research papers on drug abuse among youth

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• Int J Prev Med
• v.5(Suppl 2); 2014 Dec

A Review Study of Substance Abuse Status in High School Students, Isfahan, Iran

Mah monir nahvizadeh.

Provincial Health Center, Isfahan University of Medical Sciences, Isfahan, Iran

Shohreh Akhavan

1 Vice-chancellery for Research, Isfahan University of Medical Sciences, Isfahan, Iran

Leila Qaraat

Nahid geramian, ziba farajzadegan.

2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Kamal Heidari

3 Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

As the first experience of substance abuse often starts in adolescence, and studies have shown that drug use is mainly related to cigarette and alcohol consumption, an initial exploration of substance abuse prevalence, including cigarette and alcohol, seems to be the first step in preventing and controlling drug consumption. This study aimed to explore studies on drug use among high school students by investigating articles published in the past decade in Iran.

In this study, the databases inside the country were used to access articles related to substance abuse by students during 2001–2011, among which 7 articles on 14–19 years old high school students were studied.

The seven studied articles showed that the highest drug use prevalence pertained to cigarette and hookah, followed by alcohol, opium, ecstasy, hashish and heroin. Opium and heroin use in Kerman city were, respectively, about 4 and 5 times of their use in other studied cities.

Conclusions:

Drug use is relatively high in the adolescent and effective group of the society, which requires particular attention and prompt and immediate intervention.

INTRODUCTION

Substance abuse is a common phenomenon in the world and has invaded the human society as the most important social damage.[ 1 , 2 ] Substance abuse is a nonadaptive model of drug use, which results in adverse problems and consequences, and includes a set of cognitive, behavioral, and psychological symptoms.[ 3 ]

Iran also, due to its specific human and geographic features, has a relatively high degree of contamination.[ 4 ] The World Health Organization's report in 2005 shows that there are about 200 million opiate addicts in the world, reporting the highest prevalence in Iran and the most frequency in the 25–35 year-age group.[ 5 ] The onset of drug use is often rooted in adolescence, and studies show that substance abuse is often related to cigarette and alcohol consumption in adolescence.[ 6 ] Results of studies indicate that age, being male, high-risk behavirs, and the existence of a cigarette smoker in the family or among friends, the experience of substance abuse, inclination and positive thoughts about smoking have relationship with adolescent cigarette smoking.[ 7 ] Studies also confirm that the chance of becoming a cigarette smoker among males and females is almost equal (11.2%); however, the prevalence of regular alcohol consumption in males (22.4%) is slightly higher than in females (19.3%).[ 8 ]

Few studies have been conducted in Iran on adolescents’ patterns of substance abuse, producing various data on the prevalence and the type of consumed drugs, but there is currently no known specific pattern of substance abuse in this age group; therefore, this review study has studied drug consumption prevalence in the student population of the country by collecting various data.

This article is a narrative review focusing on studies conducted in Iran. In this research, all articles related to substance abuse and its patterns among high school students, which were conducted in Iran and published in domestic and international journals, were investigated. The articles were acquired from academic medical journals, research periodicals and the Scholar Google, Magiran, Irandoc, and Medlib. The search keywords included prevalence, substance abuse, Iranian student, and addiction.

This study explored articles in the past 10 years (2001–2011) about Iranian high school students. The full texts of the articles were often accessible in the scientific information database and magiran websites, but the full text of the article about Gilan Province was obtained after contacting the journal's office. Correspondence was made with the author of the article about Mahriz city to obtain the article as it was not published in the Toloee Behdasht journal.

These articles provide information about the consumed drug type, its prevalence in terms of the sex and age, and the experience of at-least-once consumption in the adolescent's life. Some articles had only pointed to drug consumption, which was also included in this research. Some had attended to substance abuse in general terms without distinguishing different kinds of drugs, and in some articles only psychoactive drug use, was mentioned.

The cases, in which the sample volume was not sufficient, or were not in the studied age groups, were excluded from the study. Due to different categorizations in these articles regarding the long-term prevalence of substance abuse or the experience of at-least-once consumption, in this study the shared aspect of these articles, that is, the experience of at-least-once use was adopted. Some articles had addressed the students’ predisposing factors for drug abuse, in addition to drug use prevalence, which were not included in this study for being scattered.

An initial search into the data bases yielded 11 articles, two of which were related to years before the study time frame (1997 and 1998). Furthermore, two articles were ignored, one because of its different age group (a lower age) and the other because it had addressed a particular district in Tehran with a small sample size. These results are based on 7 articles. All studies were about the 14–19 years old group, and only three studies had distinguished between the sexes. All 7 studies considered in this article were cross-sectional.

The prevalence of drug consumption in the studied cities

A study was conducted in 2003 on 500 students, from 142 high schools and vocational schools in Zahedan City, using a multi-stage cluster sampling method. In total, from the total of 259 females and 216 males who completed the questionnaire, the following results were obtained. 0.4% of the females and 2.3% of the males would usually smoke cigarette. The first experience of smoking was most often seen at the age of 14 (26.2%). The prevalence of other drugs was not studied in this research.[ 9 ] A study was conducted in 2009 on 610 students of Kerman's Male Pre-university Centers, in which the prevalence of each drug was reported, but the total consumption prevalence was not mentioned.[ 10 ]

A study in Gilan Province in 2004–2009 on 1927 high school students, including 46% females and 54% males, showed that the percentage of at-least-once use, including and excluding cigarette, was 23.7 and 12.8, respectively.[ 11 ]

A study in Karaj city in 2009–2010 on 447 high school students, including 239 females and 208 males, showed that 57% had at-least-once experience of drug use, including cigarette, of this number 56.1% were male and 43.9% were female.[ 12 ]

A study in Nazarabad city in 2007 on 400 3 rd year high school students, including 204 females and 196 males with the mean age of 17.3, showed that drug use prevalence, including and excluding cigarette, was 24.5% and 11.1%, respectively.[ 13 ] A study was performed in Lahijan city in 2004 on 2328 high school students, including 42.2% females and 57.8% males.[ 14 ] A descriptive study was conducted in 2008 on a 285-member sample of male high school students.[ 15 ]

The consumption prevalence for each drug type in different cities

A research on Kerman's Male Pre-university students yielded the following results. The consumption prevalence of hookah was 15.5%, sedatives (without medical prescription) 40.7%, alcohol 37.7%, cigarette 34.6%, strong analgesics 10.2%, nas 9.7%, opium 8.7%, hashish 6.7%, ecstasy 6.6%, and heroin 4.9%.

Consumption prevalence for each drug type in Gilan: The prevalence was 20% for cigarette, 10.5% for alcohol, 2.4% for opium, 1.2% for ecstasy, 2% for hashish, and 0.3% for heroin. In Karaj city, the consumption prevalence was 53% for hookah, 24.8% for cigarette, 13.6% for alcohol, 2% for ecstasy, 2% for opium, 1.1% for hashish, 0.4% for crystal, and 0.2% for heroin.

In Nazarabad City, the consumption prevalence was found to be 23.1% for cigarette, 2% for opium, 1% for amphetamines and ecstasy, 0.5% for heroin, 0.3% for hashish and cocaine. The male and female drug consumption was 69.7% and 36.2%, respectively, representing a significant statistical difference ( P < 0.05).

A study in Lahijan City showed that the consumption prevalence was 14.9% for cigarette, 2.4% for ecstasy, 4.1% for other drug types (with the highest rate of consumption for opium and hashish). In the Mahriz city of Yazd, the consumption prevalence among the male 3 rd year high school students in 2008 was reported 6.8% for alcohol and 3% for psychoactive substances [ Table 1 ].

The comparison of the prevalence of at-least-once drug use for each drug type in each studied region[ 9 , 10 , 11 , 12 , 13 , 14 , 15 ]

Drug consumption prevalence for each sex

A study in Zahedan also reported that at-least-once drug use prevalence was 1.6% and 8%, respectively, among females and males; and at-least-once cigarette smoking prevalence was 7.8% and 25.2%, respectively, for females with the mean age of 15.8 and males with the mean age of 16.

In Gilan, drug use, excluding cigarette, was reported 19.1% and 5.3%, respectively, for males and females, representing a significant statistical difference ( P < 0.05). Furthermore, cigarette and drug use prevalence was 31.3% and 14.8% in males and females, respectively, showing that this rate was significantly higher in males ( P < 0.05). Cigarette use prevalence was 25.9% and 3%, respectively, for male and female students. Alcohol consumption was 16.6% and 3.4% for males and females, respectively. Opium consumption was 3.3% and 1.5% among males and females, respectively, which was a significant statistical difference (…). Drug consumption, excluding cigarette, was 19.1% and 5.3%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.05). Ecstasy use prevalence was reported 3% and 1.1%, respectively, for males and females, pointing to a statistically significant difference ( P < 0.00081); 0.5% of males and 0.1% of females were heroin consumers, lacking any significant statistical difference ( P > 0.05). In Karaj city, drug consumption prevalence was studied for each sex and drug type [ Table 2 ].

