LIST OF ABBREVIATIONS

AIDS- acquired immunodeficiency syndrome

DSM-5 -Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

GHS -Ghana Health Service

GSS- Ghana Statistical Service

HIV-Human immunodeficiency virus

MOH -Ministry of Health

UNODC- United Nations Office On Drugs and Crime

WHO - World Health Organization

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 CHAPTER ONE

INTRODUCTION

This chapter presents an introduction to the study. The chapter begins with a background of the

study, statement of the problem, objectives of the research (main and specific) significance of the

study, delimitations, definition of terms and organization of the research chapters.

1.0 Background of the Study

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013)defines

substance as psychoactive drug or toxinDSM-5 groups substances into 11 classes: alcohol,

amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, tobacco, opioids,

phencyclidine, and sedatives or hypnotics or anxiolytics. But for alcohol and tobacco, the other

substances are generally regarded as illicit drugs.

The use of licit and illicit drugs is among the key worldwide public health problems. The abuse

of these and other prescription drugs is common among adolescents and young adults (Swadi,

2010). These drugs use constitutes major risk factor for the development of somatic,

psychological, interpersonal, and socio-cultural problems (Cullen, 2013).

A substance may also be referred as a chemical which in its natural or synthetic form can affect

the way the body functions. It could cause change in temperament, discernment and behaviour

when it is smoked, injected, drunk, inhaled, or swallowed (Hussein, 2018).

The World Drug Report 2015 (Arslan et al., 2015, United Nations Office on Drugs and Crime,

2015)recorded that a total of 246 million people, or 1 in every 20 people aged 15 to 64 years,

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used at least one form of illicit drug in 2013. This meant an increase of 3 million over the

previous year (2012). It was further recorded that 27 million people (out of the 246 million) were

problem drug users, suffering from drug use disorders or drug dependence. About 12.19 million

of those problem drug users injected drugs, while about 1.65 million of those who injected drugs

lived with human immunodeficiency virus during the year 2013 (United Nations Office on Drugs

and Crime, 2015). In their international classification of diseases, the WHO likens problem drug

use toad verse use of drug and continuous reliance on drugs.

Adverse substance use is described by distinct proof of the use of such substance being liable for

physical injury (for example, as in organ damage) and psychosomatic harm (for instance,

substance induced psychosis). According to the International Statistical Classification of

Diseases and Related Health Problems, tenth revision(Hirsch et al., 2012, ICD-10), evidence of

drug dependence involves the affected person presenting with three or more of the following

pointers (Petersen & Hyde, 2010): victim demonstrates strong and consistent longing for the

drug; reduced ability to resist the use of the substance; withdrawal and isolation of oneself;

reduced response to usual effects of the substance; user has developed tolerance with transition

into a state of yearning for greater doses in order to experience the desired personal effect; victim

unreasonably expends time seeking, using and recovering from substance use; that victim

continues to use other drugs without concern for consequent harms. Victim should be observed

to have demonstrated or experienced the associated adverse effects for a minimum of a month at

some point in time in the course of a year.

The World Health Organization’s report of the top ten causes of admission among psychiatric

hospitals in Ghana in 2002 rated substance abuse second (17.43 %) to schizophrenia. Substance

use related disorders placed fourth (16.3 %) among outpatient cases (WHO, 2006). In their report

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at a workshop organized by the Ministry of Interior, the Ghana Police Service estimated that

about 70% of all crimes in the country were drug or alcohol related (Ministry of Interior

Workshop Report on Public Safety -The Role of Security Agencies in Ghana, 2006).

Public policy approach to sinking the harmful effects associated with illicit substance use in the

general population, especially among the youth, are of particular importance due to the

adversarial implications for the health of individuals, society and the economy of Ghana. This

study seeks to analyze laboratory test results of substance use with focus on providing empirical

evidence to inform public policy on drugs.

In the widest sense, a drug refers to any substance other than food or water which can cause

changes in the way the body functions- mentally, physically or emotionally- following its use

(Hussein, 2018). This definition encompasses alcohol, tobacco, caffeine, solvents (e.g. thinner or

turpentine), over the counter drugs, prescribed drugs and illicit drugs.

Anecdotal reports from psychiatric hospitals in Ghana indicate that substances that are

commonly abused include alcohol, cannabis, cocaine, morphine, codeine, heroin, nicotine,

pethidine as well as inhalants including glue, petrol and thinner.

1.1 Problem statement

Substance use and its associated problems impact comprehensively on society- such as

increasing crime rate, health related issues which leads to risk of mental disorders, spread of

HIV, hepatitis B & C, lung and liver problems and economically problems which leads to the

(e.g. implication for government expenditure on treatment of substance use related disorders.

(UNODC 2014).

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Only 1 out of every 6 problem drug users in the world has access to treatment, as many countries

shave large shortfalls in the provision of services (World Drug Report, 2014, 2014). Nonetheless,

there exist huge regional inequalities, with 1 in 3 problem substance users having access to

treatment in North America, 1 in 4 in Oceania, 1 in 5 in Western and Central Europe while about

1 in 18problem drug users (primarily cannabis use) receive treatment in

Africa. The UNODC (2014) laments that there were some 187,100 preventable deaths in 2012

attributed to drug overdose.

Kandel, et al., (2012)argued that the formulation of policies regarding the availability of mood

changing drugs and the strategies that could be developed in relation to prevention, education

and treatment programmes require methodical knowledge about rates of use of various

identifiable substances, the changes in rates over time, the social and psychological factors

associated with use, and the consequences of such use. However, (Pollack et al., 2011)cautioned

that drug use is often surreptitious and therefore its true trends, patterns and prevalence within a

population are imperfectly known.

