009), this situation is attributable to many

factors, one of which is the increasing culture of intoxication among youths. This review

aims at describing the findings of studies regarding the patterns and determinants of alcohol

use among Nigerian adolescents in secondary school. Second, it highlights these findings

and makes a historical comparison by taking a cursory look at studies that have investigated

this substance over three decades. Third, it argues for the formulation and implementation

of alcohol control policies that can help to reduce alcohol availability and ensure safer

consumption. This review will help to provide information on the state of knowledge and

also point out areas for future research in Nigeria.

Recently, researchers have shown an increasing interest in studying alcohol and

other substance use among adolescents on the African continent (e.g., Carney, Myers,

Louw, Lombard, & Flisher, 2013; Harris et al., 2012), arguably because what is occurring in

most Western countries is being replicated in Africa (where alcohol use among young

people is not popular due to some socio-cultural constraints). Although abstinence is

relatively high in Nigeria due to socio-religious factors (World Health Organization WHO,

2011)), several past studies (e.g., Anumonye, Omoniwa, & Adaranijo, 1977; Gureje, Obikoya,

& Ikuesan, 1992) and recent ones (e.g., Esan, Makanjuola, Oladeji, & Gureje, 2013; Brisibe,

Ordinioha, & Dienye, 2012; Ibanga, Adetula, & Dagona, 2009) have reported hazardous

alcohol consumption among various spectra of drinkers in Nigeria. Indeed, Umoh, Obot, &

Obot (2012) argued that Nigeria’s adult per capita consumption (12.3 litres) is among the

highest in Africa and this is attributed to several factors.

First, although Nigeria has a regulation (advertising code) with regard to alcohol

marketing and a federal law specifying the minimum purchasing age (De Bruijin, Ferreira-

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Borges, Engels, & Bhavsar, 2014; WHO, 2014), there are no written alcohol control policies

to regulate the production and marketing of alcohol (WHO, 2014; Dumbili, 2014a). In a

similar vein, it has been argued that transnational alcohol industries in Nigeria do not strictly

adhere to the existing advertising code (Farrell & Gordon, 2012). One of the reasons for this

is that ‘‘the Nigerian government does not strictly regulate the advertising industry’’ (De

Bruijin et al., 2014 p.16). Against this backdrop, alcohol companies engage in marketing

practices that contravene international marketing standards (Farrell & Gordon, 2012), and

this facilitates easy availability of alcohol (Umoh et al., 2012). Second, buy-two-get-one-free,

drink-and-win, and other similar promotions are regularly sponsored by the transnational

alcohol companies in Nigeria (De Bruijn, 2011). Despite the fact that the legal purchasing

age is 18 years, anybody can buy alcohol in Nigeria due to the non-enforcement of the

existing law (De Bruijin et al., 2014) and a lack of means to prove one’s age (Dumbili, 2014b).

Additionally, there is high production and consumption of unrecorded alcohol (WHO, 2014)

such as palm wine (sap from palm tree), ogogoro (gin distilled from fermented palm wine),

burukutu and pito (fermented beverages from Sorghum or maize (Ejim, Brands, Rehm, &

Lachenmeier, 2007)).

Traditionally, socio-cultural factors have hindered young people from using alcohol

in many parts of Nigeria (Odejide, Ohaeri, Adelekan, & Ikuesan, 1987), but the influx of

European-made alcoholic beverages during the colonial era (Heap, 1998) and the

establishment of the first brewery in 1949 (Heap, 1996), influenced young people’s

consumption of alcohol in Nigeria. Again, the competition that followed the establishment

of ‘Guinness Nigeria’ in 1962 (Van Den Bersselaar, 2011), in addition to the prioritization of

the establishment of alcohol companies (over other sectors) by state governments in the

1970s and 1980s, further contributed to the growing alcohol availability, and its use and

misuse among young people (Alos, 2000).

In the 1980s, this increase in the production of alcohol as a result of the growth of

breweries led to an increase in the use and abuse of this drug among young people in

southern Nigeria (Oshodin, 1984). Oshodin argued that this was because ‘‘parents often

send younger people to purchase alcohol, and they can easily buy some for themselves’’

because ‘‘alcohol is generally available without age limits’’ (Oshodin, 1981 p.211). Although

Oshodin’s argument was based on what occurred in the 1970s and 1980s, the situation has,

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if anything worsened for a myriad of reasons. Despite the fact that some state-owned

breweries existed during the period in which Oshodin conducted his study, there were only

two major transnational alcohol companies: Guinness Nigeria and Nigerian Breweries (partly

owned by Heineken Alos, 2000)). Following the adoption of neoliberal economic policies in

1986 by the Nigerian government, many other local and foreign brewing companies were

established to the extent that the number of government-registered brewing plants

increased from 22 in 1982 to 33 in 1990 (Oyelaran-Oyeyinka, 2002).