The comparison of the prevalence of at-least-once drug consumption for each sex in each studied region

Drug consumption prevalence based on the age distribution in the studied populations

As the study conducted on students with the mean age of 16 in Zahedan showed that the highest incidence of the first experience of cigarette smoking belonged to the age of 14. A study in Kerman on students with the mean age of 17.9 about the age at the first experience yielded the following results for each drug type: 14 for cigarette, 14.6 for alcohol, 13.9 for hookah, 13.1 for sedatives, 15.3 for analgesics, 17 for ecstasy, 16.7 for hashish, 16.7 for heroin, 16.7 for opium, and 15.3 for naswar.

A study in Gilan indicated that drug and cigarette consumption had significantly increased in males aged 19 and above (88.9% of males aged 19 and above) ( P < 0.05). According to a study in Nazarabad, the highest drug use onset was at the age of 15–16. The students’ mean age in the Karaj study was 16.9.

Exploring the MFT performed in the USA on the 10 th graders showed that drug use had increased from 11% to 34% during 1992–1996. In 1998, 12.10% of the 8 th year and 12.5% of the 10 th graders and 25.611 th % had experienced illegal drug use in the previous month.[ 16 ] It was shown that hashish, followed by opium and alcohol, is the most commonly used illicit drug.[ 17 ] The immediate necessity of planning for reducing the consumption of these drugs among students, and consequently among university students, has become increasingly important.

Investigating addictive drugs prevalence among university students showed the prevalence in the following order: Hookah (74.5%), cigarette (67.5%), opium (6.1%), alcohol (13.5%), psychoactive pills (5.26%), hashish and heroin. Entertainment constitutes the tendency for drug consumption in most cases (47.4%).[ 18 ] Results of a meta-analysis showed that 7% of Iranian adolescents regularly smoke, and 27% had experienced smoking. The increased cigarette use prevalence among Iranian adolescents is a major public health concern.[ 19 ] Paying attention to healthy recreations for adolescents and the youth has become increasingly important and needs planning for discouraging drug use. The cross-sectional prevalence of drug use in 1997 among American 12–17 years old adolescents was reported 11.4%, which was close to drug use prevalence, excluding cigarette.[ 16 ]

Another study showed that 56% of male and 42% of female university students were drug users, which accords with the present research with regard to the higher number of the males.[ 20 ] Since, the addiction problem is an old problem in other countries, it might be better to use the solutions practiced by them to speed up our reaction in cases which adhere to our culture and customs.

At-least-once alcohol use prevalence among the 8 th year American students in 2005 and 2006 was 27% and 20%, respectively, increasing to 88% among the 12 th year students.[ 20 ] The history of hashish consumption among the 8 th , the 10 th , and the 12 th year students was 10%, 23%, and 36%, respectively, representing a remarkable difference with our country's students.[ 20 ] About 0.5% of the 8 th year and 10% of the 12 th year students consumed cocaine, and the consumption of amphetamines by the 12 th year students was 1.5%,[ 20 ] being almost close to the consumption rate of Iranian students. The open consumption of hashish is common in France by almost one-third of the population (nearly 30%), compared with the average rate of 19% in European countries; also the consumption of ecstasy and cocaine has increased over 2000–2005, although it is 4% but yet remarkable.[ 21 ]

A study on students’ knowledge of narcotics in Rafsanjan and Yazd cities showed that 5.6% of Yazdian and 10% of Rafsanjanian students had at least one addicted person in their families. Also, 2.23% of the Yazdian and 7% of the Rafsanjanian students held that narcotics could also be useful.[ 22 ] The important issue here is the existence of an addicted relative and his or her leadership role in this regard; therefore, this point suggests the further importance of the sensitivity of this age group with regard to their dependence on narcotics.

It is noteworthy that Kerman City, compared to other studied cities, has received higher rates of drug use, such that opium and heroin consumption in this city has been, respectively, almost 4 and 5 times that of other cities. These statistics also hold true clearly with regard to ecstasy and alcohol consumption, each being almost 3 times that of Karaj and Gilan. Hashish consumption in the pre-university stage in this city is also higher than in other cities, which might be related to easier drug access in Kerman.

In the cities, in which sex-distinct studies were conducted, drug consumption by males had been, with no exception, far higher than by the females, which is, almost 4 times except for hookah and then cigarette. Of course, it is not possible to judge firmly about drug use general prevalence as a result of the few studies in this field; however, the important point is the relatively high drug use among the adolescent and effective group of the society, which deserves particular attention for education and intervention in this group. It has been observed that adolescent and young crystal users, compared to nonusers, show clinical symptoms, have less control and affection in their families, with excitable, aggressive and anxious personalities, and low accountability;[ 23 ] on the other hand, behavioral problems and friend influence are among the strongest risk factors of drug consumption among adolescent consumers.

Nevertheless, it is not clear to what extent the adolescent can manage the effect of behavioral problems and peer group interaction for refusing invitations for drug consumption.[ 24 ] It has been stated that using software programs would assist in the prevention and increasing the youth's skills for reducing drug use.[ 25 ] It has been shown that adolescent inclination to and consumption of drugs decrease significantly in the 1 st year of educational intervention.[ 26 ] On the other hand, studies indicate that there is a relationship between the borderline personality disorder and the extent of drug abuse.[ 27 ]

Therefore, prevention programs for harm reduction, treatment and consultation as the main objective of the intervention structure should apply to consumers.[ 28 ] Also, emphasis should be laid upon the relationship between schools and parental care as important protective factors for adolescents’ health.[ 29 ] Adolescence is a growth period which is associated with a relatively high rate of drug use and its related disorders. Accordingly, recent progress in evaluating drug abuse among adolescents would continue for information sharing in the field of clinical and research services.[ 30 ] Therefore, attention to this group through coherent planning for damage prevention would still remain in priority.

CONCLUSIONS

Source of Support: Nil

Conflict of Interest: None declared.

• Open access
• Published: 13 November 2021

Risk and protective factors of drug abuse among adolescents: a systematic review

• Azmawati Mohammed Nawi 1 ,
• Rozmi Ismail 2 ,
• Fauziah Ibrahim 2 ,
• Mohd Rohaizat Hassan 1 ,
• Mohd Rizal Abdul Manaf 1 ,
• Noh Amit 3 ,
• Norhayati Ibrahim 3 &
• Nurul Shafini Shafurdin 2  

BMC Public Health volume  21 , Article number:  2088 ( 2021 ) Cite this article

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Drug abuse is detrimental, and excessive drug usage is a worldwide problem. Drug usage typically begins during adolescence. Factors for drug abuse include a variety of protective and risk factors. Hence, this systematic review aimed to determine the risk and protective factors of drug abuse among adolescents worldwide.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was adopted for the review which utilized three main journal databases, namely PubMed, EBSCOhost, and Web of Science. Tobacco addiction and alcohol abuse were excluded in this review. Retrieved citations were screened, and the data were extracted based on strict inclusion and exclusion criteria. Inclusion criteria include the article being full text, published from the year 2016 until 2020 and provided via open access resource or subscribed to by the institution. Quality assessment was done using Mixed Methods Appraisal Tools (MMAT) version 2018 to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis of the included studies was undertaken.

Out of 425 articles identified, 22 quantitative articles and one qualitative article were included in the final review. Both the risk and protective factors obtained were categorized into three main domains: individual, family, and community factors. The individual risk factors identified were traits of high impulsivity; rebelliousness; emotional regulation impairment, low religious, pain catastrophic, homework completeness, total screen time and alexithymia; the experience of maltreatment or a negative upbringing; having psychiatric disorders such as conduct problems and major depressive disorder; previous e-cigarette exposure; behavioral addiction; low-perceived risk; high-perceived drug accessibility; and high-attitude to use synthetic drugs. The familial risk factors were prenatal maternal smoking; poor maternal psychological control; low parental education; negligence; poor supervision; uncontrolled pocket money; and the presence of substance-using family members. One community risk factor reported was having peers who abuse drugs. The protective factors determined were individual traits of optimism; a high level of mindfulness; having social phobia; having strong beliefs against substance abuse; the desire to maintain one’s health; high paternal awareness of drug abuse; school connectedness; structured activity and having strong religious beliefs.

The outcomes of this review suggest a complex interaction between a multitude of factors influencing adolescent drug abuse. Therefore, successful adolescent drug abuse prevention programs will require extensive work at all levels of domains.

