Monitoring Drug Abuse in South Africa
Monitoring Drug Abuse in the SADC region

Substance use among South African university students: a quantitative and qualitative study

Karl Peltzer1 and Nancy Phaswana2
1Department of Psychology, University of the North
2Department of Social Work, University of the North
1999

Introduction
There is much concern in South Africa about alcohol misuse among young people. 1 The reported drinking rates of young people in a nation-wide survey are considered to be high, especially among males.2 More recently, concern has been expressed at the rapid increase in alcohol use and abuse in Third World countries. The ‘new’ patterns of alcohol and cannabis use and misuse in these countries are said to be qualitatively different from the traditional ‘integrated’ drinking patterns, in which highly ritualised and ceremonial drinking used to take place in a context of positive societal meaning, which was clearly controlled, and mainly restricted to adults. The use of alcohol, cannabis, tobacco, and illicit drugs by university students, in particular, is a matter of concern to all involved in student welfare.

The importance of understanding the role of cultural and contextual factors in drug use and misuse is increasingly being recognised. It has been suggested that in Africa the combination of traditional cultural practices and the increasingly pervasive ethos of 'modernity' and 'Westernisation' may be responsible for an increase in drug misuse.3 The consumption of alcoholic beverages and cannabis in South Africa has a long history. During precolonial times, alcohol drinking was mainly the preserve of elders and senior members of society including traditional healers, but it was uncommon among youth and women of child-bearing age. Alcohol was mainly consumed during different types of festivities and ritual ceremonies, including weddings, ceremonies held for the deceased, coming-of-age ceremonies for both boys and girls, meetings of reconciliation, ceremonies for propitiation of ancestral spirits, and graduation ceremonies of diviners.4 The significant increases in the current use are difficult to explain, thus prompting the suggestion for further corroborative qualitative studies. The present study presents an analysis of prevalence, patterns and experiences of drug use (especially alcohol and cannabis) among South African students.

Methods
The study used a combined quantitative and qualitative approach. Part 1 was the administration of a substance-use questionnaire and part 2 (with the same sample) included focus group discussions on substance use. It was felt that the qualitative methodology could provide rich, in-depth information regarding participants’ attitudes and beliefs about alcohol and cannabis use.

Instruments
Data pertaining to prevalence and frequency of drug use were obtained from a 123-item, substance-use questionnaire developed by the World Health Organisation5 including:

(1) basic socio-demographic data; (2) information on lifetime, current, and past use of eleven substances: namely alcohol, cigarettes, cannabis, salicyte analgesics, stimulants, antibiotics, hypno-sedatives, heroin, cocaine, hallucinogens and organic solvents, (3) optional items which relate to familiar and best friend’s usage of some selected substances, their perceived harmfulness and perceived availability. The questionnaires were self-completed. However, students who needed assistance were assisted and questions were clarified to ensure that the questionnaire was completed correctly.

Sample and procedure 
Fifteen social work students were identified through their lecturer at the University of the North. Each was asked to bring along at least 6 university student friends for the group sessions. Ninety University of the North undergraduate students (47 males and 43 females) were identified using this strategy. The mean age for male students was 22,3 years (SD=3,4) and for female students 21,8 years (SD=3,2). The ethnic background was mainly Northern Sotho (47%), Tsonga (26%) and others (27%). The students taking part were guaranteed anonymity.

All volunteers were provided with information detailing the subject and the purpose of the discussion, and how the focus group would operate. The same person, a young, experienced group facilitator, able to relate well with youth, conducted all focus groups. Each participant formally consented to participation. Students were randomly assigned to focus groups, each consisting of 10 people. Since it was assumed that the major drugs used and abused were alcohol and cannabis, the focus groups concentrated on these substances. Asking a series of prearranged questions (see below) facilitated the group.

Group discussions lasted approximately one-and-a-half hours and, with the permission of the participants, all discussions were audiotaped. After each group discussion, tapes were transcribed. Transcriptions were read several times to allow researchers to develop agreement and an understanding of the ‘themes’ of responses. One independent substance-abuse researcher was asked to rate the themes and codes on a regular basis as a reliability measure (65% of the codes were subject to reliability checks). In the event of a discrepancy between the independent and the two researchers, inter-researcher agreement was sought to ensure the validity of the coding scheme.

Results
a) Survey results
The survey results in Table 1 indicate lifetime prevalence rates and in Table 2 past-month prevalence rates for most commonly used substances. For both lifetime and past-month use alcohol, cigarettes, glue and cannabis were, in descending order, the most prevalent substances used. Other drugs (salicyte analgesics, stimulants, antibiotics, hypno-sedatives, heroin, cocaine, hallucinogens and organic solvents) were not reported at all. For all substances, males had higher prevalence rates than females except for glue (see Tables 1 & 2).