Although many of the local breweries closed down before 1995 (Oyelaran-Oyeyinka,

2002), Guinness Nigeria and Nigerian Breweries survived and acquired some of the bankrupt

breweries (Alos, 2000). Following the return of a democratic government in 1999, many

other translational alcohol companies were established in Nigeria. For example, SABMiller

acquired a Port Harcourt-based brewery in 2009 and in 2012 invested $100 million to

acquire or build new breweries (SABMiller News and Media, 2014). SABMiller currently

produces ‘‘REDD’S’’ (a ready-to-drink alcoholic beverage) and ‘Hero beer’, amongst other

brands. In 2014, Tradall, an American company, introduced Bacardi Breezer (Obi, 2014). Not

only have new companies been established, but also the existing companies have

introduced new products, especially brands that target young drinkers and women (Obot,

2013). For example, between 2006 and 2013, Guinness Nigeria introduced a myriad of

ready-to-drink alcoholic beverages, such as Smirnoff Ice, SNAPP, Orijin, etc. (Obot, 2013). In

consequence, these companies not only contribute to the growing alcohol availability, but

they also facilitate the use and misuse of alcohol, especially among young people. This is

because they target young people with diverse youth-oriented social events, promotions

and other marketing strategies (De Bruijn, 2011; Dumbili, 2014b).

Presently, Nigeria ranks second for young people’s heavy episodic drinking in Africa,

despite the high level of unrecorded consumption (WHO, 2014). Among students, there is

growing concern that the majority misuse alcohol and this is attracting scholarly attention in

Nigeria. Amongst the university populations, studies show diverse patterns and motives for

alcohol use on different campuses (Abayomi, Onifade, Adelufosi, & Akinhanmi, 2013;

Abikoye & Osinowo, 2011). Again, research shows that students who consume alcohol also

use other psychoactive substances (Abikoye & Adekoya, 2010; Makanjuola, Daramola, &

Obembe, 2007). Several studies have also reported the use of licit and illicit drugs among

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out of school adolescents (Abdulkarim, Mokuolu, & Adeniyi, 2005; Adebiyi, Faseru,

Sangowawa, & Owoaje, 2010; Morakinyo & Odejide, 2003) and those in different secondary

schools (Agaku, Alpert, Vardavas, Adisa, & Connolly, 2014; Imhonde & Aluede, 2007;

Onohwosafe, Egenege, & Blinkhorn, 2008) in Nigeria.

However, there is disagreement regarding patterns of alcohol use and the factors

that predict the consumption of such substances among scholars. While some attribute

alcohol misuse to a lack of parental discipline (e.g., Abasiubong, Idung, Udoh, & Ekanem,

2012) and easy availability (e.g., Adebiyi et al., 2010), others argue that it is either due to

peer pressure or the social environment (e.g., Imhonde & Aluede, 2007). Additionally, to my

knowledge, no comprehensive review of alcohol use among secondary school students

exists in Nigeria. The only identified study (Omigbodun & Babalola, 2004) was not

comprehensive as it only included one study conducted among secondary school students.

It is against this backdrop that this article has been written.

Methods

Search Strategies

This review describes and synthesises the results of the studies that met the inclusion

criteria and draws some conclusions based on the findings. Electronic databases were

searched in August and September 2013 including African Journals Online, the African

Journal Archive, PubMed, the Cochrane Library, EBSCO host, MEDLINE, PsychArticles and

Sociological Abstracts, so as to identify studies published between January 1981 and August

2013. Additional searches were made using Google Scholar to identify studies that may have

been omitted from the other databases. It is worthy of note that only English language

databases were searched with the combination of keywords including:

‘‘patterns/prevalence of alcohol use among Nigerian adolescents’’, ‘‘patterns of alcohol use

among secondary school students in Nigeria’’, ‘‘alcohol misuse in Nigerian high schools’’,

‘‘patterns of drug/substance use in Nigerian secondary/high schools’’ and ‘‘perceived

benefits of alcohol among Nigerian secondary/high school students’’.