Peer Review reports

Introduction

Drug abuse is a global problem; 5.6% of the global population aged 15–64 years used drugs at least once during 2016 [ 1 ]. The usage of drugs among younger people has been shown to be higher than that among older people for most drugs. Drug abuse is also on the rise in many ASEAN (Association of Southeast Asian Nations) countries, especially among young males between 15 and 30 years of age. The increased burden due to drug abuse among adolescents and young adults was shown by the Global Burden of Disease (GBD) study in 2013 [ 2 ]. About 14% of the total health burden in young men is caused by alcohol and drug abuse. Younger people are also more likely to die from substance use disorders [ 3 ], and cannabis is the drug of choice among such users [ 4 ].

Adolescents are the group of people most prone to addiction [ 5 ]. The critical age of initiation of drug use begins during the adolescent period, and the maximum usage of drugs occurs among young people aged 18–25 years old [ 1 ]. During this period, adolescents have a strong inclination toward experimentation, curiosity, susceptibility to peer pressure, rebellion against authority, and poor self-worth, which makes such individuals vulnerable to drug abuse [ 2 ]. During adolescence, the basic development process generally involves changing relations between the individual and the multiple levels of the context within which the young person is accustomed. Variation in the substance and timing of these relations promotes diversity in adolescence and represents sources of risk or protective factors across this life period [ 6 ]. All these factors are crucial to helping young people develop their full potential and attain the best health in the transition to adulthood. Abusing drugs impairs the successful transition to adulthood by impairing the development of critical thinking and the learning of crucial cognitive skills [ 7 ]. Adolescents who abuse drugs are also reported to have higher rates of physical and mental illness and reduced overall health and well-being [ 8 ].

The absence of protective factors and the presence of risk factors predispose adolescents to drug abuse. Some of the risk factors are the presence of early mental and behavioral health problems, peer pressure, poorly equipped schools, poverty, poor parental supervision and relationships, a poor family structure, a lack of opportunities, isolation, gender, and accessibility to drugs [ 9 ]. The protective factors include high self-esteem, religiosity, grit, peer factors, self-control, parental monitoring, academic competence, anti-drug use policies, and strong neighborhood attachment [ 10 , 11 , 12 , 13 , 14 , 15 ].

The majority of previous systematic reviews done worldwide on drug usage focused on the mental, psychological, or social consequences of substance abuse [ 16 , 17 , 18 ], while some focused only on risk and protective factors for the non-medical use of prescription drugs among youths [ 19 ]. A few studies focused only on the risk factors of single drug usage among adolescents [ 20 ]. Therefore, the development of the current systematic review is based on the main research question: What is the current risk and protective factors among adolescent on the involvement with drug abuse? To the best of our knowledge, there is limited evidence from systematic reviews that explores the risk and protective factors among the adolescent population involved in drug abuse. Especially among developing countries, such as those in South East Asia, such research on the risk and protective factors for drug abuse is scarce. Furthermore, this review will shed light on the recent trends of risk and protective factors and provide insight into the main focus factors for prevention and control activities program. Additionally, this review will provide information on how these risk and protective factors change throughout various developmental stages. Therefore, the objective of this systematic review was to determine the risk and protective factors of drug abuse among adolescents worldwide. This paper thus fills in the gaps of previous studies and adds to the existing body of knowledge. In addition, this review may benefit certain parties in developing countries like Malaysia, where the national response to drugs is developing in terms of harm reduction, prison sentences, drug treatments, law enforcement responses, and civil society participation.

This systematic review was conducted using three databases, PubMed, EBSCOhost, and Web of Science, considering the easy access and wide coverage of reliable journals, focusing on the risk and protective factors of drug abuse among adolescents from 2016 until December 2020. The search was limited to the last 5 years to focus only on the most recent findings related to risk and protective factors. The search strategy employed was performed in accordance with the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) checklist.

A preliminary search was conducted to identify appropriate keywords and determine whether this review was feasible. Subsequently, the related keywords were searched using online thesauruses, online dictionaries, and online encyclopedias. These keywords were verified and validated by an academic professor at the National University of Malaysia. The keywords used as shown in Table  1 .

Selection criteria

The systematic review process for searching the articles was carried out via the steps shown in Fig.  1 . Firstly, screening was done to remove duplicate articles from the selected search engines. A total of 240 articles were removed in this stage. Titles and abstracts were screened based on the relevancy of the titles to the inclusion and exclusion criteria and the objectives. The inclusion criteria were full text original articles, open access articles or articles subscribed to by the institution, observation and intervention study design and English language articles. The exclusion criteria in this search were (a) case study articles, (b) systematic and narrative review paper articles, (c) non-adolescent-based analyses, (d) non-English articles, and (e) articles focusing on smoking (nicotine) and alcohol-related issues only. A total of 130 articles were excluded after title and abstract screening, leaving 55 articles to be assessed for eligibility. The full text of each article was obtained, and each full article was checked thoroughly to determine if it would fulfil the inclusion criteria and objectives of this study. Each of the authors compared their list of potentially relevant articles and discussed their selections until a final agreement was obtained. A total of 22 articles were accepted to be included in this review. Most of the excluded articles were excluded because the population was not of the target age range—i.e., featuring subjects with an age > 18 years, a cohort born in 1965–1975, or undergraduate college students; the subject matter was not related to the study objective—i.e., assessing the effects on premature mortality, violent behavior, psychiatric illness, individual traits, and personality; type of article such as narrative review and neuropsychiatry review; and because of our inability to obtain the full article—e.g., forthcoming work in 2021. One qualitative article was added to explain the domain related to risk and the protective factors among the adolescents.

PRISMA flow diagram showing the selection of studies on risk and protective factors for drug abuse among adolescents.2.2. Operational Definition

Drug-related substances in this context refer to narcotics, opioids, psychoactive substances, amphetamines, cannabis, ecstasy, heroin, cocaine, hallucinogens, depressants, and stimulants. Drugs of abuse can be either off-label drugs or drugs that are medically prescribed. The two most commonly abused substances not included in this review are nicotine (tobacco) and alcohol. Accordingly, e-cigarettes and nicotine vape were also not included. Further, “adolescence” in this study refers to members of the population aged between 10 to 18 years [ 21 ].

Data extraction tool

All researchers independently extracted information for each article into an Excel spreadsheet. The data were then customized based on their (a) number; (b) year; (c) author and country; (d) titles; (e) study design; (f) type of substance abuse; (g) results—risks and protective factors; and (h) conclusions. A second reviewer crossed-checked the articles assigned to them and provided comments in the table.

Quality assessment tool

By using the Mixed Method Assessment Tool (MMAT version 2018), all articles were critically appraised for their quality by two independent reviewers. This tool has been shown to be useful in systematic reviews encompassing different study designs [ 22 ]. Articles were only selected if both reviewers agreed upon the articles’ quality. Any disagreement between the assigned reviewers was managed by employing a third independent reviewer. All included studies received a rating of “yes” for the questions in the respective domains of the MMAT checklists. Therefore, none of the articles were removed from this review due to poor quality. The Cohen’s kappa (agreement) between the two reviewers was 0.77, indicating moderate agreement [ 23 ].

The initial search found 425 studies for review, but after removing duplicates and applying the criteria listed above, we narrowed the pool to 22 articles, all of which are quantitative in their study design. The studies include three prospective cohort studies [ 24 , 25 , 26 ], one community trial [ 27 ], one case-control study [ 28 ], and nine cross-sectional studies [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. After careful discussion, all reviewer panels agreed to add one qualitative study [ 46 ] to help provide reasoning for the quantitative results. The selected qualitative paper was chosen because it discussed almost all domains on the risk and protective factors found in this review.

A summary of all 23 articles is listed in Table  2 . A majority of the studies (13 articles) were from the United States of America (USA) [ 25 , 26 , 27 , 29 , 30 , 31 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], three studies were from the Asia region [ 32 , 33 , 38 ], four studies were from Europe [ 24 , 28 , 40 , 44 ], and one study was from Latin America [ 35 ], Africa [ 43 ] and Mediterranean [ 45 ]. The number of sample participants varied widely between the studies, ranging from 70 samples (minimum) to 700,178 samples (maximum), while the qualitative paper utilized a total of 100 interviewees. There were a wide range of drugs assessed in the quantitative articles, with marijuana being mentioned in 11 studies, cannabis in five studies, and opioid (six studies). There was also large heterogeneity in terms of the study design, type of drug abused, measurements of outcomes, and analysis techniques used. Therefore, the data were presented descriptively.

After thorough discussion and evaluation, all the findings (both risk and protective factors) from the review were categorized into three main domains: individual factors, family factors, and community factors. The conceptual framework is summarized in Fig.  2 .

Conceptual framework of risk and protective factors related to adolescent drug abuse

DOMAIN: individual factor

Risk factors.