Nonetheless, most data used for substance use trends analyses and other related studies are based

on self-reports of selected participants. Consequently, the National Institute of Drug Abuse

(1997) raised important concerns about the possibility of deceptive or inaccurate responses with

respect to these self-reported data for various reasons including participant’s fear of being

socially stigmatized. Magura & Kang, (2012) and the National Institute of Drug Abuse (1996)

reported of available findings that were suggestive of widespread. Underreporting attributed to

existing self-reported data from persons who participated in substance abuse studies and

treatment programmes.

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Anecdotal report from the Ghana Narcotics Control Board calls for pressing need to investigate

current trends and patterns of drug use in the countries of Sub-Saharan Africa, especially Ghana.

However, review of literature reveals various analyses captured from selfreported data of

selected participants. In Ghana, studies about substance use trends based on empirical data

(laboratory confirmed results) are sparse. Studies such as this could form firm basis for policies

and advocacy programmes concerning substance use in the country.(Csete et al., 2016).

In view of the potential high risks of substance misuse, it has been observed that most of the

youth in Yamfo abuse substance, there is need to assess the common substance of abuse and the

effects these substances have on the youth.

1.2 Objective of the study

1.2.1 General objectives

To investigate the substances of abuse among the youth of Yamfo.

1.2.2 Specific objectives

The specific objectives of this study are to;

Determine the common substance, abused among the youth in the study area.

1. Determine factors that influence substance abuse among the youth.

2. Find out their opinions on the effects of these substances.

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1.3 Significance of the study

The findings of this study could be used to educate the youth and the community on substance

use in Yamfo. Furthermore, the findings of this study will help educators, health care

professionals, and other professionals involved with the youth to understand the prevalence of

substance use and abuse, associated morbidities and most importantly, to develop effective

evidence-based strategies that could be used to control the substance use problems among the

youth in Yamfo.

Moreover, the study will provide information that will hopefully serve as a guide for policy

makers such as the Mental Health Authority and other recognized able bodies to generate

effective programs and interventions towards addressing issues of substance abuse among the

youth in Ghana.

1.4 Delimitation of the study

The scope of this study is limited to the geographical boundaries of Tano North district Yamfo to

be precise the youth in the community who are willing to participate in the study.

1.5 Limitations

The study is limited to the Youth (age range 15-35) in Yamfo community.

1.6 Definition of terms

Substance: A chemical used in the treatment, cure, prevention or diagnosis of disease or to

enhance physical and mental well-being

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Substance use: Chronic or habitual use of any chemical substance to alter states of body or

mind, other than medically warranted purposes leading to effects that are detrimental to the

individual’s physical or mental health or the welfare of others

Substance dependence: This refers to the uncontrollable craving and use of substances despite

the potential or actual harm to the person and society that may result from it.

Youth: The time of life when one is young between childhood and maturity.
1.7 Organizations of chapters

This study will be organized into five chapters. The first chapter will be about general

introduction of the study which entails the background of the study, statement of the problem,

objectives of the study, significance of the study, delimitation of the study, limitations of the

study and organization of chapters. The second chapter will be the literature review of the study

in respect to the objectives for this study. The third chapter will focus on the methodology of the

study which include the research design, target population of the study, setting, the sample size,

sampling technique, data collection instrument, data collection procedure and data analysis. The

fourth chapter will discuss the outcome of the study, which include presentation and discussion

of results, and analysis of data. The summary of the major findings of the study, conclusion and

relevant recommendation will be in the fifth chapter.

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 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter contains literature relating to substance use among youths. The literature is used to

identify relevant theoretical and conceptual framework for defining the research problem, lay the

foundation for this study, inspire new research ideas, and determine any gaps or inconsistencies

in the body of research(Polit et al., 2012).

Related literature focus on; substances most abuse among the youth, prevalence of substance use

among youth, factors that influences substance abuse and the effects of substance abuse on users

2.1.0 Substance Use among youth

Legal and illegal substances are commonly used among the youth. Legal substances are socially

acceptable psychoactive substances(De Miranda & Parry, 2011) and include over the counter and

prescription medicines, such as pain relievers, tranquilisers including benzodiazepines, cough

mixtures containing codeine and slimming tablets (Craig & Baucum, 2016).

Illegal substances are prohibited and the use or trading of these substances constitute a criminal

offence (De Miranda, 2011). These substances include cocaine, heroin, ketamine, cannabis,

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ecstasy, fentanyl, morphine, methaqualone(Mandrax), opium, flunitrazipam (Rohypnol),

methamphetamine and Wellconal(Craig et al., 2014).

An estimated 13 million youths become involved with alcohol, tobacco and other substances

annually (Lennox & Cecchini, 2019). In general, tobacco and alcohol are the most frequently

used substances by young people, with cannabis use accounting for 90% or more of illicit

substance use in North America, Australia, and Europe(Alexander, 2015). Furthermore, the

Canadian Centre on Substance Abuse (2012) has conducted a survey which indicated that the

average age for first users of substances was 12 years.

About 64.7% of the youth in grades 7 to12reported the lifetime use of alcohol, 29% cannabis,

43% cocaine powder and less than 4% other substances including heroin, ketamine and crystal

methamphetamine(Canadian Centre forSubstance Abuse, 2012).