 

Table 1: Lifetime prevalence rates for University of the North students (N=90)

Substance
Male (N=47) (%)
Female (N=43) (%)
Alcohol 37 (79) 11 (26)
Cigarettes 23 (49) 2 (5)
Glue 13 (30) 2 (5)
Cannabis 12 (27) 1 (2)

Table 2: 1-month (past month) prevalence rates (N=90)

Substance
Male (N=47) (%)
Female (N=43) (%)
Alcohol 26 (57) 2 (5)
Cigarettes 12 (26) 0 (0)
Cannabis 3 (7) 1 (2)
Glue 0 1 (2)

Table 3 indicates the frequency of the age of first use by gender for the various substances

Table 3: Age of first use of substance

Substances
Age of first use
Male (%)
Female (%)
Cigarettes 10 (or less) - 16 15 (33) 2 (5)
  17 + 7 (16) 0
Glue 10 (or less) - 16 9 (23) 2 (5)
   17 + 4 (10) 0
Alcohol 10 (or less) - 16 16 (34) 5 (13)
  17 + 22 (47) 4 (10)
Cannabis 10 (or less) - 16 3 (7) 1 (2)
    17 + 9 (22) 0

For both males and females it appears that the age of first use was less for cigarettes and glue than for alcohol and cannabis. Moreover, it seems females started earlier with the substances mentioned here than males.

Both male and female students reported that they were introduced to substance use by the following (in rank order): (1) friends or acquaintances: alcohol (46%), cigarettes (21%), glue (12%) and cannabis (11%), (2) family member or relative: cigarettes (7%), alcohol (6%), and (3) others: cannabis (3%), cigarettes (2%), glue (1%). None of the females were introduced to alcohol by family members but only by friends, whereas males were introduced to alcohol by both friends and family. Both male and female students reported that the following family members or relatives used the following substances (in rank order): (1) brother: alcohol (39%), cigarettes (27%), cannabis (3%) and glue (1%), (2) parents: cigarettes (14%), alcohol (10%), and (3) others: cigarettes (7%), alcohol (6%) and cannabis (4%). None of the sisters of the participants are using substances.

b) Focus group results
The focus group results are reported under the headings of the questions that were asked.

  1. How did you first find out about alcohol and cannabis?
    Most participants stated that they knew about alcohol and cannabis during their early childhood. They mentioned four ways in which they got to know alcohol and cannabis.

(1) Exposure by family members, relatives and people that they know through teaching them how to brew it, sending them to buy it at the bottle stores, serving their parents’ customers with alcohol, who urged them to taste it before selling it to them to make sure it is ready to be drunk; (2) Seeing peers using them (cannabis and alcohol), i.e. smoking cannabis on street corners, dodging periods from school to smoke cannabis in the toilets, drinking alcohol during farewell functions and school trips; (3) Witnessed police arresting people using cannabis; (4) Attending talk shows at school on drug abuse.

  1. What kind of people use alcohol and cannabis?
    Participants stated that alcohol is a drink for everyone: young and old, educated and uneducated, males and females, churchgoers and sinners. However, they identified that most elderly people drink home-brewed liquor (KB) [a home-brewed beer] while most rich people drink ‘hot stuffs’. In terms of cannabis, participants identified as users: celebrities (musicians), athletes (especially football players and boxers), show people (dancers and speakers), idle and delinquent youth, unemployed and poorly paid workmen, manual workers and business men, frustrated people, people who grew up in families where cannabis was not prohibited, thieves, overweight people and low-class people.
  2. Why do people use cannabis and alcohol?
    Various reasons were given for why people use alcohol and cannabis. They were categorised as follows: (1) gaining mental and physical strength (cannabis only); (2) social reasons such as to be sociable, to celebrate an occasion, group identification and pleasure seeking; (3) imitating role models; (4) for distraction and coping, e.g. to forget worries, to get relief from anxiety, depression, loneliness and self doubt; (5) to get courage; (6) for intrinsic reasons such as to enjoy the feeling and the flavour; and (7) for its medicinal value (cannabis).
  3. Where do people get alcohol and cannabis from?
    It was mentioned that alcohol consumption is an ordinary activity in most societies, therefore alcohol is everywhere: brewed from home, sold in restaurants, shops, garages, shebeens, student residences, student and staff cafeterias, police barracks, bars and bottle stores. It is found where ever there are people because it is in great demand. No ‘bashes’, festivals and parties go on without it. Regarding cannabis, participants indicated that it can be purchased from private sellers (who are usually identifiable through red eyes, swollen face and black lips), hawkers who sell it openly at congested places (e.g. bus ranks), gangsters who sell it to make money. It grows naturally (especially on the mountains), some people grow it in their own yards and is thus freely available. It could also be received from foreign countries through illicit trafficking.
  4. How can alcohol and cannabis be used?
    Numerous ways of using cannabis and alcohol were given. Apart from being smoked in pipes, participants stated cannabis may be boiled, be used as an ingredient in traditional relish, the seeds could be ground to be applied to wounds, it could be sniffed, burned to inhale the smoke, chewed to arouse appetite, bubbled [involves drawing cannabis smoke through water using a pipe and then breathing it in], smeared on hair for nourishment, and can also be used as an ornament. Regarding alcohol, participants indicated that besides drinking it, it could be sprinkled on the meat, it could be used during religious ceremonies, i.e. during the Holy Communion, and also be used during other rituals.
  5. Do different methods of use produce different effects?
    The following comments summarise respondents’ view on this question:

