1. Introduction

1.1 Background to the study

Drug abuse is the overuse, misuse, or addiction to drugs for purposes other than those prescribed by a physician [1]. Any substance that is used to treat or prevent disease in humans or animals is considered a drug [2]. Drug use affects how the body operates, either favorably or unfavorably, depending on the user's body type, the drug's type, dosage, and whether it is used alone or in conjunction with other drugs [3]. Drug abuse as excessive and persistent self-administration of a drug without regard to the medically or culturally accepted patterns [4]. It could also be viewed as the use of a drug to the extent that it interferes with the health and social function of an individual [5]. Addiction to drugs like heroin, morphine, and prescription painkillers is a severe global issue that has an impact on the social, economic, and physical well-being of all countries [6]. There are an estimated 26.4 million to 36 million drug users globally [7], with an estimated 2.1 million having substance use disorders linked to the prescription of painkillers in 2012 and an estimated 467,000 being heroin addicts [8]. The negative effects of this usage have been severe and are getting worse [9]. For instance, since 1999, there have been more than four times as many unintentional overdose deaths in the United States from prescription painkillers [10]. Globally, men abuse drugs at a higher rate than women [7]. Overall, men are more likely than women to use marijuana, cocaine, and opiates, although non-medical use of opioids and tranquilizers is equally common among men and women [7]. Considering some countries in the African continent such as Kenya, 5.4% of enrolled girls and 11.7% of enrolled boys take drugs [11]. Between 2010 and 2014, 367 substance addiction patients were hospitalized to a university teaching hospital in Nigeria from a cross-sectional research [12]. Those under the age of 31 tended to misuse alcohol, whereas those between the ages of 15 and 30 abused cannabis and amphetamine more frequently than alcohol [5]. According to recent findings in Ghana, out of 50,000 drug users, 35,000 are students in junior/senior high schools and higher education institutions between the ages of 12 and 35. The remaining 15,000 were adults, with 6,000 women and 9,000 men [13]. One of the main factors contributing to mental illness among Ghana's youth and adults is marijuana use [9], with some users finding themselves in psychiatric facilities while others end themselves on the streets or in prayer camps [14]. According to a non-governmental organization called Vision for Alternative Development (VALD), 12.8% of students between the ages of 13 and 15 who participated in Ghana's Junior High Schools' Global Youth Tobacco Survey in 2009 smoked any tobacco product [15]. Cannabis is the least expensive and also the most often misused narcotic in Ghana, according to a VALD study [7]. Herbs, leaves, and other plant materials have been used to treat and prevent disease since ancient times [11]. Medications when used properly will be beneficial and does not themselves pose any risk [16]. Adolescents' physical and psychological development can suffer substantial, and perhaps irreparable consequences from chronic substance use [5]. Drug use may be advantageous or detrimental depending on the method of consumption [2]. A material is considered a drug if its chemical effects have the potential to alter biological function, physiological and psychological process in an individual [6]. It is also regarded as a drug that alters bodily processes like perception, cognition, mood and behaviour [14]. So, they may be viewed as chemical modifications of living tissues that could result in alterations to behaviour and physiological processes [7]. Drug misuse is a significant global public health issue [1]. One of the most alarming health-related trends in Nigeria and other areas of the world is the use and misuse of drugs by teenagers in schools or students [4]. Several teenagers in schools or students who are in school participate in mental health programs, either temporarily or for an extended period of time. Some develop mental illnesses, have trouble adjusting to the environment at school, and eventually quit [2]. Teenagers in schools or students desire to live independently and without adult supervision, which leads them to commit a variety of criminal offenses (such as drug addiction, rape, robbery, cultism, and vandalism) that are harmful to their families, communities, schools, and the country as a whole [13]. Adolescent drug abuse has been associated with moral decay, violence, assault, psychosis, and even murder [16]. Hence the need to conduct a study to assess the prevalence of drug abuse and its associated challenges among teenagers in schools or students of Tamale metropolis and Sagnarigu Municipality in the northern region of Ghana become appropriate following recent documentation and report of it usage in the region.