Studies conducted in South Africa (Madu & Matla, 2014) indicate that the average age of a first-

time substance user is 12 years, which is similar to findings in European countries (Karen Lesly,

2015). In a study conducted by Fisher(2012), 45% of participants had tried with the use of

substance and 32% were still using them, while in a study conducted in treatment centres in the

Free State, Northern Cape, and North West, alcohol was found to be the most common primary

substance of abuse among patients(Plüddermann, Parry & Bhana, 2014).

In addition to that, a survey conducted in Cape Town found that more than 10% of 17 to 25 year

olds had been drunk more than 10 times (South African CommunityNetwork on Drug Use

Report 11, 2017).There is also a considerable misuse of over the counter and prescription

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medicines such as slimming tablets, analgesics, tranquilisers and cough mixtures. Cannabis was

found to be the second most common substance used among patients under 20 in treatment

centres in the Free State and North West (Plüddermann et al., 2014).

Cocaine use is relatively common in the Northern Cape and Western Cape for patients under the

age of 20 (Plüddermann et al., 2014).

There has also been a dramatic increase in the use of heroin and cocaine as secondary substances

of misuse in Cape Town and Gauteng. Poly-substance abuse remains high in treatment

centres(Plüddermann et al., 2014).

Many substance users are poly-substance users that are using various substances in combination

with alcohol as well as other combinations, such as cocaine and heroin (Parry et al., 2014). There

are also reports of increasing availability and use of synthetic substances such as ecstasy and

CAT, which are sniffed or snorted. In a study by Plüddermann, Parry, Bhana, Dada and Fourie

(2009), Alcohol, cannabis, and heroin were the most common primary substances of abuse for

patients younger than 20 years.

According to Plüddermann et al.,(2014), over 75% of patients younger than 20 years are black, a

significant increase over previous periods; 88% are male and 12% are female. About 31% of

patients reported swallowing their substances when alcohol is excluded. Almost 92% report

smoking as their mode of use. Only 1% of patients reported that they injected drugs. Blacks

constitute the majority of patients in treatment centres, followed by whites, coloureds, and Asian

(Plüddermann et al., 2014).

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For many youths, substance abuse proceeds academic and health problems including lower

grades, higher truancy, drop out decisions, delayed or damaged physical, cognitive and

emotional development or a variety of other costly consequences(Lennox & Cecchini,

2019).Thus substance abuse occurs in various countries including Ghana and among various

racial groups. Whites, blacks, coloureds and Indians are experiencing a problem of substance

abuse among adolescents in their families. Substance abuse also occurs among the youth from

various socio-economic backgrounds. That is evident in studies conducted in urban and rural

areas (Madu & Matla, 2014), which shows that substance abuse does not only occur among the

poor but also among wealthy families.

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2.2.0Factors that influences substance abuse among youth

Jon Rose, (2014) observed that young people who come to the attention of health and welfare

professionals often use substances as a means of coping with situational and emotional distress.

While these substance uses may also exacerbate problems, practical assistance in areas such as

accommodation, family, recreation, financial, vocation and educational support will most often

need to precede or coincide with any substance use management.

2.2.1 Peer group influence

This has been noted as a key factor to substance use among the youth. In the social learning

perspective (Akers et al. 1977) individuals learn delinquency by modelling-exposure to social

approval of delinquent acts, and anticipated rewards for engaging in delinquency. Peer group

influences on deviance are especially likely when there is weak bonding to the family and school

Several studies conducted on factors associated with alcohol use among the youth in Ethiopia

showed that peer influence is perhaps the highest predictor of substance use among the youth

(Reda et al., 2012). The Centre for Disease Control in 2010 said that youth are influenced more

by peers than their families when it comes to alcohol use (Centre for Disease Control, 2010).

Another study indicated that most students in our communities drink due to peer influence.

Peers could affect person’s preferences. For example, seeing friends consume an addictive

substance could act as a cue and stimulate the persons desire for that substance (Garrett, 2017).

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2.2.3 Family background

According to McMorris et al. (2015), a child's first standards of behaviour are formed through

the teaching of parents and other adults in the environment. She goes on to say that if a youngster

notices a disconnect between his or her parent’s teaching and practice, it fosters uncertainty,

which leads to deviant behaviour in the youth. They further stated the youth with parents who

abuse substance have a higher rate of parental and/or family difficulties than individuals whose

parents do not use substance. This can result in poor parent-child bonding, which can lead to a

lack of commitment to traditional activities and, in certain cases leads to drug use.

Youths who have had insufficient parental support are more likely to seek help and

understanding elsewhere (Maisto et al., 2014). Many people find affection, empathy, and support

in the substance-abusing subgroup's lifestyle.

2.2.4 Advertising

A large deal of study has demonstrated that the media to which young people are exposed can

lead to them and teenagers trying substance for the first time (Jernigan et al., 2017). Television,

movies, advertisements, and the internet have all been known to entice and mesmerize

individuals into consuming alcohol. Alcohol advertising contributes to increased alcohol

consumption by creating an environment that suggests that alcohol intake and overconsumption

are typical behaviours. The alcohol business also played a key part in glamorizing alcohol

consumption as contributing to prosperity and a bright future through relentless advertising

(Jernigan et al., 2017).

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2.2.5 Personal factors

Personal factors are those that are attributed to an individual's traits, such as age, sex, education

level, and knowledge(Chen et al., 2012). Personal variables are also connected to inherited

genetic components from parents who have struggled with alcoholism(Deutsch et al., 2014).