Almost all the articles highlighted significant findings of individual risk factors for adolescent drug abuse. Therefore, our findings for this domain were further broken down into five more sub-domains consisting of personal/individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance history, comorbidity and an individual’s attitude and perception.

Personal/individual traits

Chuang et al. [ 29 ] found that adolescents with high impulsivity traits had a significant positive association with drug addiction. This study also showed that the impulsivity trait alone was an independent risk factor that increased the odds between two to four times for using any drug compared to the non-impulsive group. Another longitudinal study by Guttmannova et al. showed that rebellious traits are positively associated with marijuana drug abuse [ 27 ]. The authors argued that measures of rebelliousness are a good proxy for a youth’s propensity to engage in risky behavior. Nevertheless, Wilson et al. [ 37 ], in a study involving 112 youths undergoing detoxification treatment for opioid abuse, found that a majority of the affected respondents had difficulty in regulating their emotions. The authors found that those with emotional regulation impairment traits became opioid dependent at an earlier age. Apart from that, a case-control study among outpatient youths found that adolescents involved in cannabis abuse had significant alexithymia traits compared to the control population [ 28 ]. Those adolescents scored high in the dimension of Difficulty in Identifying Emotion (DIF), which is one of the key definitions of diagnosing alexithymia. Overall, the adjusted Odds Ratio for DIF in cannabis abuse was 1.11 (95% CI, 1.03–1.20).

Significant negative growth exposure

A history of maltreatment in the past was also shown to have a positive association with adolescent drug abuse. A study found that a history of physical abuse in the past is associated with adolescent drug abuse through a Path Analysis, despite evidence being limited to the female gender [ 25 ]. However, evidence from another study focusing at foster care concluded that any type of maltreatment might result in a prevalence as high as 85.7% for the lifetime use of cannabis and as high as 31.7% for the prevalence of cannabis use within the last 3-months [ 30 ]. The study also found significant latent variables that accounted for drug abuse outcomes, which were chronic physical maltreatment (factor loading of 0.858) and chronic psychological maltreatment (factor loading of 0.825), with an r 2 of 73.6 and 68.1%, respectively. Another study shed light on those living in child welfare service (CWS) [ 35 ]. It was observed through longitudinal measurements that proportions of marijuana usage increased from 9 to 18% after 36 months in CWS. Hence, there is evidence of the possibility of a negative upbringing at such shelters.

Personal psychiatric diagnosis

The robust studies conducted in the USA have deduced that adolescents diagnosed with a conduct problem (CP) have a positive association with marijuana abuse (OR = 1.75 [1.56, 1.96], p  < 0.0001). Furthermore, those with a diagnosis of Major Depressive Disorder (MDD) showed a significant positive association with marijuana abuse.

Previous substance and addiction history

Another study found that exposure to e-cigarettes within the past 30 days is related to an increase in the prevalence of marijuana use and prescription drug use by at least four times in the 8th and 10th grades and by at least three times in the 12th grade [ 34 ]. An association between other behavioral addictions and the development of drug abuse was also studied [ 29 ]. Using a 12-item index to assess potential addictive behaviors [ 39 ], significant associations between drug abuse and the groups with two behavioral addictions (OR = 3.19, 95% CI 1.25,9.77) and three behavioral addictions (OR = 3.46, 95% CI 1.25,9.58) were reported.

Comorbidity

The paper by Dash et al. (2020) highlight adolescent with a disease who needs routine medical pain treatment have higher risk of opioid misuse [ 38 ]. The adolescents who have disorder symptoms may have a risk for opioid misuse despite for the pain intensity.

Individual’s attitudes and perceptions

In a study conducted in three Latin America countries (Argentina, Chile, and Uruguay), it was shown that adolescents with low or no perceived risk of taking marijuana had a higher risk of abuse (OR = 8.22 times, 95% CI 7.56, 10.30) [ 35 ]. This finding is in line with another study that investigated 2002 adolescents and concluded that perceiving the drug as harmless was an independent risk factor that could prospectively predict future marijuana abuse [ 27 ]. Moreover, some youth interviewed perceived that they gained benefits from substance use [ 38 ]. The focus group discussion summarized that the youth felt positive personal motivation and could escape from a negative state by taking drugs. Apart from that, adolescents who had high-perceived availability of drugs in their neighborhoods were more likely to increase their usage of marijuana over time (OR = 11.00, 95% CI 9.11, 13.27) [ 35 ]. A cheap price of the substance and the availability of drug dealers around schools were factors for youth accessibility [ 38 ]. Perceived drug accessibility has also been linked with the authorities’ enforcement programs. The youth perception of a lax community enforcement of laws regarding drug use at all-time points predicted an increase in marijuana use in the subsequent assessment period [ 27 ]. Besides perception, a study examining the attitudes towards synthetic drugs based on 8076 probabilistic samples of Macau students found that the odds of the lifetime use of marijuana was almost three times higher among those with a strong attitude towards the use of synthetic drugs [ 32 ]. In addition, total screen time among the adolescent increase the likelihood of frequent cannabis use. Those who reported daily cannabis use have a mean of 12.56 h of total screen time, compared to a mean of 6.93 h among those who reported no cannabis use. Adolescent with more time on internet use, messaging, playing video games and watching TV/movies were significantly associated with more frequent cannabis use [ 44 ].

Protective factors

Individual traits.

Some individual traits have been determined to protect adolescents from developing drug abuse habits. A study by Marin et al. found that youth with an optimistic trait were less likely to become drug dependent [ 33 ]. In this study involving 1104 Iranian students, it was concluded that a higher optimism score (measured using the Children Attributional Style Questionnaire, CASQ) was a protective factor against illicit drug use (OR = 0.90, 95% CI: 0.85–0.95). Another study found that high levels of mindfulness, measured using the 25-item Child Acceptance and Mindfulness Measure, CAMM, lead to a slower progression toward injectable drug abuse among youth with opioid addiction (1.67 years, p  = .041) [ 37 ]. In addition, the social phobia trait was found to have a negative association with marijuana use (OR = 0.87, 95% CI 0.77–0.97), as suggested [ 31 ].

According to El Kazdouh et al., individuals with a strong belief against substance use and those with a strong desire to maintain their health were more likely to be protected from involvement in drug abuse [ 46 ].

DOMAIN: family factors

The biological factors underlying drug abuse in adolescents have been reported in several studies. Epigenetic studies are considered important, as they can provide a good outline of the potential pre-natal factors that can be targeted at an earlier stage. Expecting mothers who smoke tobacco and alcohol have an indirect link with adolescent substance abuse in later life [ 24 , 39 ]. Moreover, the dynamic relationship between parents and their children may have some profound effects on the child’s growth. Luk et al. examined the mediator effects between parenting style and substance abuse and found the maternal psychological control dimension to be a significant variable [ 26 ]. The mother’s psychological control was two times higher in influencing her children to be involved in substance abuse compared to the other dimension. Conversely, an indirect risk factor towards youth drug abuse was elaborated in a study in which low parental educational level predicted a greater risk of future drug abuse by reducing the youth’s perception of harm [ 27 , 43 ]. Negligence from a parental perspective could also contribute to this problem. According to El Kazdouh et al. [ 46 ], a lack of parental supervision, uncontrolled pocket money spending among children, and the presence of substance-using family members were the most common negligence factors.

While the maternal factors above were shown to be risk factors, the opposite effect was seen when the paternal figure equipped himself with sufficient knowledge. A study found that fathers with good information and awareness were more likely to protect their adolescent children from drug abuse [ 26 ]. El Kazdouh et al. noted that support and advice could be some of the protective factors in this area [ 46 ].

DOMAIN: community factors

• Risk factor

A study in 2017 showed a positive association between adolescent drug abuse and peers who abuse drugs [ 32 , 39 ]. It was estimated that the odds of becoming a lifetime marijuana user was significantly increased by a factor of 2.5 ( p  < 0.001) among peer groups who were taking synthetic drugs. This factor served as peer pressure for youth, who subconsciously had desire to be like the others [ 38 ]. The impact of availability and engagement in structured and unstructured activities also play a role in marijuana use. The findings from Spillane (2000) found that the availability of unstructured activities was associated with increased likelihood of marijuana use [ 42 ].

• Protective factor

Strong religious beliefs integrated into society serve as a crucial protective factor that can prevent adolescents from engaging in drug abuse [ 38 , 45 ]. In addition, the school connectedness and adult support also play a major contribution in the drug use [ 40 ].

The goal of this review was to identify and classify the risks and protective factors that lead adolescents to drug abuse across the three important domains of the individual, family, and community. No findings conflicted with each other, as each of them had their own arguments and justifications. The findings from our review showed that individual factors were the most commonly highlighted. These factors include individual traits, significant negative growth exposure, personal psychiatric diagnosis, previous substance and addiction history, and an individual’s attitude and perception as risk factors.