2. Methods

2.1 Research Design

The abuse of drug among students in the second cycle schools is determined through a cross-sectional survey. This design facilitates data collection from a large number of participants at a specific time point.

The cross-sectional survey design is appropriate for this investigation because it permits the examination of the prevalence, causes, effects and help seeking behaviours among students. The design aides in identifying potential risk factors and support areas for drug abuse challenges, by collecting data from students with varying levels of experience and responsibilities. In general, a cross-sectional survey design is an effective and efficient method for attaining this research study’s objective.

2.2 Study setting

The research was conducted among students in the second cycle school/ senior high schools in the northern region of Ghana. One of Ghana's sixteen administrative regions, the Northern Region is distinguished by its diverse cultural heritage and blend of pastoral and urban areas. The northern region is a viewed as a among the fastest development region with the attended negative implication including substance abuse. By conducting the study at these schools, the results can be extrapolated to other schools in the region.

2.3 Study population

The research targeted Senior High School students in the Northern region of Ghana. The target population included both male and female students. The inclusion criteria in the research was students in Senior High Schools under the Tamale metropolis and Sagnarigu Municipality, both male and female, ability to read and understand properly and of sound mind while the exclusion criteria was persons who are not students or students who are not in Senior High Schools under the Tamale metropolis and Sagnarigu Municipal and people who cannot read and understand.

2.4 Target population

The research was conducted in 10 selected schools in the Tamale metropolis and Sagnarigu Municipality. The respondents of the research constituted both male and female students. One-hundred (100) respondents was randomly selected from each of the 10 Senior High Schools in the Metropolis and Municipality. A total of 1000 respondents was selected for the research. The 10 Senior High Schools, which include; Ghana senior school, Vittin senior high School, St Charles Minor Seminary/Senior High School, Dabokpa senior high/Technical school and Tamale Girls Senior high school in the Tamale metropolis and Tamale Senior High School, Northern School of Business Senior High School, Business Senior High School, Tamale Islamic Science Senior High School and Business College International Senior High School in the Sagnarigu Municipal.

2.5 Sample size and sample size determination

The sample size was determined using the formula for calculating the sample size for a cross-sectional survey design. Assuming a confidence level of 95% and a margin of error of 5%, the required sample size was determined.

The formula for calculating the sample size for a cross-sectional survey design is:

n = (Z^2 * p * (1 - p)) / E^2

Where:

n is the required sample size

Z is the z-score corresponding to the desired confidence level

p is the estimated proportion of the population with a particular characteristic

E is the desired margin of error

Given that the population size of the students in the schools was approximately 40000, the estimated proportion of the population (p) can be assumed to be 0.5 to ensure maximum variability, which provides a conservative estimate.

Using a confidence level of 95% and a margin of error of 5% (0.05), the corresponding z-score is approximately 1.96.

n = (1.96^2 * 0.5 * (1 - 0.5)) / (0.05^2)

n = (3.8416 * 0.25) / 0.0025

n = 0.9604 / 0.0025

n = 1000 students

Therefore, the calculated sample size is approximately 1000. Hence, a sample size of 1000 students was deemed appropriate for this study, considering a confidence level of 95% and a margin of error of 5%. This sample size provided a reasonable representation of the target population, allowing for accurate estimation and generalizability of the findings.

2.6 Sampling Techniques

Selection of the schools was based on Senior High Schools that are within the Tamale Metropolis and Sagnarigu Municipal. The top 10 Senior High Schools based on population across the metropolis and Municipality was selected for the research. Student’s selection was done across all departments of each school. A minimum of 20 students was randomly selected from each department until the required number of respondents (100) for each school was reached to respond to the questionnaire to avoid biasness. Respondents were selected using simple random sampling technique in each school. Simple random sampling technique is when every member of the population has an equal chance of being selected. This method of sampling was adopted in order to avoid biasness. Every student of the 10 schools who was available on the day and time of conducting the research was given equal opportunity as long as the targeted number of respondents was not exceeded.