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Other search terms included: ‘‘determinants of alcohol use among secondary/high

school students’’, ‘‘factors that engender alcohol/drug use among Nigerian adolescents’’,

‘‘psychosocial correlates of substance use among Nigerian adolescents’’ and ‘‘reasons for

alcohol/substance use among Nigerian adolescents’’. Following the multiple screening of

the literature, 81 studies were identified. Screening resulted in the exclusion of 62 papers

based on duplicates, abstracts, or the study not measuring how each substance was used or

how many used it (prevalence and incidence). Figure 1 provides a detailed flow diagram of

how the 19 papers included in the review were selected. With regard to the studies that

examined multiple substances, only the data on alcohol were extracted due to the scope of

this article. It is worthy of note that even though the scope of the paper was to synthesise

studies that examined alcohol, the majority of the identified studies did not measure only

alcohol, and this confirms Makanjuola et al.'s (2007) assertion that many young Nigerians

that use alcohol combine this substance with other drugs. This arguably is one of the

reasons why substance researchers in Nigeria have examined multiple substances in their

studies.

Inclusion criteria

The studies included must have measured alcohol or combined alcohol and other gateway

drugs such as tobacco, elicited samples from only students in secondary school (between

the ages of 12 and 25) and have been published between January 1981 and August 2013. As

this article is exploratory in nature, it is worthy of note that the studies accepted for the

present review were not chosen based on their technical quality; thus there may be

variation in their quality.

Results

Study Characteristics

Nineteen titles met the inclusion criteria. All of the papers were published in journals. The

majority of these studies (n = 13, 68.4%) examined more than one substance while six

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(Adeyemo, 2007; Amiegheme, 2013; Odejide et al., 1987; Oshodin, 1981a; 1981b; 1984)

examined only alcohol. Additionally, none of the papers adopted qualitative or mixed

methods approaches. They all used quantitative methodology with self-report instruments.

Among the six studies that measured only alcohol, one (Amiegheme, 2013) employed a

descriptive non-experimental design, one (Odejide et al., 1987) used a cross-sectional

design, and four (Oshodin, 1981a; 1981b; 1984; Adeyemo, 2007) did not provide details of

the research designs adopted. Additionally, five of these studies (Adeyemo, 2007;

Amiegheme, 2013; Oshodin, 1981a; 1981b; 1984) aimed to measure factors that influence

alcohol or the reasons for use whilst one (Odejide et al., 1987) examined the pattern and

prevalence of alcohol use.

Among the studies that examined multiple substances, one (Oshodi, Aina, & Onajole,

2010) employed cross-sectional and descriptive designs, nine (Abasiubong, Atting, Bassey, &

Ekott, 2008; Abiodun, Adelekan, Ogunremi, Oni, & Obayan, 1994; Adelekan, 1989; Adelekan

& Ndom, 1997; Atoyebi & Atoyebi, 2013; Egbuonu, Ezechukwu, Chukwuka, & Uwakwe,

2004; Fatoye & Morakinyo, 2002; Fatoye, 2003; Igwe & Ojinnaka, 2010) adopted cross-

sectional survey designs, and three (Eneh & Stanley, 2004; Famuyiwa, Aina, & Bankole-Oki,

2011; Nevadomsky, 1981) did not provide study design details. Additionally, 11 (84%) of the

studies that measured multiple substances examined the pattern and prevalence of

substance use while the remaining two explored factors that encourage substance use.

Study Locations

Together, there were two (10.5%) studies conducted in south-eastern Nigeria, eight (42.1 %)

from the south-south and nine (47.4%) from south-western Nigeria. Similarly, five (83.3%) of

the studies that measured only alcohol were conducted in the south-south, one was

conducted in the south-west and none was conducted in the south-east. Additionally, no

study from northern Nigeria met the inclusion criteria. The importance of indicating the

study location is that Nigeria is a multi-ethnic, cultural and religious entity (with over 250

different native languages), and these diversities may influence how substances are used in

each region.

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Patterns of Alcohol use

Thirteen (68.4%) of the studies revealed that a large number of students use multiple

substances, but the drinking patterns differed depending on the study samples, the number

of drugs that were measured, and the recall periods. Among the 13 studies that examined

multiple substances, six (46.2%) reported that alcohol was the most used and abused

substance in terms of the lifetime and current use. Two (15.4%) studies revealed that

alcohol was the second most used substance out of the 12 drugs (Fatoye, 2003) and three

drugs (Egbuonu et al., 2004) that these scholars studied. Similarly, two (15.4%) studies

(Abiodun et al., 1994; Fatoye & Morakinyo, 2002) indicated that out of the five and 12

respective drugs measured, alcohol was the fourth most used drug. Furthermore, one study

(Adelekan & Ndom, 1997) did not provide details because it examined the trend in

substance use, but nonetheless it revealed how alcohol use rose during the years of the

study. It is equally worthy of note that only two studies (Famuyiwa et al., 2011; Igwe &

Ojinnaka, 2010) explicitly reported that alcohol was used or abused concurrently with other

substances while the other 11 studies measured each substance individually.