Personality traits such as hostility, low self-esteem, and difficulty controlling impulsive

behaviour are also included in the individual's profile on behavioural, emotional, and cognitive

styles, as well as personality traits such as hostility, low self-esteem, and difficulties in

controlling impulsive behaviour(Deutsch et al., 2014).

Other personal characteristics include traumatic incidents and psychiatric problems. The majority

of teens cite the joyful aspects of drinking, such as the delicious taste of alcohol and its tendency

to make people feel good or high, as the primary reasons for drinking.

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2.3.0 The effects of Substance Abuse on Users

Substance use has profound health, economic, and social consequences. The negative

consequences of substance abuse affect not only individuals who misuse substances but also their

families and friends, various businesses and government resources. Substance use and

dependence have grave consequences for existing social systems, affecting crime rates,

hospitalisations, child abuse and neglect, and rapidly consuming public funds(Goldfrank &

Hoffman, 2013). The exact effect of a substance will depend on the substance used, how much

is taken, in what way, and on each individual’s reaction. Substances can be extremely harmful

and it is relatively easy to become dependent on them.

2.3.1 Health effects of substances

There is an array of health related harms associated with substance use and abuse (Berk &

Donald 2015) For the purpose of this study, only the effects of substances known to be abused in

Ghana will be discussed.

2.3.2 Brief description of various substances and their effects.

Substances to be discussed include alcohol, cigarettes, cannabis, cocaine, heroin, ketamine and

crystal amphetamine. These are the drugs that are known to be abused in Ghana

2.3.3 Alcohol

This is a central nervous system depressant with effects similar to those of sleeping pills or

tranquilisers (Craig & Baucum, 2016). Larger doses of alcohol distort vision, impair motor

coordination and slur speech(Carson, Butcher & Mineka, 2015). Other common physiological

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changes include damage to the endocrine glands and pancreas, heart failure, erectile dysfunction,

hypertension and stroke, which are responsible for the swelling and redness in the face, and

especially the nose, of chronic alcohol abusers (Davison et al., 2020).

Short term abuse of alcohol may affect cognitive performance of alcohol abusing students

Furthermore, there is an increased probability of engaging in high-risk sexual behaviours,

placing the user at risk for both unwanted pregnancies and sexually transmitted diseases,

including HIV/AIDS(Rice & Dolgin, 2010).

This is because of the addictive and intoxicating effects of many substances, which can alter

judgement and inhibition and lead people to engage in impulsive and unsafe behaviours (Carson

et al., 2015). While intravenous drug use (IDU) is well known in this regardless recognised is the

role that substance abuse plays more generally in the spread of HIV, the virus that causes AIDS

by increasing the likelihood of high-risk sex with infected partners.

Substance misuse and dependence can also worsen the progression of HIV and its consequences,

especially in the brain. Injecting drug users are at great risk of contracting HIV/AIDS, anyone

under the influence of a substance, including alcohol is at heightened risk. This includes

intravenous drug users who share contaminated syringes or injection paraphernalia, as well as

anyone who engages in unsafe sex, for example, with multiple partners, unprotected sex or

‘transactional’ sex. The latter refers to trading sex for substances or money that could expose

them to infection (Nolen-Hoeksema, 2014).

Long term habitual use of alcohol increases tolerance but eventually causes damage to the

brain(Kring et al., 2010). Individuals abusing alcohol are more likely to think of taking their

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lives. Thus, those who abuse alcohol are more likely to do things that they might later regret.

They might end up dying because of alcohol(Davison et al., 2020).

About one-third of these deaths occur as a result of respiratory paralysis, usually as a result of a

final large dose of alcohol in people who are already intoxicated (Nolen-Hoeksema, 2014).

Furthermore, excessive use of alcohol leads to loss of consciousness, disability and death

induced by alcohol related traffic accidents(Rice et al., 2014).

Alcohol users may gradually build up tolerance for the substance so that ever-increasing amounts

may be needed to produce the desired effects Excessive use of alcohol is linked to the use of

other substances. Thus, the average life span of the average alcoholic is 12 years shorter than that

of an average citizen(Carson et al., 2015).

2.3.4 Tobacco

This is smoked, chewed or ground into small pieces and inhaled as snuff. Nicotine is the

addicting agent of tobacco. The most probable harmful components in the smoke from burning

tobacco are nicotine, carbon monoxide and tar (Davison et al., 2020).

Cigarettes discolour teeth, affect skin colour and makes breath, body and clothes smell

unpleasant. In addition to that, smoking increases heart rate, constricts blood vessels, irritates the

throat and deposits foreign matter in sensitive lung tissues, thus limiting lung capacity (De

Miranda et al, 2015). Years of smoking can lead to premature heart attacks, lung and throat

cancer, emphysema, and other respiratory diseases. Even moderate smoking shortens a person’s

life by an average of 7years(Craig & Baucum, 2016).Withdrawal of nicotine produces

nervousness, anxiety, light headedness, headaches, fatigue, constipation or diarrhoea, dizziness,

sweating, cramps, tremors, and palpitations.

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Smokers also become tolerant of nicotine. When the supply of tobacco is curtailed, smokers

show unreasonable, antisocial behaviour similar to that of heroin dependents(Rice et al.,

2010).Cigarettes are one of the leading causes of premature death(Davison et al., 2020). The

National Council on Smoking estimates that about 25 000 smoking-related deaths occur annually

(Department of Social Development, 2006).

The health hazard of smoking is not restricted to those who smoke. The smoke coming from the

burning of a cigarette, so-called second hand smoke, or environmental tobacco smoke (ETS),

contains higher concentrations of ammonia, carbon monoxide, nicotine and tar than does the

smoke actually inhaled by the smoker. Environmental tobacco is blamed for more than 50 000

deaths each year (Davison et al., 2020).Non-smokers are also at great risk of developing

cardiovascular disease and lung cancer.