2.7 Sources of Data

The researchers devised a structured questionnaire to assess the level of substance abuse among students in the senior high schools in northern Ghana. Participants were administered the questionnaire in person. Relevant literature on drug abuse stress among students (both published and unpublished) comprised secondary sources of information.

2.8 Data Collection Instrument

The research was conducted through survey and data collected through using a well-structured questionnaire. The questionnaire consisted of 5 parts which include: Demographic Information, Prevalence of Teenage Drug Abuse, Causes of Teenage Drug Abuse, Effects of Teenage Drug Abuse and Seeking Help and Prevention.

2.9 Data Collection Procedure

Participants were administered the structured questionnaire in person. During the data collection process, the participants were informed of the purpose and importance of the study, and their participation was solicited voluntarily. This ensured that participants were aware of the study's goals and were able to make an informed decision regarding their participation.

It was essential that the questionnaire be administered during school working hours at a convenient location within the selected schools to ensure maximal participation and convenience for the students. Collecting data during school working hours caused minimal disruption to the participants' routines and allowed them to complete the questionnaire within their allotted school work schedule. This method increased response rates and decreased the likelihood of non-response bias. By administering the questionnaire in person, the researchers were able to address any questions or concerns the participants may have had, ensuring the accuracy and totality of the data collected.

Moreover, executing the data collection procedure in person enabled a personal connection between the researchers and the participants, which could foster a sense of trust and encourage truthful responses.

2.10 Data Analysis Process

The data collected was subjected to preliminary analysis using Statistical Package for the Social Sciences (SPSS) software version 27. After the data was collected, it was edited to improve its quality for coding. The analysis of the data was done through descriptive statistics which helped the researchers to tabulate data and present it in graphic format. The findings were presented as frequencies and percentages.

2.11 Reliability and Validity of Data

The reliability and validity of the data was ensured by conducting a pre-test of the structured questionnaire on a small sample of students in a similar school within northern region. The pre-test assessed the clarity, comprehensiveness, and consistency of the questionnaire.

2.12 Ethical Consideration

The proposed study followed ethical guidelines and obtain ethical clearance from the Institutional Review Board of the University for Development Studies. Informed consent was obtained from all participants/their guidance and counselling tutor, and confidentiality and anonymity was ensured by using unique identification codes instead of names. Participants were informed about their right to withdraw from the study at any time without penalty.

3. Results

The present study conducted an analysis on the prevalence of drug abuse among students in second cycle schools in northern region of Ghana. Results are presented below;

The Demographic Features of the Respondents, the results in figure 1 provide an overview of the demographic characteristics of the students participating in the study.

Demographic characteristic of respondents

Figure 1: Gender Distribution of Respondents

(Source: Field Data, 2023)

Table 1: Age Distribution of Respondents

(Source: Field Data, 2023)

Figure 2: Religion of Respondents

(Source: Field Data, 2023)

Figure 3: Class of Respondents

(Source: Field Data, 2023)

Prevalence of Teenage Drug Abuse

Table 2: Response on Abusing Drugs

(Source: Field Data, 2023)

Figure 4: Types of Abused Drugs

(Source: Field Data, 2023)

Table 4: Sources of Abused Drugs

(Source: Field Data, 2023)

Factors contributing to drug abuse/Causes of Teenage Drug Abuse

Table 5: Factors That Causes Teenage Drug Abuse

(Source: Field Data, 2023)

Table 6: Factors That Motivate Teenagers in schools or students into Drug Abuse

(Source: Field Data, 2023)

Effects of Teenage Drug Abuse

Table 7: General Effects of Teenage Drug Abuse

(Source: Field Data, 2023)