Within the individual factor domain, nine articles were found to contribute to the subdomain of personal/ individual traits [ 27 , 28 , 29 , 37 , 38 , 39 , 40 , 43 , 44 ]. Despite the heterogeneity of the study designs and the substances under investigation, all of the papers found statistically significant results for the possible risk factors of adolescent drug abuse. The traits of high impulsivity, rebelliousness, difficulty in regulating emotions, and alexithymia can be considered negative characteristic traits. These adolescents suffer from the inability to self-regulate their emotions, so they tend to externalize their behaviors as a way to avoid or suppress the negative feelings that they are experiencing [ 41 , 47 , 48 ]. On the other hand, engaging in such behaviors could plausibly provide a greater sense of positive emotions and make them feel good [ 49 ]. Apart from that, evidence from a neurophysiological point of view also suggests that the compulsive drive toward drug use is complemented by deficits in impulse control and decision making (impulsive trait) [ 50 ]. A person’s ability in self-control will seriously impaired with continuous drug use and will lead to the hallmark of addiction [ 51 ].

On the other hand, there are articles that reported some individual traits to be protective for adolescents from engaging in drug abuse. Youth with the optimistic trait, a high level of mindfulness, and social phobia were less likely to become drug dependent [ 31 , 33 , 37 ]. All of these articles used different psychometric instruments to classify each individual trait and were mutually exclusive. Therefore, each trait measured the chance of engaging in drug abuse on its own and did not reflect the chance at the end of the spectrum. These findings show that individual traits can be either protective or risk factors for the drugs used among adolescents. Therefore, any adolescent with negative personality traits should be monitored closely by providing health education, motivation, counselling, and emotional support since it can be concluded that negative personality traits are correlated with high risk behaviours such as drug abuse [ 52 ].

Our study also found that a history of maltreatment has a positive association with adolescent drug abuse. Those adolescents with episodes of maltreatment were considered to have negative growth exposure, as their childhoods were negatively affected by traumatic events. Some significant associations were found between maltreatment and adolescent drug abuse, although the former factor was limited to the female gender [ 25 , 30 , 36 ]. One possible reason for the contrasting results between genders is the different sample populations, which only covered child welfare centers [ 36 ] and foster care [ 30 ]. Regardless of the place, maltreatment can happen anywhere depending on the presence of the perpetrators. To date, evidence that concretely links maltreatment and substance abuse remains limited. However, a plausible explanation for this link could be the indirect effects of posttraumatic stress (i.e., a history of maltreatment) leading to substance use [ 53 , 54 ]. These findings highlight the importance of continuous monitoring and follow-ups with adolescents who have a history of maltreatment and who have ever attended a welfare center.

Addiction sometimes leads to another addiction, as described by the findings of several studies [ 29 , 34 ]. An initial study focused on the effects of e-cigarettes in the development of other substance abuse disorders, particularly those related to marijuana, alcohol, and commonly prescribed medications [ 34 ]. The authors found that the use of e-cigarettes can lead to more severe substance addiction [ 55 ], possibly through normalization of the behavior. On the other hand, Chuang et al.’s extensive study in 2017 analyzed the combined effects of either multiple addictions alone or a combination of multiple addictions together with the impulsivity trait [ 29 ]. The outcomes reported were intriguing and provide the opportunity for targeted intervention. The synergistic effects of impulsiveness and three other substance addictions (marijuana, tobacco, and alcohol) substantially increased the likelihood for drug abuse from 3.46 (95%CI 1.25, 9.58) to 10.13 (95% CI 3.95, 25.95). Therefore, proper rehabilitation is an important strategy to ensure that one addiction will not lead to another addiction.

The likelihood for drug abuse increases as the population perceives little or no harmful risks associated with the drugs. On the opposite side of the coin, a greater perceived risk remains a protective factor for marijuana abuse [ 56 ]. However, another study noted that a stronger determinant for adolescent drug abuse was the perceived availability of the drug [ 35 , 57 ]. Looking at the bigger picture, both perceptions corroborate each other and may inform drug use. Another study, on the other hand, reported that there was a decreasing trend of perceived drug risk in conjunction with the increasing usage of drugs [ 58 ]. As more people do drugs, youth may inevitably perceive those drugs as an acceptable norm without any harmful consequences [ 59 ].

In addition, the total spent for screen time also contribute to drug abuse among adolescent [ 43 ]. This scenario has been proven by many researchers on the effect of screen time on the mental health [ 60 ] that leads to the substance use among the adolescent due to the ubiquity of pro-substance use content on the internet. Adolescent with comorbidity who needs medical pain management by opioids also tend to misuse in future. A qualitative exploration on the perspectives among general practitioners concerning the risk of opioid misuse in people with pain, showed pain management by opioids is a default treatment and misuse is not a main problem for the them [ 61 ]. A careful decision on the use of opioids as a pain management should be consider among the adolescents and their understanding is needed.

Within the family factor domain, family structures were found to have both positive and negative associations with drug abuse among adolescents. As described in one study, paternal knowledge was consistently found to be a protective factor against substance abuse [ 26 ]. With sufficient knowledge, the father can serve as the guardian of his family to monitor and protect his children from negative influences [ 62 ]. The work by Luk et al. also reported a positive association of maternal psychological association towards drug abuse (IRR 2.41, p  < 0.05) [ 26 ]. The authors also observed the same effect of paternal psychological control, although it was statistically insignificant. This construct relates to parenting style, and the authors argued that parenting style might have a profound effect on the outcomes under study. While an earlier literature review [ 63 ] also reported such a relationship, a recent study showed a lesser impact [ 64 ] with regards to neglectful parenting styles leading to poorer substance abuse outcomes. Nevertheless, it was highlighted in another study that the adolescents’ perception of a neglectful parenting style increased their odds (OR 2.14, p  = 0.012) of developing alcohol abuse, not the parenting style itself [ 65 ]. Altogether, families play vital roles in adolescents’ risk for engaging in substance abuse [ 66 ]. Therefore, any intervention to impede the initiation of substance use or curb existing substance use among adolescents needs to include parents—especially improving parent–child communication and ensuring that parents monitor their children’s activities.

Finally, the community also contributes to drug abuse among adolescents. As shown by Li et al. [ 32 ] and El Kazdouh et al. [ 46 ], peers exert a certain influence on other teenagers by making them subconsciously want to fit into the group. Peer selection and peer socialization processes might explain why peer pressure serves as a risk factor for drug-abuse among adolescents [ 67 ]. Another study reported that strong religious beliefs integrated into society play a crucial role in preventing adolescents from engaging in drug abuse [ 46 ]. Most religions devalue any actions that can cause harmful health effects, such as substance abuse [ 68 ]. Hence, spiritual beliefs may help protect adolescents. This theme has been well established in many studies [ 60 , 69 , 70 , 71 , 72 ] and, therefore, could be implemented by religious societies as part of interventions to curb the issue of adolescent drug abuse. The connection with school and structured activity did reduce the risk as a study in USA found exposure to media anti-drug messages had an indirect negative effect on substances abuse through school-related activity and social activity [ 73 ]. The school activity should highlight on the importance of developmental perspective when designing and offering school-based prevention programs [75].

Limitations

We adopted a review approach that synthesized existing evidence on the risk and protective factors of adolescents engaging in drug abuse. Although this systematic review builds on the conclusion of a rigorous review of studies in different settings, there are some potential limitations to this work. We may have missed some other important factors, as we only included English articles, and article extraction was only done from the three search engines mentioned. Nonetheless, this review focused on worldwide drug abuse studies, rather than the broader context of substance abuse including alcohol and cigarettes, thereby making this paper more focused.

Conclusions

This review has addressed some recent knowledge related to the individual, familial, and community risk and preventive factors for adolescent drug use. We suggest that more attention should be given to individual factors since most findings were discussed in relation to such factors. With the increasing trend of drug abuse, it will be critical to focus research specifically on this area. Localized studies, especially those related to demographic factors, may be more effective in generating results that are specific to particular areas and thus may be more useful in generating and assessing local control and prevention efforts. Interventions using different theory-based psychotherapies and a recognition of the unique developmental milestones specific to adolescents are among examples that can be used. Relevant holistic approaches should be strengthened not only by relevant government agencies but also by the private sector and non-governmental organizations by promoting protective factors while reducing risk factors in programs involving adolescents from primary school up to adulthood to prevent and control drug abuse. Finally, legal legislation and enforcement against drug abuse should be engaged with regularly as part of our commitment to combat this public health burden.

Data availability and materials

All data generated or analysed during this study are included in this published article.

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The authors acknowledge The Ministry of Higher Education Malaysia and The Universiti Kebangsaan Malaysia, (UKM) for funding this study under the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). We also thank the team for their commitment and tireless efforts in ensuring that manuscript was well executed.