As shown in Table 1, three (50%) of the six studies that examined alcohol alone

reported that students in lower classes (younger students who are less than 18 years old)

were using this substance more than students in the upper classes. Importantly, none of

these 19 studies reported data on the frequency or quantity of alcohol use in terms of daily,

weekly or monthly consumption. Despite this, two studies revealed that palm wine was the

most common alcoholic beverage used by the respondents followed by ogogoro (native

gin). Again, two studies reported that ogogoro was most prevalent (due to its use as herbal

medicine and for traditional religious worship or festivals). With regard to alcohol use by

gender, 10 (52.6%) out of the 19 studies reported more use and misuse among males, two

(10.5%) did not observe any significant difference, while seven studies (36.8.1%) did not

provide details on the pattern of alcohol use by gender.

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Context of alcohol consumption

Among the seven studies that elicited data from rural and urban areas, two studies

indicated that alcohol was used more in rural areas than in the urban centres while two

studies reported more use in urban schools. In terms of the percentage of alcohol use by

region, six of the eight studies conducted in the south-south indicated that over 50% of the

respondents used alcohol. On the other hand, only two of the nine studies conducted in

south-western Nigeria revealed a similar result, and this region reported the lowest

percentage (8.3%) of current alcohol use. Igwe & Ojinnaka's (2010) study from south-

eastern Nigeria reported 31.6% abuse while Egbuonu et al.'s (2004) study from the same

region reported 9.5% current use. Regarding the drinking environment, Odejide et al. (1987)

and Oshodin (1981a; 1984) reported data that included drinking among friends, at home

and during festivals.

A brief historical trend

Historically, four out of the six studies that measured only alcohol were conducted in the

south-south (present Edo state) in the early 1980s. Although the reason why more alcohol

studies were conducted in the south-south cannot be inferred directly, it is likely because

many breweries are located in this region, especially in Benin City. Therefore, this may be

engendering alcohol availability, use and misuse among adolescents. Relatedly, studies

conducted on or before 1987 focused on alcohol alone (with the exception of Nevadomsky,

1981). According to Alos (2000), when the Nigerian economy experienced a boom from the

late 1970s to the early 1980s, many alcohol companies were established. This increased the

production and availability of alcohol, providing Nigerian youths with easy access to alcohol

and this resulted in its use and misuse (Anumonye et al., 1977; Odejide, Ohaeri, & Ikuesan,

1989). This may be one of the reasons why studies conducted earlier in the 1980s (with the

exception of Nevadomsky, 1981) focused on alcohol alone.

Additionally, studies conducted in the early 1980s (with the exception of

Nevadomsky, 1981) collected data from fewer respondents (i.e., not more than 500 pupils)

than studies conducted between the late 1980s and 2013 (although three studies conducted

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in the 2000s had less than 500 respondents). With regard to the instrument of data

collection, the results show that none of the studies that were conducted in the 1980s or

those that measured only alcohol used any WHO-developed survey instruments to collect

data from their respondents (see Tables 1 and 2). The use of such instruments started in the

1990s.

Again, studies that combined multiple substances became popular in the late 1980s

and, with the exception of Abasiubong et al. (2008), they used larger samples compared to

studies that measured alcohol alone (see Tables 1 and 2 for further details). One consistent

factor across the years is that (with the exception of Fatoye and Morakinyo 2002), males

were higher in number among the respondents. This may be because males use more

substances than females. Similarly, females are more difficult to recruit for sensitive studies,

such as those on substance use in Nigeria.

With regard to the factors that predicted alcohol use and misuse across the years,

the data show that alcohol availability influenced adolescents’ alcohol consumption across

the three decades (see Tables 1 and 2). Similarly, factors such as parental alcohol use, male

gender, peer pressure and poor academic performance were consistent predictors of

adolescents’ alcohol consumption in the 1980s, 1990s and 2000s. Importantly, while

parental high economic status (i.e., coming from a family with a high income) was reported

in the early 1980s to be a predictor of adolescents’ alcohol use (e.g., Oshodin, 1981b), this

was not reported in the studies conducted between the late 1980s and 2013. As noted

earlier, one factor that may be responsible for this is the oil boom, which arguably caused

an increase in disposable income (Alos, 2000). Thus, it is likely that students spent part of

their pocket money on alcohol. Additionally, the review showed that early alcohol initiation

(i.e., having started drinking before gaining admission to secondary school) predicted

alcohol use among students and this result was consistent across the years. An insightful

part of this finding is that this was not only reported by the studies that measured just

alcohol, but also by those that examined multiple substances.