Table 8: Personal Experience on Effects of Teenage Drug Abuse

(Source: Field Data, 2023)

Table 9: Response on Long Term Effects

(Source: Field Data, 2023)

Seeking Help and Prevention

Table 10: Respondents Awareness on Support Systems

(Source: Field Data, 2023)

Table 11: Respondents Willingness to Seek for Help

(Source: Field Data, 2023)

Table 12: Response on Education Received on Drug Abuse

(Source: Field Data, 2023)

4. Discussion

The issue of drug abuse among teenagers in schools or students has been a growing concern for societies around the world. Recent research findings shed light on the prevalence and patterns of drug abuse among adolescents. This discussion aims to analyse the findings of a study that questioned respondents about their drug abuse experiences and patterns, as well as to relate these findings to recent articles addressing teenage drug abuse.

4.1 Demographic Features of the Respondents

Ten senior high schools within northern region were chosen for the research, which include; Ghana senior school, Vittin senior high School, St Charles Minor Seminary/Senior High School, Dabokpa senior high/Technical school and Tamale girls Senior high school in the Tamale metropolis and Tamale Senior High School, Northern School of Business Senior High School, Business Senior High School, Tamale Islamic Science Senior High School and Business College International Senior High School in the Sagnarigu Municipal. One-hundred (100) respondents were selected from each school. A total of 1000 respondents across all levels took part in the research. Out of the total 1000 respondents that took part in the research, 650 (65%) were male while 350 (35%) were female. The respondents were Muslims dominated with 822 (82.2%) Muslims and 178 (17.8%) Christians. Majority 750 (75%) of the respondents were between the ages of 16-19 years, 200 (20%) were between 12-15 years while only 50 (5%) were 20 years and above. A total of 450 (45%) of the respondents were first year students, 350 (35%) were second year students and 200 (20%) were final/third year students.

4.2 Prevalence of Teenage Drug Abuse

Respondents were questioned on the prevalence of drug abuse. They were questioned as to whether they have ever abused drugs/alcohol before. Out of 1000 respondents, 584 (58.4%) agreed to have used or abused drugs before while, 416 (41.6%) of them responded not to have ever used/abused drugs before. Considering the 584 respondents who agreed to have abused drugs before, 70 (12%) did so between the ages of 12-14 years, 350 (60%) were between 15-17 years and 164 (28%) were 18 years and above. Moreover, 280 (48%) of the respondents who have abused drugs before did so with shisha, 140 (24%) abused tramadol, 70 (12%) abused alcohol, 48 (8.2%) were abusing marijuana while 22 (3.8%) respondents each abused cocaine and cigarette respectively. Furthermore, the source of the drugs abused were further questioned and 466 (79.8%) of the respondents obtained the abused drugs from friends, 48 (8.2%) obtained them from dealers and 70 (12%) stole them from people possessing them.

The findings of the research indicate that majority 58.4% of the respondents were into drugs or abusing drugs while 41.6% were not. The prevalence of alcohol and marijuana use were relatively low compared to those found among Nigerian adolescent (17) and South Africa youth (11) but similar to those found among Ghanaian teenagers in schools or among students (11). However, the rate of abuse of shisha in this research was similar to that of the youth in Central and Greater Accra regions of Ghana, where it was the most abused drug among the youth. (18)

4.3 Causes of Teenage Drug Abuse

A lot of factors drag teenagers in schools or students into drug abuse ranging from peers group influence, curiosity, boredom, accessibility to drugs, media influence, stress, anxiety, mental health issues among others. Respondents were asked on factors that they believed have contributed to teenage drug abuse, 482 (48.2%) of them believed it is due to lack of parental involvement against drug abuse with their ward, 116 (11.6%) believed it is lack of discipline, 220 (22%) believed it is due to media influence, 66 (6.6%) said it is due to their accessibility to those drugs, 100 (10%) believed it is due to social pressure and 16 (1.6%) associated it with mental health issues. Considering respondents who were engaged in drug abuse, 312 (53.4%) of them were introduced to it by their peers/friends, 227 (38.9%) were into it as a result of being curious, 25 (4.3%) were due to stress or anxiety while 20 (3.4%) were due to boredom.