Cigarettes remain an alluring symbol of maturity to some adolescents despite overwhelming

evidence that cigarette smoking is a serious health hazard and the increasingly negative image

associated with smoking in the minds of many young adults (Craig & Baucum, 2016). Cigarette

smoking is a highly addictive habit that is difficult to break. Once started, it is not a habit that the

majority of smokers can break by an effort of will (Nolen-Hoeksema et al., 2014).

2.3.5 Cannabis

This is made from the dried and crushed leaves and flowering tops of the hemp plants Cannabis

sativa. It is most often smoked, but it may be chewed, prepared as tea, or eaten in baked goods.

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The intoxicating effects of cannabis, like those of most substances, depend in part on its potency

and the size of the dose(Butcher et al., 2015).

Smokers of cannabis find it makes them feel relaxed and sociable. The short term somatic effects

include blood shot and itchy eyes, dry mouth and throat, increased appetite, reduced pressure

within the eye and somewhat raised blood pressure(Davison et al., 2020). The substance

apparently poses a danger to people with already abnormal heart functioning, for it elevates heart

rate, sometimes dramatically(Kring et al., 2010).

Short term effects of cannabis also include problems with memory and learning, distorted

perception of sight, sound, time, and touch, trouble with thinking and problem solving. Long

term use of cannabis causes lung cancer. Large doses have been found to bring rapid shifts in

emotion, to dull attention, to fragment thoughts and to impair memory (Butcher et al, 2015).

Scientific evidence indicates that cannabis interferes with a wide range of cognitive functions.

These studies revealed intellectual impairment in those under the influence of cannabis. Because

cannabis is intoxicant, it impairs memory and concentration. It also interferes with a range of

intellectual tasks in a manner that impairs classroom learning among student users.

Adolescents with good to excellent academic records who become heavy cannabis users begin to

have difficulty in paying attention or remembering what they read or hear in class(Rice, 2010).

Some find it difficult to read aloud or speak in class and generally stop participating in the

learning process. When not being disruptive, they are often inattentive, lost in daydreams or

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mindless staring and frequently nod off. They cut classes regularly, with very little regard for the

consequences of their actions(Alloy et al., 2018).

Extremely heavy doses have sometimes been found to induce hallucinations, extreme panic,

sometimes arising from the belief that the frightening experience will never end (Carson et al,

2015).Withdrawal symptoms can occur following discontinuation of high-dose chronic

administration of cannabis. These symptoms include irritability, decreased appetite, sleep

disturbance, sweating, tremor, vomiting and diarrhoea. Several studies have demonstrated that

being high on cannabis impairs complex psychomotor skills necessary for driving(Rice, 2012).

Highway fatality and driver-arrests figures indicate that cannabis plays a significant proportion in

accidents and arrests (Davison et al, 2020).

Cannabis can lead to psychological dependence, in which a person experiences a strong need for

the substance whenever he or she feels anxious and tense (Carson et al., 2015). Smoking

cannabis is highly correlated with adolescent use of other dangerous substances such as heroin

(Alloy et al., 2018).

2.3.6 Heroin (Horse or Hary)

It is a white, odourless powder produced from morphine by a simple chemical process (De

Miranda, 2011). It is usually injected for a maximum effect, although it can also be sniffed,

smoked or taken orally. Heroin affects the central nervous system, causes respiratory depression,

nausea and vomiting (Craig et al, 2014)

In addition to the effects of the substance itself, street heroin may have additives that do not

dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidney or brain.

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This can cause infection or even death of small patches of cells in vital organs (Carson et al.,

2015).

With regular use, tolerance develops this means that the abuser must use more heroin to achieve

the same intensity or effect. Addicts usually lose their appetite for food, which leads to

malnutrition. They neglect their health, suffer chronic fatigue and are in a general devitalized

state (Rice, 2012). Heroin produces euphoria, drowsiness, reverie, and sometimes a lack of

coordination (Davison et al., 2020).

An additional problem now associated with intravenous drug use is exposure through sharing

needles to HIV/AIDS(Nolen-Hoeksema et al., 2014). Use of heroin can lead to death from

homicide, suicide or accidents and from overdosing of the substance (Carson et al., 2015).

2.3.7 Cocaine (coke)

This is extracted from the leaves of the coca plant. It is available as an odourless, fluffy, white

powder. Cocaine can be swallowed, sniffed (snorted) or injected. It is highly addictive in any

form (Davison et al., 2020). The main undesirable effects are nervousness, irritability and

restlessness, mild paranoia, physical exhaustion, mental confusion, loss of weight, fatigue or

depression when coming down and various afflictions of the nasal mucous membranes and

cartilage (De Miranda, 2015).

Cocaine affects the brain. Users of cocaine become confused, anxious and depressed.

Frequent users of cocaine might experience a ‘cocaine psychosis ‘consisting of hallucinations

and delusions among others of insects crawling under their skin. Other known risks of cocaine

use include death from stroke, heart attack, or respiratory failure (Craig & Baucum, 2016).

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Cocaine increases sexual desire and produces feelings of self-confidence, well-being and

fatigability. Ceasing cocaine can take hold of people with as much tenacity as do other addictive

substances. Cocaine causes cognitive impairments, such as difficulty paying attention and

remembering (Kring et al., 2010). Crack cocaine is linked to the transmission of HIV/AIDS

because some users engage in prostitution to support their habit.