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Determinants of alcohol use

As shown in Tables 1 and 2, 17 (89.5%) out of the 19 studies that were included in the

review provided data on the factors that influenced alcohol use. Despite the fact that 17

studies reported such findings, only seven (36.8%) studies (two that measured multiple

substances and five that examined only alcohol) were conducted specifically with the aim of

revealing the factors that determine substance use. Thus, the results presented in this

section are based on these seven studies.

Individual/Behavioural Factors

Internationally, diverse motives for using alcohol among adolescents have been reported

(Dixon, Leen-Feldner, Ham, Feldner, & Lewis, 2009; Mackie, Conrod, Rijsdijk, & Eley, 2011;

Patrick & Schulenberg, 2011). Four studies in this review reported that students used

alcohol for self-enhancement purposes such as drinking to feel better, to forget one’s

problems, to stay awake at night to read, and to reduce stress, while one of the findings

indicated that students drink in other to enjoy a social gathering. Similarly, four (57.1%)

studies reported that peer pressure, such as drinking to satisfy friends or in order to not

deviate from group norms, predicted alcohol use.

Environmental and Structural Factors

Oshodin (1981b) reported that adolescents’ alcohol use was high due to the high volume of

alcohol production and availability. As noted, this was caused by the proliferation of

breweries from the late 1970s to the early 1980s in Nigeria. Again, familial factors such as

parental drug use, parental permissiveness, the lack of an age restriction to purchase

alcohol, a lack of supervision, poor parenting (in the form of not applying enough discipline)

or having divorced or separated parents, were reported by four studies as being

determinants of substance use, how substances were used and what these adolescents felt

about using them. Also, two studies reported interesting findings on alcohol use and

academic performance. Oshodin (1981b) noted that alcohol was mainly used by students

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who revealed that they had no intention of going to university, and Fatoye (2003) found

that poor academic standing encouraged alcohol use.

Discussion

Major Findings

This review has described the findings of studies conducted in Nigeria in order to highlight

what is known about alcohol ab(use) among students and provide a basis for the necessary

policy interventions. It should be recalled that alcohol use was not common among young

people in the traditional era (i.e., before colonial era) because ‘‘alcohol consumption was a

sign of being an elder’’ (Heap, 1998 p.29), but findings from the review point to the fact that

adolescents are drinking with diverse patterns and motives. Although some of the studies

that examined multiple substances reported low use of alcohol, many factors may have led

to the diverse alcohol use patterns reported. First, the majority of the respondents in some

of the studies were Muslims and alcohol use among Muslims in Nigeria is generally frowned

upon. It is also likely to be because some studies measured multiple substances, especially

over-the-counter drugs (e.g., Famuyiwa et al., 2011; Igwe & Ojinnaka, 2010), which are

commonly sold by roadside chemists and hawkers in Nigeria.

Similarly, Egbuonu et al.'s (2004) respondents were all females, and the result of this

study is undeniably due to the fact that females in most Nigerian communities are not socio-

culturally permitted to consume alcohol and other substances (Dumbili, 2015). This is why

Ikuesan (1994) argued that while it is culturally permissible for adult males to drink and

even get drunk in some Nigerian communities, females are often barred from drinking and

will be regarded as feckless if they ever get drunk. Ikuesan added that this can deter suitors

from asking for the hand in marriage of a known female alcohol user and her female siblings

may also suffer the same fate.

Overall, the findings showed that Nigerian adolescents in secondary school consume

substances. The substances consumed have changed. The studies conducted in the 1980s

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showed that alcohol was consumed (e.g., Oshodin, 1981a; 1981b; 1984) but in

contemporary Nigeria, multiple substances are consumed, as many of the studies (e.g.,

Famuyiwa et al., 2011; Igwe & Ojinnaka, 2010) reported. This is in agreement with

Makanjuola et al.'s (2007 p.113) study that revealed ‘‘a significant association between

lifetime alcohol use and tobacco, sedatives, sniffing agents and cannabis’’ among university

students.