Regarding causes of drug abuse our study found the following; lack of parental involvement in the fight against teenage drug abuse have been the major cause of it. Media influence has also been another key cause of drug abuse since most teenagers in schools or students see people do it on the media and they tend to practice it. Social pressure such as peer pressure has also contributed to the increase of teenage drug abuse. [19] reported that Peer influence is the main causes of drug abuse among the youth in Kenya which agrees with this research’s findings. Furthermore, (14) conducted a research in the Ankaful Psychiatric hospital in Cape Coast in the central region of Ghana where most of the student/clients associated the cause of their involvement in drug abuse to peers similarly to our findings.

4.4 Effects of Teenage Drug Abuse

Drugs abuse generally have several effects on human life and development. A lot of teenagers in schools or students who engages in drug abuse suffers several effects such as physical health problems, mental health problems, poor academic performance, legal problems etc. on their lives and the society. The general effects of drug abuse include physical health problems which 318 (31.8%) of respondents believed abusers would experience, 484 (48.4%) respondents believed they would suffer from mental health problems, 32 (3.2%) believed it has legal effects and 166 (16.6%) believed it has family issues. Regarding respondents who engaged in drug abuse, they were asked on their personal experience on the effects of drug abuse, 292 (50%) of them believed it affects their academic performance, 58 (10%) of them agreed it causes relationship problems, 199 (34%) agreed it has health issues, 29 (5%) agreed it causes financial difficulties and only 6 (1%) of them agreed it has legal consequences. However, 884 (88.4%) of the respondents agreed that the abuse of drugs has long term effects on the lives of the abusers while 116 (11.6%) believed it did not to have any future or long term effects. The effects of drug abuse in this current study points to the fact that abusers mostly suffer from physical and mental health problems and also a decline in academic performance. According to [15] in Egypt, an association between tobacco use and education and also sex was found, which is not consistent with our findings. According to them, lower education level is a significant independent predictor for current smoking in older people, which is also consistent with other studies. According to [20], also revealed that drug users suffer from school- associated outcomes like low-class performance, low attendance, and also school dropout which firmly agrees with our findings.

Our findings also were similar to [1] who stated that despite the fact that health stock depreciates with age, the current study found that Ghanaian male adults have a higher probability to engage in smoking as they age. Our findings found it true because some of the teenagers in schools or students in the senior high school were engaged in smoking.