"If you have smoked cannabis you can really feel it. It goes straight to the mind, it works. When you drink it has to go through the absorption process. Smoking reaches the very part to the consciences (mind) in a very effective way. Sniffing cannabis using a straw is much addictive".

 "I used to serve my mother’s customers with liquor. Every time when I serve a customer. I took a sip. Later on I felt I needed a stronger alcohol. I started selling my mother’s beer without her knowledge. I used the money to buy beer which is stronger than the home-brewed beer."

  1. What are the effects of alcohol and cannabis?
    The majority of the participants believed that the use of alcohol and cannabis were problematic, even though they acknowledged they were useful in some ways. Regarding their usefulness, they indicated that they both help one to cope with a difficult situation, they are energisers, they stimulate one’s mind, they are curative, relieve stress and cause one to become brave. Coincidentally, the positive effects of alcohol and cannabis that were identified by the students were similar to the reasons that motivated them to use the latter (see question 3). The negative effects are categorised into physiological (general deterioration of health), behavioural (aggressive behaviour) and social (loss of status, family and friends). Under physiological, subjects mentioned that alcohol damages the brain, liver, and kidney; it destroys the immune system, smells bad, and depresses brain activities. The physiological effects of cannabis that were mentioned were coma, stomach aches, lung damage, impaired vision, throat cancer, hallucination, and that it makes people thin.

The negative behavioural effects caused by alcohol and cannabis were captured in the following responses:

"I once saw my uncle smoking cannabis and his behaviour afterwards was very terrible. After smoking, he would beat his wife, his behaviour changed completely."

"My neighbours were drinking beer and then could fight each other all the night long."

"My friends were doing silly things after smoking cannabis, e.g. not knowing how to talk to elderly people."

The negative social effects were captured in the following responses:

"I started drinking alcohol when I was still young and even now I am still drinking it. During the olden days I could even go to the extent of selling my father’s property in order to have money to buy alcohol."

"Loss of respect, family, friends, money and everything."

  1. Can people be addicted to alcohol and cannabis?
    Generally, participants indicated that alcohol and cannabis are addictive. However, a few felt cannabis was not addictive. The following are a sample of the expressions that were captured:

 "Some of my friends would buy alcohol instead of food because they cannot do without it. There is a certain guy whom I know, before going to school, he should take one can of beer otherwise his hands will shiver, he won’t be able to handle a chalk."

"If you drink today, tomorrow you have to drink again to remove the hangover. This leads to continuous drinking which might lead to addiction."

"Cannabis is a daily bread to my cousin. At first the policemen used to arrest him for using it. Nowadays they no longer arrest him because they have realised that he cannot do otherwise. He is a slave of cannabis."

"People who take cannabis because they do not have confidence in themselves, end up being addicts because every time when they are confronted with a situation which needs their confidence they would have to take cannabis."

  1. Are there any traditional beliefs relating to alcohol and cannabis?
    Participants indicated that traditionally cannabis and alcohol are useful in variety of ways. Firstly, both are used during cultural activities such as rituals and initiation ceremonies. Secondly, cannabis is a remedy for many diseases while alcohol is used as an ingredient in a range of traditional medicines. The following responses were captured:

"After a child is born its hair shouldn’t be cut until a particular duration of time has elapsed.

Before the child’s hair is cut it is smeared on with home-brewed liquor and afterwards they cut it."

"We used to perform ancestral worship at home. We would go under the tree that has been chosen to represent the home of ancestors. My mother would pour liquor on the ground under that tree, afterwards we go into the house and drink the remaining alcohol."

"To perform the rituals. When praying to them we use alcohol especially the home-brewed one we prepare liquor saying that the ancestors are thirsty."

"I knew alcohol for the first time when there was an initiation ceremony within our village. This kind of ceremony is made for the people who have graduated from the initiation school. Elderly people would brew the traditional beer to give the occasion the dignity it deserves.

"My grandmother is a traditional dancer of ancestors, she smokes cannabis before dancing."