Furthermore, the result has shown that students drink alcohol and use other

substances for diverse reasons such as a stress reliever, to be bold, to forget about their

problems or to alleviate anxiety. That these adolescents use alcohol for multiple reasons,

lends support to the findings of a recent review among Nigerian university students

(Dumbili, 2013). In that review, the findings showed that while some students use alcohol to

ease stress, stay awake in order to read at night, others use heavy drinking to enhance their

social capital. Again, the fact that these secondary school students see alcohol as a means of

alleviating anxiety is due to ignorance because alcohol use has been reported to increase

anxiety among Nigerian university students (Adewuya, Ola, & Aloba, 2006).

Similarly, the findings revealed that familial factors such as parental drinking,

parental permissiveness or a lack of discipline, and divorce or separation, determined

adolescents’ alcohol use, and this lends credence to several studies conducted in Western

societies. For example, Van Der Zwaluw et al. (2008) argued that alcohol use among parents

increased young people’s drinking in the Netherlands while parental permissiveness or a

liberal attitude resulted in high alcohol consumption among young people in the USA

(Ledoux, Miller, Choquet, & Plant, 2002; Pokhrel, Unger, Wagner, Ritt-Olson, & Sussman,

2008). Evidence shows that these familial influences engender early initiation of alcohol,

which continues among adolescents as they grow into adulthood. This confirms Chikere &

Mayowa's (2011) finding that 11.6% of their respondents initiated alcohol use between the

ages of 11 and 15 years while 45% started drinking alcohol between the ages of 16 and 20

years.

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Implications of the Findings for Policy Formulation/Implementation

The results of the review have shown that Nigerian secondary school students use and

misuse alcohol (and other substances), and one of the major predictors of this is the

widespread availability of alcohol. It was evident that the availability and easy access to

alcohol predicted alcohol use and misuse over the three decades (i.e., 1980s, 1990s, and

2000s). This finding is worth reflecting on in some detail because of its implications. Despite

the fact that unrecorded alcohol consumption is high in Nigeria (Obot, 2007; WHO, 2014),

evidence shows that Nigeria ranks second for heavy episodic drinking in Africa (WHO 2014).

Also, studies show that while young Nigerians who drink engage in hazardous drinking

practices (Olumide et al., 2014), Nigeria does not have written alcohol control policies that

define or specify standard drinks (Dumbili, 2014b). Additionally, alcoholic beverage

containers scarcely carry an inscription of alcohol by volume (ABV) on their labels (Dumbili,

2014b). Therefore, consumers of this drug are likely to suffer more alcohol-related harm

because there is no definition of responsible drinking.

Relatedly, there are no written policies to regulate alcohol production, marketing

and availability (WHO, 2014; Dumbili, 2014b; Umoh et al., 2012) and thus, alcohol

companies rely on self-regulation (Dumbili, 2014b; Obot, 2007). In fact, this lack of written

alcohol policies has been attracting scholarly attention since the 1970s. In 1977, Anumonye

et al. (1977) reported that alcohol was excessively consumed among Nigerians, and one of

the reasons for this was the widespread availability of alcohol. These scholars blamed the

government for not regulating the alcohol industry via policy and for removing the ban that

the colonial government placed on the locally-produced gin. In consequence, Anumonye et

al. (1977) recommended that the government should respond to the rising alcohol

availability, use and misuse by formulating/implementing alcohol control policies.

In the 1980s, scholars (e.g., Odejide et al., 1989; Odejide et al., 1987) reported that

Nigerian adolescents were increasingly using and abusing alcohol. One of the reasons that

they identified for this was that alcohol was easily accessed by youths. As such, they called

for the formulation and implementation of alcohol control policies in Nigeria, stating that

‘‘without such policies, it will be difficult to implement drug education in schools’’ (Odejide

et al., 1989 p.235). A similar recommendation was made by Obot (1990) with regard to

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regulating not just alcohol, but also other drugs. More recently, Dumbili (2014a; 2014b) and

Obot (2013; 2007) have also identified the need to formulate evidence-based alcohol

control policies to check alcohol availability in Nigeria but no written policies have been

formulated to date. To further reveal the extent of this neglect of policy recommendations,

in 2010, Nigeria’s representative was one of the 193 delegates (from the WHO Member

Nations) to adopt the World Health Assembly’s (WHA 63.13) resolution to

formulate/implement alcohol policies in countries where such policies did not exist (Chick,

2011; WHO, 2010).