In addition, unprotected sex with multiple partners is routine in ‘crack houses’(Craig & Baucum,

2016). Dependence on cocaine is extremely difficult to break, leading to a high relapse after

treatment(De Miranda, 2011) . Users who take larger doses may die of an overdose, often from a

heart attack.

2.3.8 Ketamine

The street names or slang names are Cat, Valium, K, Special K and Vitamin K, forms the next

category of substances. Although it is manufactured as an injectable liquid, in illicit use ketamine

is generally evaporated to form a powder. Ketamine is odourless and tasteless, so it can be added

to beverages without being detected and induces amnesia.

The substance is sometimes given to unsuspecting victims and used in the commission of sexual

assaults referred to as ‘Drug rape’. Ketamine can cause dream like states and hallucinations.

Users report sensations ranging from a pleasant feeling of floating to being separated from their

bodies. Low dose intoxication from ketamine results in impaired attention, learning ability and

memory. In high doses, ketamine can cause delirium, depression and potentially fatal respiratory

problems(De Miranda, 2011).

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2.3.9 Crystal methamphetamine

Thesis often referred to as ‘crystal meth’ or ‘ice’. Methamphetamine can be taken orally or

intravenously. It can also be taken intranasal, that is snorting. Craving for methamphetamine is

particularly strong, often lasting several years after use (Davison et al., 2020). Several studies

conducted indicated that chronic use of amphetamine causes damage to the brain, affecting both

dopamine and serotonin systems (Kring et al., 2010).

Immediately after smoking or injecting the substance, the user experiences an intense sensation,

called a ‘rush’ or ‘flash’ that lasts only a few minutes. Snorting or swallowing methamphetamine

produces euphoria, a high, but not a rush(Nolen-Hoeksema, 2014).

Other possible effects include wakefulness and insomnia, decreased appetite, irritability,

aggression, anxiety, nervousness, convulsions, and heart attack. Methamphetamine is addictive

and users can develop a tolerance quickly, needing larger amounts. Methamphetamine can also

cause strokes and death

From the above discussion, it is evident that substances have a negative effect on the lives of the

youth. Since substances do not only affect the individual user, the next section will explore the

social effects of substances.

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2.4.0 Effects of substance on the abusers

2.4.1 Social effects of substances

Dependence to any substance is damaging to the individual as well to society(Alloy et al, 2018).

Substance abuse does not only affect the individual, it also affects the family, friends, teachers at

school and other members of the community. Adolescents abusing substances may become

withdrawn, moody, irritable or aggressive. That often leads to a deterioration in family, peer

group, and school relationships (Parrott et al., 2016).

These adolescents academic performance drops and truancy often increases and they end up

being expelled from school due to their behaviour (Donald et al., 2017).Furthermore, school

children who use substances often suffer from impairment of short-term memory and other

intellectual faculties, impaired tracking ability in sensory and perceptual functions,

preoccupation with acquiring substances, adverse emotional and social development and thus

generally impaired classroom performance. Reduced cognitive efficiency leads to poor academic

performance, resulting in a decrease in self-esteem and the adolescent may eventually drop out

altogether. This contributes to instability in an individual’s sense of identity which, inturn, is

likely to contribute to further substance consumption, thus creating a vicious circle(Lakhanpal &

Agnihotri, 2014).

The more a student uses tobacco, alcohol, cannabis, cocaine, and other substances, the more

likely he or she will perform poorly in school, drop out, or not continue on to higher

education(Berk et al., 2015). Furthermore, adolescents who abuse substances may neglect their

schoolwork and even be absent from school. They are less likely to value academic

25
achievements; they expect less academic success and do, in fact, obtain lower grades. In addition

to that, they also become aggressive towards teachers and other learners (Donald et al., 2017).

Some substances are expensive, thus a need to sustain the dependence may lead to theft,

involvement in violence and eventually even to organised drug-related crime (Donald et al.,

2017).

Some adolescents drop out of school and turn to other crimes such as robbery and gangrelated

activities to support their habit. Previous studies confirm that there is a link between substance

abuse and criminal activities (Butcher et al., 2015).

Young people often steal money to buy substances the substance, and obtaining it, becomes the

centre of the abuser’s existence, governing all activities and social relationships. The effect of

these substances on the general inhibition of impulses, social judgement is often distorted.

Involvement in other social problems such as impulsive violence, casual or exploitative sex,

racial and other forms of intolerance or abuse may result. It is believed that over half of all

murderers are committed under the influence of substances; as are rape, assault and family

violence (Davison et al, 2020).

This adds to the danger to the adolescents and to others(Donald et al, 2017). Drugs can trigger

violent reactions and users can harm themselves or others. Furthermore, substance abuse issues

are encountered at every level of the criminal justice system, from the international trade in

substances and the use of the proceeds of that trade for corrupt ends to driving under the

influence of alcohol or other substances (United Nations Office on Drugs and Crime, 2008,

Department of Social Development, 2006). The high cost of substances means that dependents

must either have great wealth or acquire money through illegal activities, such as theft,

26
prostitution or the selling of substances(Davison et al., 2020). The correlation between opiate

dependence and criminal activities is thus rather high, undoubtedly contributing to the popular

notion that substance dependence per se causes crime

(Davison et al., 2020).

Substance use impacts on the criminal justice system, with evidence of links between drinking at

risky levels, committing crime, or being a victim of crime (Karen Lesly, 2015) Most substance-

related crimes, however, are the culmination of a variety of factors. That is, personal, situational,

cultural, and economic.