Financial support for this study was obtained from the Ministry of Higher Education, Malaysia through the Long-Term Research Grant Scheme-(LGRS/1/2019/UKM-UKM/2/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Nawi, A.M., Ismail, R., Ibrahim, F. et al. Risk and protective factors of drug abuse among adolescents: a systematic review. BMC Public Health 21 , 2088 (2021). https://doi.org/10.1186/s12889-021-11906-2

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A STUDY ON DRUG ABUSE AMONG YOUTHS AND FAMILY RELATIONSHIP << >> THE FINAL REPORT (FINAL version

We would like to thank Mr. Gary Ip, the research assistant of the Department of Social Work and Social Administration, Ms. Garlum Lau, the senior research officer married parents, boys whose either or both parents has passed away were more likely to be drug users (OR=4.633, CI=2.294, 9.355), whereas girls whose parents were divorced or separated were more likely to be drug users (OR=2.367, CI=1.178, 4.759). Parents' divorce, separation or passing away has a high influence on substance abuse among adolescents. Feeling happy about family life, good relationship with parents and acceptance to parenting are significant protective factors to substance abuse.

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Factors Influencing Youth Drug Abuse: A Review Study

Umi Omar Bunu 1 , Mikail Umar Isyaku 1 , Ibrahim Umar 2

Author(s) details

• Kampala International University, Uganda
• The Federal University Dutse, Dutse, Nigeria

Youth drug abuse appears to be influenced by various factors. Both traditional and contemporary addictive substances are abused by young individuals for multiple reasons. This review aims to assess the factors that contribute to youth drug abuse. The paper adopts a narrative approach to review studies. It draws information from published articles obtained through a general Google search and saturation of other articles using Google Scholar. A total of 18 published literature sources, containing information on the factors influencing youth drug abuse, were included in the study. The most prevalent influencing factors identified are peer influence and inadequate parental or guardian care. Therefore, it is recommended that research on the factors influencing youth drug abuse should undergo specific scientific scrutiny to address the unique challenges and develop appropriate solutions.

Umi Omar Bunu 1,* , Mikail Umar Isyaku 2 , Umar Ibrahim 3 1 Kampala International University Teaching Hospital, Western Campus, Ishaka, Uganda. 2 Human Anatomy Department, Faculty of Biomedical Sciences, Kampala International University, Western Campus, Ishaka, Uganda. 3 Public Health Department, School of Allied Health Sciences, Kampala International University, Western Campus, Ishaka, Uganda

* Corresponding Author: Umi Omar Bunu, Email: [email protected] ; Phone: 0751650808.

Keywords: Factors, Drug abuse, Influence, Peers, Youth.

1. Introduction

Drug abuse is widely recognized as a significant cause of morbidity and mortality among young individuals. Various factors have been identified as influencing non-medical drug use. This behavior is particularly prevalent in areas affected by natural disasters or armed conflicts, leading to displacement of populations (Horyniak, Melo, Farrell, Ojeda, & Strathdee, 2016; UNODC, 2014). Drug abuse is responsible for 5.9% of global fatalities and an estimated 5.1% of the global burden of illness and injury (Horyniak et al., 2016; WHO, 2014). According to the United Nations, in 2014, nearly one in every 20 individuals between the ages of 15 and 64 worldwide were confirmed drug users (WHO/UNODC, 2018). The negative health effects of drug abuse are well-documented, causing cognitive, behavioral, physiological, and psychological dysfunctions among addicted youth, among other issues (Muganga et al., 2017; Nguyen-Louie et al., 2015; WHO/UNODC, 2018).

Drug abuse has become a subject of academic and policy interest globally, as it has emerged as a significant public health concern with increasing morbidity, mortality, and prevalence over the past few decades (UNODC, 2022; Ventura, de Souza, Hayashida, & Ferreira, 2015). The projected global burden of disease categorizes drug abuse among the top three leading causes of death worldwide. Addressing the issue of drug abuse requires context-specific information on the underlying factors to develop effective interventions (Tsvetkova & Antonova, 2013; Turn Bridge, 2021; UNODC, 2022).

To better understand the factors influencing youth drug abuse, this review acknowledges that no single factor contradicts another, as each was assessed with sufficient scrutiny. Consequently, the review examines the factors that influence drug abuse among young individuals and offers recommendations for curtailing this problem. The findings will provide researchers, policymakers, and decision-makers with practical solutions for drug abuse prevention and control.

2. Methodology

This paper adopts a thematic approach to the narrative review. The initial literature search was conducted through a desk survey of academic, policy, and practice websites, following a purposeful selection process. A combination of general Google search and saturation of articles in Google Scholar was employed to ensure the retrieved literature encompassed a wide range of topics related to factors influencing youth drug abuse. Published literature from academia, civil society, and the private sector was included in the review to gain comprehensive insights into the various factors contributing to drug abuse among young individuals. Recognizing that drug abuse is a complex issue with multiple stakeholders across different settings, data collection for this review also involved retrieving relevant texts published outside the traditional academic literature. As a result, a systematic review protocol was not followed, but key actors' websites were used to identify pertinent scientific literature on factors influencing youth drug abuse.

The literature searches utilized various combinations of the following keywords: 'drugs', 'abuse', 'addiction', 'youth', 'framework', 'factors', 'adolescence', and 'teen'. The reference lists of the searched literature, relevant to the study, were further consulted for potential inclusion in the narrative presentation. While drug abuse is influenced by several interconnected factors, such as peer influence, this review specifically focuses on studies that examine influential factors of drug abuse among the youth. Additionally, given the political implications surrounding discussions on drug abuse, the review excluded works pertaining to politics within regional or local authority contexts.

3. Findings

A total of 18 relevant publications were identified for inclusion in this review. These publications provided explanations, definitions, and insights into factors associated with drug abuse, along with other related issues. From the perspective outside the drug abuse domain, the literature conceptualized the issue under various themes and sub-themes that categorically identified influential factors contributing to drug abuse. The following headings and sub-headings emerged from the literature search.

3.1. Factors Responsible for Youth Drug Abuse

No single factor solely influences drug abuse among young individuals. Multiple factors contribute to drug abuse, and youth are more likely to develop drug abuse habits if they are exposed to these factors. Drug abuse habits are developed for various reasons, including:

• Peer acceptance : Young individuals may use drugs in order to fit in or gain acceptance from their peers who engage in drug abuse.
• Emotional well-being : Drug abuse can provide pleasurable emotions and a sense of improvement in how one feels. Some young people may experience physical pain, depression, anxiety, and stress-related disorders, and they may turn to narcotics as a means of finding relief.
• Performance enhancement : Youth may abuse anabolic steroids to enhance their athletic or academic performance, or use stimulants for similar reasons.
• Curiosity and thrill-seeking : The desire to experiment with new experiences is common among young individuals, particularly activities perceived as exhilarating or daring (Medline Plus, 2019; Mohamed, Solehan, Mohd Rani, Ithnin, & Che Isahak, 2021; Sahu & Sahu, 2012).

3.1.1. Circumstances that Contribute to Youth Drug Abuse

Various circumstances can subject youth to drug abuse practices, including:

• Stressful early childhood events, such as child abuse, child sexual assault, and other traumas.
• Lack of parental supervision or monitoring.
• Genetic factors.
• Exposure to illicit drugs during pregnancy (placental exposure).
• Family history of drug abuse.
• Association with peers who engage in drug abuse (Medline Plus, 2019; Morojele Neo K, Dumbili, Obot, & Parry, 2021; Patel, Chisholm, Dua, Laxminarayan, & Medina-Mora, 2016).

3.2 Risk Factors for Drugs Abuse

Risk factors for drug abuse often coexist with various demographic attributes. Examples of risk factors include low socioeconomic status, early initiation of drug use, social circumstances, and societal tolerance of illicit drugs, among others. Specific risk factors include:

• Family factors : Parental and sibling drug abuse, as well as poor parent-child relationships and parental conflict, can contribute to youth engaging in drug abuse (Degenhardt et al., 2010; Muganga et al., 2017).
• Personal characteristics : The development of externalizing disorders during childhood, such as attention-deficit challenges or behavioral issues like sensation-seeking tendencies, as well as low education levels, can increase the risk of drug abuse (Degenhardt et al., 2010; Patel et al., 2016).
• Peer influence : Associating with peers who engage in drug abuse is one of the most significant risk factors for youth drug abuse, surpassing the influence of familial and individual factors in intensity (Potapchik & Popovich, 2014).
• Biology : Approximately half of an individual's risk for drug use is determined by inherited genes. Other risk factors for drug use and addiction may be influenced by gender, ethnicity, and the presence of other mental health disorders (NIDA, 2019).
• Environment : The environment in which a person lives can have various effects, including family and peer influences, financial stability, and overall quality of life. Environmental factors such as peer pressure, physical and sexual abuse, early drug exposure, stress, and parental supervision can significantly impact an individual's likelihood of engaging in drug abuse and developing an addiction (NIDA, 2019).
• Developmental factors : Critical stages of development interact with genetic factors to influence the risk of drug abuse. While drug use at any age can lead to abuse, individuals who are particularly vulnerable to risky drug abuse activities may experience altered developmental processes, as the parts of their brains that regulate decision-making, judgment, and self-control are still developing (NIDA, 2019).