  1. Could cannabis and alcohol taking during rituals lead someone to later abuse cannabis/alcohol?
    No consensus was reached on this question. However, the majority of the participants felt that people couldn’t become addicted to cannabis and alcohol as a result of rituals because rituals are performed occasionally (about once a year). During such occasions, people are expected to take a sip of home-brewed liquor. Some participants (though few) felt that a person can be addicted to cannabis and alcohol because of the recurrence of family problems which requires frequent ancestral worship and moreover, it is a custom that relatives should attend ancestral worship. It is possible that a person may be invited to attend the ancestral worship fortnightly. Furthermore, initiation rituals can also lead to alcohol abuse as the following quote suggests:

"People who come from the initiation school have to drink liquor whether they like it or not.  In every family where there is someone who is graduating from the initiation school a party is made. All the people who participated in the traditional school have to attend the party in each and every family where there was a participant. Those participants have to drink liquor in those families whether they like it or not. They drink all night long. Most people go to the initiation school without taking any liquor. But when they come from the initiation school they start taking it. They usually say it is because they are fully-fledged men."

Discussion
Nature and extent of substance use
This study found a similar past month prevalence rate for alcohol use (57% in male and 26% in female students) as was found among secondary school pupils in Cape Town (50,2% for male and 31,9% for females).6 With regard to past month smoking of cigarettes, the Cape Town sample was much higher, with 42,1% for males and 31,5% for females as compared to 26% for males and 0% for females in this sample. This sample was similarly lower also in regard to past-month use of cannabis and glue than the Cape Town sample, and still much lower than British University students.7 Chambwe, et al. 8 found among second year Zimbabwe University students an abstinence from alcohol use of 23% for males and 46% for females, which is similar to this sample (with 21% among males and different to 74% among females).

Circumstances of substance use 
The age of first use of substances (for cigarettes and glue less than that for alcohol and cannabis) in this study is in line with other studies.2,6 Similarly to this study, Verbeke and Corin9 found that Zairian university students identified as the type of people who use cannabis as idle youth, musicians, elderly, delinquents, athletes and persons of lower class. They also indicated that primary reasons for use of cannabis were to suppress fear, acquire energy, forget worries, overcome shyness and get courage. It was also used for its intrinsic value, i.e. to gain a state of euphoria.

Cultural and contectual factors
From the results shown, alcohol and cannabis have a broader range of uses than in many industrialised countries. The impression of some students in our focus groups is that cannabis and, to some extent, alcohol are functional drugs, rather than purely recreational drugs. For instance, people commonly use cannabis in order to help them work harder, or better. As such, it is seen as a means of combating tiredness and distractibility, and as a means of giving strength. These perceptions of the functional and occupationally positive role of cannabis are not widely reported in Western literature. The perceived medicinal properties of cannabis also constitute an important functional role. This study suggests that both the occupational and medicinal functions of cannabis are rooted in traditional cultural beliefs. In addition to this, the use of alcohol in ceremonies of initiation, cannabis to ward off evil spirits, or to help people express themselves through traditional dancing, also reflects inherited cultural values in southern Africa 3 It is suggested that the combination of traditional cultural practices and the increasingly pervasive ethos of 'modernity' and 'Westernisation', may be need further investigation as a contributing factor in the increase in drug misuse.

References 

  1. Parry CDH, Bennetts AL. Alcohol and public health in South Africa. Cape Town: Oxford University Press Southern Africa, 1998.
  2. Rocha-Silva L, de Miranda S, Erasmus R. Alcohol, tobacco and other drug use among South African Youth. Pretoria: Human Sciences Research Council, 1996.
  3. Ali S, Nyirenda T, MacLachlan M. The influence of traditional beliefs and practices on contemporary chamba (marijuana) use in Malawi. J Psychol Africa 1998; 8: 70-83.
  4. Gumede MV. Alcohol use and abuse in South Africa: a socio-medical problem. Pietermaritzburg: Reach Out Publishers, 1995.
  5. Smart RG, et al. A methodology for student drug-use survey. Geneva: WHO (Publication No 50), 1980.
  6. Flisher A, Parry C, Evans J, Lombard C, Mueller M. Prevalence rates of alcohol, tobacco, and other drug (ATOD) use among Cape Town students in grades 8 and 11. Paper presented at the 4th Annual Congress of the Psychological Society of South Africa, Cape Town, 11 September 1998.
  7. Webb E, Ashton H, Kelly P, Kamali F. Patterns of alcohol consumption , smoking, and illicit drug use in British university students: interfaculty comparisons. Drug and Alcohol Dependence 1997; 47: 145-153.
  8. Chambwe A, Slade PD, Dewey ME. Behavioural patterns of alcohol use among young adults in Britain and Zimbabwe. Br J Addiction 1983; 78: 311-316.
  9. Verbeke R, Corin E. The use of Indian Hemp in Zaire: a formulation of hypotheses on the basis of an inquiry using a written questionnaire. Br J Addiction 1976; 71: 167-174

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