When teenagers depend on alcohol and other substances to deal with daily stresses, they fail to

learn responsible decision-making skills and alternative coping mechanisms. These young people

show serious adjustment problems, including chronic anxiety, depression and antisocial

behaviour, that are both the cause and consequences of taking drugs (Berk, 2015).

They often enter into marriage, childbearing and the work world prematurely and fail at them.

These are painful outcomes that encourage further addictive behaviour (Berk, 2015). Thus

substance use does not only have an effect on the adolescents using them, it also has a negative

effect on the lives of other people. The next section presents the economic effects of substances

as substance use has negative implications for the economy of the country.

2.4.2 Economic effects of substance abuse

Substance abuse has a negative impact on the economy of the country. This includes a range of

problems such as inefficiency, impaired work performance, accidents and absenteeism at a

considerable cost to both industry and society (Parrott et al., 2016). Work productivity declines.

For example, 2.5 million workdays are lost due to absenteeism arising from substance-related

27
illnesses (Department of Social Development, 2016). Furthermore, the use of substances has a

negative impact on the health care system including the depletion of scarce resources available to

improve the health of people (Department of Health, 2017).

Medical resources are wasted and lives are lost in substance-related accidents. High amounts of

money are spent in hospitals, on prevention campaigns and in treatment centres for substance

dependents (Alloy et al, 2018, United Nations Office on Drugs and Crime, 2008). Although most

people who abuse substances do not seek professional help, people who abuse alcohol constitute

a large proportion of new admissions to mental hospitals and general hospitals (Davison et al.,

2020, Department of Social Development, 2006).

Other costs include repairs to property damaged by addicts, food and accommodation in prisons,

transportation of addicts to courts in terms of those still awaiting trial (United Nations Office on

Drugs and Crime, 2008).

Medication for treatment of substances is also expensive. The use of alcohol and other

substances presents law-enforcement problems as well. Thus, substance dependence is a

financial burden for the country. The adolescent not only suffers progressive physical and

psychological deterioration but also loses the ability psychologically, socially and often

economically to break out of the cycle of substance abuse (Donald et al, 2017).

The health and socioeconomic consequences of substance use and abuse undermine democracy,

good governance and has a negative impact on the country. As with alcohol, the socio-economic

cost of smoking is staggering. Each year smokers compile over 80 million lost days and 145

million days of disability, considerably more than do non-smoking peers (Davison et al., 2020).

28
2.5.0 Substance use in Ghana

The problem of substance misuse in Ghana is not very different from what pertains in other

countries although there may be variations in the magnitude of the problem across countries. It is

not quite clear when it actually became a problem in Ghana but the phenomenon according to

educated guesses could be traced to have existed post-independence in the 1960s. The use and

abuse of substances have since extended to include the youth.

The earliest study on substance use in Ghana which was conducted by Amarquaye (1967)

focused on marijuana use; he observed that marijuana had been available in Ghana for many

years and was locally grown. It revealed that 25% of the subjects in the study were active

smokers at the time of the study and their ages ranged from 10 to 25 years.

In their epidemiological study of drug abuse among Ghanaian youth aged 12 to 24 years, Nortey

and Senah(1990) examined modes of consumption of drugs relative to the different categories of

consumers, personality types involved with drug use, the mechanisms and places of distribution

as well as the factors which facilitated changes in the consumption of drugs. The study

concluded that the subjects were more knowledgeable about drugs than their actual rate of use.

29
Further, the study recommended institutionalisation of drug education programmes as a means to

discouraging drug use. Nonetheless, responses were solicited from participants through

questionnaires and therefore the interpretation of the findings from such self-reports should be

done with caution. From policy perspective, it sets the agenda for a comprehensive

epidemiological study of the drug phenomenon in Ghana.

Affinnih (1999) confirmed a change in the types of drugs that were abused in Ghana to include

hard drugs such as heroin and cocaine and other psychotropic substances like Valium and

Mandrax. The study argued that drug abuse in Tudu neighbourhood of the Greater Accra region

was representative of what existed in several other neighbourhoods in the city. Nevertheless,

there is yet to be conducted similar studies in other parts of the country in determining the

magnitude of the problem as well as the national prevalence relative to substance use and abuse.

In a research entitled “A national survey on prevalence and social consequences of substance

(drug) use among second cycle and out of school youth in Ghana”, the Ministry of Health

(MOH) / Ghana Health Service (GHS) and the World Health Organisation (WHO) reported that

the commonest substances used by the youth were alcohol (25.3%), cigarette (8.7%) and

cannabis (1.7%)(MOH / GHS & WHO, 2003) . The report further revealed that cocaine,

tranquilizers and heroin were less frequently used. In what appeared in literature as the most

extensive study in Ghana on substance use among the youth so far, the Ministry of Health /

Ghana Health Service and World Health Organisation(MOH / GHS & WHO, 2003) indicated

that the average age at first use of substances ranged from 14 to 19 years.

However, the study did not give detailed attention to examining the comparative differences that

could have existed between in-school and out-of-school youth and which of them had the greater

30
likelihood to abusing drugs. Further, it did not describe inter-regional similarities or differences

that might have occasioned the findings.

In his study on Substance Abuse among Senior High School Students in Ghana involving the use

of Adolescent Alcohol and Drug Involvement Scale (AADIS), Nkyi (2014) found that the

prevalence of substance use among senior high school students in Ghana was lower than those

reported in other African and western countries.