Despite being part of the WHO Member Nations, which adopted the 2010

resolution, and the extant alcohol-related problems acknowledged above, Nigerian

governments (past and present) have not taken any steps towards

formulating/implementing written alcohol policies. As noted earlier, although a federal law

mandating alcohol to be sold to persons who are 18 years and above (WHO, 2014) and an

advertising code exist in Nigeria, these are not enforced (De Bruijn et al., 2014; Farrell

&Gordon, 2012). This non-enforcement is partly responsible for the growing culture of

intoxication in Nigeria (Dumbili, 2014b). The lack of written policies and the non-

enforcement of the existing marketing regulation have been attributed to many factors of

which the most prominent is the government’s economic interest in the activities of

transnational alcohol producers (Obot 2007; Obot and Ibanga, 2002). The non-enforcement

of the existing marketing regulation has been reported to be a cause of the increase in

alcohol availability and use among undergraduate students (Dumbili, 2013; Umoh et al.,

2012) and to have created a desire to use alcohol among adolescents in urban Nigeria (De

Bruijn, 2011).

Although no study in the review wholly examined the consequences of alcohol

availability, Igwe & Ojinnaka (2010) nonetheless revealed that adolescents who abused

substances such as alcohol and tobacco had multiple mental health problems, and this lends

support to similar studies (e.g., Abayomi et al., 2013; Adewuya, 2005; Adewuya et al., 2006)

among undergraduate students. Other studies conducted among Nigerian adolescents

reported similar results. For example, Omigbodun, Dogra, Esan, & Adedokun's (2008) study,

which used the WHO Global School-Based Student Health Survey Questionnaire to examine

factors that influenced adolescents’ suicide attempts, found that alcohol consumption was a

16

predictor of suicide attempts among male respondents. Similarly, Nwagu (2015) revealed

that alcohol use resulted in adolescents’ negative sexual behaviours because it resulted in

rape and other forms of sexual abuse.

Internationally, studies conducted among young people (e.g., Pridemore & Grubesic,

2012; Young, Macdonald, & Ellaway, 2012) have revealed that alcohol availability results in

an increase in alcohol-related problems. This is because as it encourages easy access, young

people misuse it, which results in multiple problems to them and others around them.

Globally, it is believed that one major factor that facilitates alcohol availability is alcohol

marketing (Babor et al., 2010). As such, research shows that countries that strictly regulate

alcohol marketing via stringent policies have less drinking problems than those with non-

stringent measures (Bosque‐Prous et al., 2014).

Because this review has shown that alcohol is used and misused by these

adolescents (who are not supposed to buy or drink alcohol), the Nigerian government

should, as a matter of urgency, formulate and implement evidence-based alcohol control

policies to reduce the rising alcohol availability, and its use and misuse. This is because

regulating the availability of alcohol via stringent measures will not just reduce access, but it

also will discourage its abuse among youths (Gruenewald, 2011). The WHO's (2010) 10-point

policy document should be adopted and blended with the local culture. This is because the

WHO recognized that for such a policy to be effective, it should be ‘‘sensitive to national,

religious and cultural contexts’’ (WHO, 2010, p.9). Nigeria is a multicultural and religious

country, and these variables may influence the patterns and determinants of alcohol use in

different regions. Therefore, the policies to be formulated should be sensitive to the

diversities in Nigeria.

Because part of thrust of the WHO's (2010, p.10) 10-point policy was to stipulate

that each country should focus on how to reduce or control the ‘‘availability of alcohol,

marketing of alcoholic beverages, pricing policies’’, etc., the policies that will be formulated

in Nigeria should be stringent enough to reduce alcohol marketing, especially those that

target youths. Also, law enforcement agencies such as the police should ensure that the

existing laws are not flouted by either alcohol marketers or underage drinkers. This can be

achieved through effective monitoring and the prosecution of offenders.

17

Additionally, the policy makers should ensure that public health practitioners,

medical practitioners, substance researchers and other relevant stakeholders are widely

consulted throughout the policy process. Although wide consultation is recommended,

alcohol companies should not take part in the policy formulation process. This will prevent

the issue of vested interest that has marred the policy processes in other African countries

(Bakke & Endal, 2010). Importantly, it has been argued that ‘‘abstinence is a socially

acceptable choice’’ because no amount of alcohol is completely without risk (DeJong, Atkin,

& Wallack, 1992, p.675). Therefore, young people (students and non-students) should be

encouraged to abstain from drinking alcohol.

Conclusion

Although the focus of this article is on alcohol, Nigeria does not have tobacco policies either

(Agaku, Akinyele, & Oluwafemi, 2012). Therefore, based on the findings of the review, policy

measures that will regulate the availability of tobacco (and other substances) should be

formulated and implemented in Nigeria as a matter of urgency. In addition,

comprehensively-evaluated campaigns that focus on reorienting students in secondary

schools in Nigeria should be pursued. Schools should engage in counselling to provide useful

information to students regarding the consequences of using alcohol as a means of

alleviating stress or ameliorating pain due to poor academic performance.