3.2.1 Predisposing factors to Drugs Addiction

Certain individuals are more vulnerable to addiction than others due to specific events and environments that increase susceptibility to substance use. Preventing and delaying substance use for as long as possible can help decrease this susceptibility. Ensuring the safety of young individuals involves providing support from family members, implementing mental health programs, and teaching them effective coping mechanisms (Drug Free, 2022; Nguyen-Louie et al., 2015; Turn Bridge, 2021).

• Family history of addiction : It is important to inform young individuals if there is a history of addiction in the family. These discussions should begin early in their teenage years, approaching the topic in a similar manner as discussing the history of medical conditions such as asthma, diabetes, or other illnesses (Drug Free, 2022; Turn Bridge, 2021).
• Concerns about mental health : Problematic drug use is more likely to occur in individuals with underlying mental health disorders. As a parent or guardian, it is crucial to watch for signs that your ward may be abusing drugs. Early detection can reduce the risk and enhance the prevention of recurring disorders (Drug Free, 2022; Turn Bridge, 2021).
• Behavioral or impulse control issues : Children who regularly take risks, struggle with impulse control, or have difficulty following rules are more likely to develop challenges with substance use. While most young individuals are aware of the risks involved, some struggle to control their urges to engage in risky behavior. Youth with these specific behavioral traits are often referred to as having an "addictive personality" (Drug Free, 2022; Turn Bridge, 2021).
• Experience of trauma : It has been demonstrated that youth who have experienced trauma, such as violence or abuse, are much more likely to engage in drug abuse and addiction in the future. It is crucial for parents and other adults to understand how trauma can impact a child and seek appropriate support (Drug Free, 2022; Turn Bridge, 2021).
• External factors : Risk factors include peers' access to drugs and other addictive substances, as well as exposure to advertisements promoting substance use (Drug Free, 2022).
• Age at initial use : Beginning drug use at a young age is one of the most reliable and powerful indicators of an increased risk of drug abuse (Drug Free, 2022).

Risk factors for substance use change as youth transit to adulthood. Changing situations can lead to life stress and pressure at other stage of life, making people more susceptible to drug abuse and addiction (Degenhardt et al., 2016). Young adulthood is the time when drug usage becomes prevalent, because these were critical years, when drug abuse often started by them. The youth consider the stress and the pressure felt during this transitional period as justification for using drugs (Turn Bridge, 2021). Sometimes the root causes of youth drug abuse appear much deeper.

3.2.2. Personal Factors Influencing Addiction

Many youths experience the consequences of drug abuse, and the development of drug abuse-related disorders often occurs without a clear-cut personal pathway responsible for the outcome. However, certain factors can increase the likelihood of drug abuse, including the following (Chris Foy, 2022; Dalal, 2020).

• Localized poverty : The economic circumstances in which a person is raised can be a risk factor for drug abuse. Early exposure to poverty increases the likelihood of developing a drug abuse habit in adulthood. Youth who experienced poverty during their adolescence are particularly at risk for drug abuse (Chris Foy, 2022; Dalal, 2020).
• Presence of drugs in schools : A person's likelihood of developing a drug abuse habit is significantly influenced by their educational environment. During the teenage years, friends and peers have a significant impact, especially on those who struggle with low self-esteem or social insecurity (Chris Foy, 2022; Dalal, 2020).
• Aggressive behavior during early life : Childhood aggression at an early age is a risk factor for drug abuse later in life. The age at which a person started using drugs was directly correlated with incidents of violence in early life. For example, it was found that children who displayed aggressive behavior during childhood were more likely to engage in drug abuse by the age of 14 (Chris Foy, 2022; Dalal, 2020).
• Environmental vs. biological risk factors : Environmental factors play a significant role in several risk factors for drug abuse. External influences and biological traits make drug abuse more likely to occur in individuals predisposed to it. Understanding one's genetic traits at an early stage of life can help prevent a genetic predisposition to drug addiction, enabling wise decisions that steer clear of drug abuse (Chris Foy, 2022; Dalal, 2020). In addition to genetics, other biological factors include gender and other mental health issues. Having a mental health issue increases the likelihood of substance use disorders (Chris Foy, 2022). Therefore, the likelihood of youth involvement in drug use as adults depends on the biological and environmental risk factors they were exposed to during early childhood and adolescence (Chris Foy, 2022).

3.2.3. Contributing Factors to Drug Addiction

Drug abuse among youth has detrimental effects on their physical, emotional, and social well-being. Drug abuse can affect individuals from various age groups and backgrounds, indicating different reasons for drug abuse, whether it be personal or influenced by peers. Drug addiction is a sickness that requires commitment to overcome, and it is important not to blame others for one's drug abuse. Taking responsibility for getting clean, staying clean, and leading a healthy lifestyle is crucial.

• Hereditary : Although the exact relationship between drug use and family history is not fully understood, it is widely recognized that individuals with a family history of drug abuse are more susceptible to developing addictions themselves. Growing up in an environment with substance abusers increases the likelihood of experiencing psychological development that favors addiction. Certain genes have been linked to addiction, although no single gene determines whether someone will become an addict. Genes play a role in how we respond to and experience drugs (Jason, 2021).
• Lack of alternatives : One of the commonly known contributing factors to drug abuse is the social environment. Individuals in social settings with supportive friends are less likely to develop drug abuse habits. On the other hand, people who lack social connections are significantly more prone to developing drug abuse habits. Therefore, drug use and addiction are influenced by various factors, including a sense of boredom and lack of alternatives (Jason, 2021).
• Mental health conditions : It is widely acknowledged that individuals with pre-existing mental health disorders are more susceptible to drug abuse. Up to three times as many people with mental illnesses engage in recreational drug or alcohol use. The presence of mental health conditions can contribute to the development of drug addiction (Jason, 2021).
• Anxiety : Anxiety significantly increases the risk factors for drug use. It not only enhances the risk of engaging in drug abuse but also affects drug use by making users more susceptible to other risk factors (Jason, 2021).
• Prescription medications : Many prescription drugs are highly addictive, making them a high-risk factor for drug abuse. Antidepressants, sedatives, painkillers, and other prescription drugs can quickly lead to physical and emotional dependence by overstimulating the brain's dopamine receptors. Without proper monitoring, prescription drugs can result in long-term drug abuse (Jason, 2021).

Drug abuse entails various risks that can differ from person to person. It is important to remember that drug abuse is not the user's fault because no one chooses to become an addict. However, it is the user's responsibility to seek treatment, especially when they realize they are addicts (Abbo, Okello, Muhwezi, Akello, & Ovuga, 2016; Jason, 2021). Additionally, drug abuse can negatively impact a person's social life. Therefore, efforts should be focused on promoting psychosocial competence, including problem-solving skills, building self-confidence, and developing coping mechanisms for stress, anxiety, and depression. Establishing a mental health NGO to support vulnerable young people in identifying and addressing underlying addiction issues is also essential (Abbo et al., 2016; Allen, 2017).

3.2.4. Causes and Effects of Drug Abuse in Youth

There are undoubtedly certain underlying factors and issues that contribute to youth drug abuse, which are as follows:

• Media : Many young people perceive drug abuse as a common occurrence due to its portrayal in movies, music, and television shows (Sahu & Sahu, 2012).
• Boredom : Youth who struggle with idleness are more susceptible to drug abuse. They often turn to drugs as a coping mechanism to alleviate inner emptiness (Sahu & Sahu, 2012).
• Self-medication : Young people who frequently experience disappointment may resort to drug abuse as a form of self-medication. If they cannot find a suitable and healthy outlet for their stress, they may turn to drugs for comfort (Sahu & Sahu, 2012).
• Influence of others : Young people often witness adults, including their parents, using drugs and other substances like tobacco. This exposure can create a sense of obligation to try what others are doing in their community, leading them to believe that drug abuse is beneficial (Sahu & Sahu, 2012).

4. Recommendations

• Further investigation is needed to identify specific influential factors related to drug use among youth in different settings. This understanding will enable tailored solutions to address drug abuse.
• Future studies should utilize standardized drug abuse tools that have been tested elsewhere to ensure consistent and comparable results.
• Primary healthcare, as the first point of contact for the community, should be equipped to handle drug abuse-related issues, ensuring accessibility, availability, and affordability of public healthcare systems.