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 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter was focused on the methodological processes that were used to carry out this

research. This included: the study design, study type, study population, sample size, sampling

techniques, data collection instruments as well as tools for analyzing data collected and ethical

consideration.

3.1 Study design

A cross-sectional design was used in this study. This study usually allows researchers to collect a

great deal of information quite quickly. Data were often obtained inexpensively using self-report

surveys. Researchers were then able to amass large amounts of information from a large pool of

participants. The study takes place at a single point in time without manipulating variables.

3.2 Study area

Yamfo was the study area for the research. It is a town in the Ahafo region of Ghana. Yamfo has

a population of about 20,522. Yamfo is a farming community. It has one tertiary school and two

secondary schools. Yamfo is in the Tano North district.

The main ethnic group in the town is Akans even though there are different ethnic groups

(Dagari, Bono, Ewe’s) and different religious background because of the economic activities that

goes on in the town. The town has an electricity supply and water as well. Concerning the health

32
needs of the people in the town and its surroundings; the Yamfo Health centre is there to provide

the health needs of the people. (GSS, 2012)

MAP OF YAMFO

Figure 1: The map of Yamfo

Source: Ghana Statistical Service (2012)

3.3 Target population

This study involved residents of Yamfo who are above fifteen years of age because they can

provide relevant and reliable information with regard to the study objective.

3.3.1 Inclusion criteria

Males and females who were between the ages of 15 – 35 years living in Yamfo and were willing

to participate were included in the study.

3.3.2 Exclusion criteria

This study excluded people who were between the ages of 0-14 years as well as individuals who

were not willing to participate in the study between the ages of 15-35 years

33
3.4 Sampling

3.4.1 Sample size determination

The sample size for the study was determined using the Cochrane sample size formula. This

allows you to calculate an ideal sample size given a desired level of precision, desired confidence

level and the estimated proportion of the attribute present in the population and it is appropriate

in situations with large populations(Wang & Gelfand, 2002).

Cochrane formula;

𝑧2𝑝𝑞
n= 𝐶2

n = Sample size

Z = z value at 95% confidence level = 1.96 value in the z table P

= p value = 0.5 q = (1-p) = (1 - 0.5) = 0.5

C = Confidence level = 0.05

n=

n = 385

Modification for the Cochran Formula for Sample Size Calculation in Smaller Populations will

be given as;

n°
n= n°−1
1+( )
N

34
n = new adjusted sample size n° = Cochran’s sample size recommendation

which was the rounded of 385 N = population size which is 20,522

This study requires the use of a purposively sampling the population size for the research.

Caregivers and non-caregivers were purposively selected.

n=

n = 377.928 ≈ 378

The participant for the study was calculated to be three hundred and seventy eighty (378) but due

to factors such as resources, time, data collectors and unforeseen circumstances, the population

size was reduced and the participants for the study was three hundred (300) which made the

study convenient and meeting the set objectives.

3.4.2 Sampling technique

The study employed a simple random sampling approach to randomly select households and

individuals for the study. In this sample method each member of the population had an equal

chance of being selected for the study. This technique was used for the study because this study

involved residents who were willing to partake in the research from a large population in order to

get accurate results.

35
3.5 Data collection tools

Data was collected with a well-structured questionnaire. The questionnaire was adapted and

modified from different reviewed literature.(Hussein, 2018, Aliyu et al., 2016, Lennox et al,

2016)The question and statements was arranged according to the specific objectives of my study.

After checking of questionnaires completeness from my supervisor, it was handed out to the

participants who were consent to participate in the study. The questions were openended

questions and categorized into five sections. The first section were the demographic

characteristics of the respondents comprising of their age, sex, education background, the

second section comprised of questions and statements that seek to sought out their knowledge

relating to the common substance abuse among the youth in the study, the third section which

will comprise of the factors that contributes to substance abuse among the youth and the last

section which comprise of statements and questions relating to their opinions on the effects of

substance use among the youth.

3.6 Data collection procedure

The primary data for the study was a well-structured questionnaire which was approved by my

able supervisor. The data collection was assisted by data collectors who was enlightened on the

data collection procedure to help finish within time. Data was collected within a period of one

month.

I also made copies of questionnaire for the respondents. Respondents who were consent to the

study were required to select from a set of given options that were appropriate to their situation.

Respondents who agreed to read and respond to the questions by themselves were given 20-

minutes to answer the questionnaire.

36
The questions were read out and interpreted by the researcher to those who do not understand

English Language and appropriate answers given were recorded.

The area for the study was divided into a cluster of four. The first cluster took the direction of the

north. The other clusters took the direction of south, east and west respectively. The directions

for the study were altered when a quarter of the population for the study was reached until all the

directions were met.

The first household in the first cluster was begun with the activity whereby respondents were

selected from the household. After the first household was selected, a count of two was made to

select the next households that falls on the second count. This activity was continued and was

repeated for the other clusters until the sample size for the study is reached.

In a house where there are more than one participant’s in the household, I wrote yes and no on a

piece of paper, those who selected Yes and are interested in the study were allowed participate in

the study to help get an accurate results in order to avoid repetition of same answers.

3.7 Data analysis

Statistical software known as Statistical Product and Service Solutions (SPSS version, 20) was

used to analyse the data to avoid human errors and reduce work load.

3.9 Ethical consideration

A research proposal was submitted to my supervisor for approval. When approved, a letter was

taken from the College of Health-Yamfo administration to the community for their consent. The

37
researcher will also seek consent from all the respondents involved in the study. Respondents

were also assured of confidentiality and their ability to withdraw from the study

38