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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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