As no study has reported findings on screening, intervention and treatment centres,

schools should employ people with expertise on how to use validated instruments such as

the Alcohol Use Disorder Identification Test (AUDIT) and CAGE to perform periodic

assessments of alcohol use and disorder among students in secondary schools. The

screening of students for hazardous and harmful alcohol consumption, brief intervention

and referral for treatment (SBRIT) should also be performed at intervals in all secondary

schools because this will help to identify those with disorders early enough, which in turn

will reduce the harm caused by alcohol among Nigerian students. Because the findings

revealed that familial influences such as poor parenting predicted drinking among

adolescents, parents should desist from sending their children to buy alcohol for them. As

the results also show that some parents feed their sick children herbal alcohol mixtures and

18

permit adolescents to drink alcohol, these practices should be discouraged and discontinued

in Nigeria.

Strengths and Weaknesses in the existing literature

Nine of the studies in the review that measured multiple substances had large samples and

this makes generalizability possible. Other strengths are that the majority (e.g., Atoyebi &

Atoyebi, 2013; Igwe & Ojinnaka, 2010; Nevadomsky, 1981) drew their samples from a

combination of schools in the state they examined instead of examining a particular school,

while some adopted the WHO’s validated instruments. With regard to the weaknesses, the

decision to employ self-administered instruments and quantitative designs by all of the

studies in the review had serious implications for the quality of their results. This, in part, is

because the self-report questionnaire is often flawed for many reasons, such as the

respondents’ lack of ability to exactly recall their drinking patterns (especially children or

adolescents). Also, four of the studies that measured only alcohol did not provide details of

their methodologies and this has implications for the quality of their results (i.e., not

providing details of their methodologies makes it difficult for readers to judge whether or

not the research process that produced the results was rigorous).

Importantly, quantitative designs often do not capture people’s lived experience or

provide nuanced data, and perhaps they do not capture the ‘real reasons’ why individuals

drink. Thus, they may not be enough to proffer solutions to the increasing alcohol-related

problems in Nigeria. Furthermore, the studies that examined only alcohol did not recruit

large samples and this makes generalizability more difficult. It is noteworthy that several

measurement issues such as alcohol misuse or abuse and substance misuse were not

clarified in detail, and none of the studies employed AUDIT (which is one of the best

instruments currently used among substance researchers (Babor, Higgins-Biddle, Saunders,

& Monteiro, 2001).

Strengths and weaknesses of the current review

Although exploratory in nature, this is the first attempt to synthesize studies conducted

among secondary school students in Nigeria. Thus, by highlighting the findings of diverse

19

studies conducted in different regions of Nigeria, and especially by considering a historical

trend, the present article has attempted to provide vital information that will facilitate

interventions in different states of Nigeria. Despite that, the non-inclusion of grey literature

may have affected the results. Also, the papers reviewed were not selected based on their

quality. Therefore, the variation in the quality of the papers may have affected the outcome

of the review.

Directions for future Studies

This article has highlighted numerous gaps that will engender further research in the

following directions. First, there is a need to conduct studies that employ qualitative designs

among young people in order to subjectively explore the factors discussed above. This is

imperative because all of the studies identified employed quantitative approaches. Again,

this provides confirmation of Dumbili's (2014c) assertion that substance research in Nigeria

is dominated by quantitative scholars. Second, studies that measure only alcohol, the

motives for using it and the implications of this use should be conducted in different

regions. This is necessary because the cultural diversity in Nigeria may predict substance use

and its motives among different users.

Additionally, because many of the studies lacked methodological rigour, rigorous

methods should be employed in subsequent studies and longitudinal studies should be

conducted. Because no study has asked questions about daily, weekly or monthly quantities

of alcohol consumption among adolescents, studies that measure the quantity of alcohol

consumption are needed. Furthermore, studies should be conducted in the northern part of

Nigeria because no study in the review was identified in this region. This is necessary for a

holistic intervention to be possible. In sum, the review has attempted to describe the

patterns and determinants of alcohol use among Nigerian secondary school students as well

as to make policy recommendations that will ensure safer consumption among alcohol users

in Nigeria. Future empirical studies and reviews that provide information on the impact of

adolescents’ alcohol use and how alcohol marketing facilitates underage drinking in

contemporary Nigeria are needed.

20

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