use among South African university students: a quantitative
and qualitative study
Peltzer1 and Nancy Phaswana2
of Psychology, University of the North
2Department of Social Work, University of
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.
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.
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 friends 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.
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.
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).
1: Lifetime prevalence rates for University of the North students
2: 1-month (past month) prevalence rates (N=90)
3 indicates the frequency of the age of first use by gender
for the various substances
3: Age of first use of substance
of first use
(or less) - 16
(or less) - 16
(or less) - 16
(or less) - 16
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.
Focus group results
focus group results are reported under the headings of the questions
that were asked.
did you first find out about alcohol and cannabis?
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.
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.
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.
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).
- 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
- 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.
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".
to serve my mothers 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 mothers beer
without her knowledge. I used the money to buy beer which
is stronger than the home-brewed beer."
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 ones 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
"I once saw my uncle
smoking cannabis and his behaviour afterwards was very terrible.
After smoking, he would beat his wife, his behaviour changed
"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 fathers property in order to have money to buy alcohol."
"Loss of respect, family,
friends, money and everything."
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 wont 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
"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."
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:
a child is born its hair shouldnt be cut until a particular
duration of time has elapsed.
Before the childs 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
"My grandmother is a
traditional dancer of ancestors, she smokes cannabis before
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 couldnt 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."
and extent of substance use
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).
of substance use
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.
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.
CDH, Bennetts AL. Alcohol and public health in South Africa.
Cape Town: Oxford University Press Southern Africa, 1998.
L, de Miranda S, Erasmus R. Alcohol, tobacco and other
drug use among South African Youth. Pretoria: Human Sciences
Research Council, 1996.
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.
MV. Alcohol use and abuse in South Africa: a socio-medical
problem. Pietermaritzburg: Reach Out Publishers, 1995.
RG, et al. A methodology for student drug-use survey.
Geneva: WHO (Publication No 50), 1980.
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.
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.
A, Slade PD, Dewey ME. Behavioural patterns of alcohol use
among young adults in Britain and Zimbabwe. Br J Addiction
1983; 78: 311-316.
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