4.5 Seeking Help and Prevention

Resource centres such as the National Commission on Civic Education (NCCE), Narcotics Control Commission (NCC), both as government institutions/agencies are working towards drug abuse education and support for the young ones in Ghana. Also the Ghana Education Service Guidance and Counselling unit is playing a vital role in our school systems to support teenagers in schools or students with drug related challenges. These state institutions need to continue their effort towards supporting the youth in their development stages. Furthermore, in the civil society space, Total Life Enhancement Centre Ghana (TOLECGH), a psychology-focused institution advocating for mental health and the first private psychological service provider (premier psychology clinic) in the entire northern Ghana based in Tamale has been engaging students from basic to tertiary levels on the concepts of drug abuse and how to overcome it for effective development. TOLECGH operates in six thematic areas mental health advocacy, provision of psychological services, counselling services, emotional intelligence and management, capacity building/livelihood empowerment and mental health research. TOLECGH is a mental health and psychosocial support service (MHPSS) provider with special focus on youth and women. In the northern region of Ghana is Basic Needs Ghana a leading mental health organisation championing mental health in the Northern Region and the entire regions in Ghana and other Civil Societies Organisations (CSOs) are campaigning against drug abuse and are always ready to assist individuals especially teenager to disengage in it. This study found majority of the respondents 584 (58.4%) of respondents were aware of resource centres or support systems available for teenagers in schools or students struggling with drug abuse while 416 (41.6%) were not aware of such support systems. However, only 416 (41.6%) were willing to seek for help for drug abuse, 566 (56.6%) were not willing to seek for help and 18 (1.8%) were not sure of choice to make. It is important to note that these reasons for refusal to seek help could vary from person to person and may be influenced by a combination of personal, societal and systemic factors. These could range from stigma, denial, fear of the consequences, financial barriers, cultural and religious beliefs, lack of trust in the systems, low level of mental health literacy and limited access to mental health resources. it's essential to address these barriers systematically to reduce stigma, increase motivation to seek help to encourage individuals and their families to seek for the help they truely need for mental health and substance abused challenges choice. Respondents’ response on education they have received on drug abuse are as follows: 634 (63.4%) of the respondents got educated on drug abuse through school programs, 166 (16.6%) received their education from community programs, 116 (11.6%) received their education from radio programs while 84 (8.4%)) never had any education at all on n drug abuse. Organizations, agencies, and help centres play a crucial role in the fight against teenage drug abuse in Ghana by providing education, prevention, intervention, treatment, and support services. Counselling and rehabilitation centres can play a significant role in the fight against teenage drug abuse in Ghana by providing essential support, education, and interventions. Majority of the students suggested that parents can be more involved in the quest in preventing the abuse of drugs. Also, parents should expose to their wards the effects of drug abuse. These finding agrees with a report by [16], whose research focused was among the youth in Dansoman Community in the Greater Accra region of Ghana. Again, respondents supported education and information share among parents and children on the effects of drugs as a solution to drug abuse. Furthermore, students also agreed that to prevent drug abuse, students should always be engaged in extracurricular activities.

Stigma related to seeking mental health services in our environment could be the reason why even with high awareness of support services many of the teenagers in schools or students still do not want to seek for help regarding drug abuse.

5. Conclusion

From the study outcomes, the following conclusions can be drawn:

1. Taking drugs without a Doctors’ or Physician’s prescription constitutes drug abuse. Also, prescribed drugs that are being taken to overdose, establishes drug abuse.
2. A lot of teenagers in schools or students in the Tamale metropolis and Sagnarigu Municipal are into drug abuse especially with shisha and tramadol.
3. Negative peer influences mostly lead to drug abuse. Lack of adequate parental supervision and parental drugs usage could lead teenagers to also abuse the drugs.
4. Drug abusers can result in immoral behaviours such as stealing, bullying, and school-related outcomes such as poor performance, low attendance, and also dropout.
5. Finally, most teenager are aware of the resource centres or help centres to seek for assistance and counselling services against drug abuse. However, even though the awareness is high majority of them did not want to seek help. This could be due to the stigma associated with drug abuse and its mental health related challenges.

6. Recommendations

The following recommendations have been made for adaption and implementation following the findings of our study to relevant stakeholders in the youth Eco space.

1. The Ghana Education Service needs to complement education on drug abuse in the school curriculum. This will provide students with more insight in order to understand drug abuse, causes, effects, and solutions available.
2. Since negative peer influence and insufficient parental supervision leads to students' drug abuse, it is recommended that the National Commission for Civic Education (NCCE), other governmental agencies and CSOs engage on peer education among students to reduce the influence of negative peer pressure on students.
3. Parents should also be educated to intensify their monitoring and supervisory roles in the form of positive parenting.
4. Teachers and parents, should intensify their monitoring roles both in school and after school. This will help minimise the rate at which students' abuse drugs.
5. Ghana Education Service (GES) to build the capacity of school based counsellors to be well equipped to handle students with drug related challenges.
6. The GES to engage more Counselling professionals in the Senior High School to support student with drug abuse challenges.

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