5. Conclusion

Drug abuse among youth is a significant public health problem worldwide. The use of illicit drugs is associated with premature illness and death on a global scale. Effectively addressing drug abuse relies on understanding its underlying causes. This review offers valuable insights into these factors, which can be utilized by academics, policymakers, and decision-makers to combat the destructive impact of drug abuse on the future generations of all societies, regardless of their location. It is recommended that further research be conducted to examine the factors influencing youth drug abuse in specific settings, enabling tailored approaches to address the challenges and find solutions.

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• Muganga, R., et al. (2017). Perceived factors influencing drug abuse among university students in Western Uganda. International Journal of Science and Research (IJSR) , 6 (11), 554-559.
• Nguyen-Louie, T. T., Castro, N., Matt, G. E., Squeglia, L. M., Brumback, T., & Tapert, S. (2015). Effects of emerging alcohol and marijuana use behaviors on adolescents' neuropsychological functioning over four years. Journal of Studies on Alcohol and Drugs , 76 (5), 738-748.
• NIDA. (2019). Genetics and Epigenetics of Addiction Drug Facts. Retrieved from https://nida.nih.gov/publications/drugfacts/genetics-epigenetics-addiction
• Patel, V., Chisholm, D., Dua, T., Laxminarayan, R., & Medina-Mora, M. E. (2016). Mental, neurological, and substance use disorders: Disease Control Priorities (Volume 4).
• Potapchik, E., & Popovich, L. (2014). Social cost of substance abuse in Russia. HIV Infection and Immunosuppressive Disorders , 4, 1-5.
• Sahu, K. K., & Sahu, S. (2012). Substance abuse: Causes and consequences. Journal of Natural Science, Biology, and Medicine , 9 (12), 52-59.
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Open Peer Review

Gareth White posted a Review

As someone who has done research in this field, I found this article to be quite informative and useful. It tries to make a very complex topic accessible by providing a bird’s eye view of a pressing issue. However, in order to be more impactful I find that some areas could be strengthened. This would help readers to better understand what the authors are trying to achieve ultimately.

Topic: Good general opening  but it could be important to mention the scope of the analysis: country, region, global?

Methodology: It is quite unclear if this is a scoping review, a systematic review, etc. 

Inclusion of studies: It is very unlikely that only 18 documents were found after running a search on drug abuse unless a specific region or country is being investigated. PubMed yields thousands of results.

Conclusion:  The last sentence might be clear to the scientific community but will be difficult to understand for a different type of audience which might be interested in this topic:

“The most prevalent influencing factors identified are peer influence and inadequate parental or guardian care. Therefore, it is recommended that research on the factors influencing youth drug abuse should undergo specific scientific scrutiny to address the unique challenges and develop appropriate solutions.”

The work carried out by researchers who are also scientists needs to receive additional scientific scrutiny - Why? Quality? Flawed findings? A stronger conclusion is required here.

Introduction

I commend the authors for not using stigmatizing language such as the term “addict”.

• It would be important to clarify what is meant by youth: children, teenagers, young adults?
• A description of drugs would be useful for the reader: opiates? new psychoactive substances? Marijuana?
• Are there significant differences prevailing in developing versus developed contexts?

Methodology

What were the research questions and how was the method selected accordingly?

“The initial literature search was conducted through a desk survey of academic, policy, and practice websites, following a purposeful selection process.”

• The authors appear to have followed an iterative qualitative approach (in analysis and included qualitative papers as well?)which is quite original for this type of research. Unfortunately, this does not provide enough information on the criteria used and the basis of the methodological decisions made to select or exclude data, scientific, policy papers, etc. For example why were policy websites examined if the study only focused on scientific papers? This dilutes the potential impact of their research by short-selling the approach used which sounds very vague as a result:

“A combination of general Google search and saturation of articles in Google Scholar was employed to ensure the retrieved literature encompassed a wide range of topics related to factors influencing youth drug abuse.”

The findings 

This section provides a good summary of the types of factors which emerged during the analysis and is again in line with qualitative analysis leading to typological results. However, I have some concerns about the definition of “drug abuse”: is it about uncontrolled addiction or consuming harmful substances for health or illegal consumption of pharmaceutical products ? Is controlled drug use  for recreational use acceptable then? 

Why is this section missing?

I believe some of the criticisms expressed previously could be tackled here but most importantly: what is this literature review contributing to the rest of the scientific community in the first place ? The following paragraph from the introduction could be further elaborated in this section:

“To better understand the factors influencing youth drug abuse, this review acknowledges that no single factor contradicts another, as each was assessed with sufficient scrutiny. Consequently, the review examines the factors that influence drug abuse among young individuals and offers recommendations for curtailing this problem. The findings will provide researchers, policymakers, and decision-makers with practical solutions for drug abuse prevention and control.

Shawn Bates posted a Review

Bunu et al. explore factors that influence youth drug use. This group used a narrative review to identify themes that are associated with using drugs in adolescence. Furthermore, they grouped their findings from this review in an easy-to-read format. They found several different factors that might influence youth drug use, including but not limited to, peer drug use, familiar drug use, externalizing behavioral disorders, and hereditary factors. This is a paper that will be of use to those looking for a quick, easy-to-read resource on factors that influence youth drug use. It is well-written; however, it is lacking in depth. I have some comments outlined below:

• Which key actors were identified? List these in Methods section.
• The authors did not discuss the scientific validity of the studies they reviewed, or if the factors they identified had been empirically studied.
• The authors discuss factors without delving sufficiently into them. For example, they describe “heredity” as a risk factor for drug use. However, they do not mention which genes, or any genes, have been identified.
• There is no mention of the neuroscience of drug use. Youth have underdeveloped prefrontal cortices, which has been shown to influence risky decisions and increase predisposition to using drugs.
• There are some overlapping topics. For example, “peer influences” and “presence of drugs in school”.
• Define “NGO”.

Evelyne Baroud posted a Review

The article provides a brief overview of this important topic. While easy to read, The article would gain from making a number of changes. 

• The topic of drug use is heterogenous. A clearer definition of what the authors mean by “drug abuse” would be helpful, in order to clarify the scope of this review. Do the authors refer to specific substance use disorders, or to general misuse? Opiate use disorder, cannabis use disorder, alcohol use disorder etc. are different disorders. 
• The methodology section would gain from being more developed, with more information on the selection process of the included articles, which databases were used, what age groups were included, how did the authors define youth?
• In the paragraph on aggression as a risk factor, it would be helpful to clarify if the referenced studies accounted for other variables, how they explained this relationship, and if the relationship between aggression and substance use might be mediated by other variables. 
• It would be helpful for references to be incorporated in a clearer way throughout the text
• Some of the material seems redundant (e.g family factors as risk factors, genetics as risk factor, biology as risk factor). 
• The introduction section would benefit from more cohesion and from being more developed. 
• Overall, there is no clear elaboration on data of included the studies and their findings. Rather, the authors list risk factors in a brief narrative way

Carmen Ferrer-Pérez posted a Review

The article by Umi Omar Bunu and colleagues addresses a topic of interest and relevance: the factors influencing substance abuse among young people. To address this topic, they opted for a narrative review based on 18 scientific articles.

While the topic is of interest, the approach has some limitations, which I will outline below. Firstly, it is advisable for scientific review papers to be conducted using a systematic review procedure. This procedure increases the replicability of the study and the qualityof the conclusions drawn from it.

Additionally, an improvement in the structure of the results section is also recommended. It is necessary for the authors to reconsider which variables will be included in each section and define them clearly. Currently, it is difficult to understand the differences between the contents of the various sections (for example, between risk factors and factors predisposing to addiction). Furthermore, many variables are repeated in different sections.

I encourage the authors to further delve into the study of this topic from the perspective of a systematic review.

Bilal Ahmed posted a Review

The article is pretty good in nature and covered a very good topic. However, from my point of view, it has several limitations that, if addressed, could improve the manuscript's quality. Also, need to improve writing style and grammar. 

• Need to improve the Introduction and linking between the paragraphs.
• Need to discuss the importance of the study.
• Need to more focus on the methodological section and discuss it in detail.
• The recommendation and conclusion are almost the same, but need to improve it.

Smita Goorah posted a Review

I was very interested to read this article written by 3 authors from Africa. This article addresses a very important topic which is a relevant public health issue in Africa. The authors have attempted to conduct a review of the literature and have come to some interesting conclusions. In my opinion, the methodology would be strengthened by a more comprehensive and structured review as a review of 18 publications is not sufficient to provide sufficient information. In addition, the articles should preferably be from impact factor journals. Regarding in-text referencing, this should be formatted correctly and consistently, and the list of references should be more comprehensive for this type of paper. The article is written clearly, but the authors should discuss the findings in greater depth. 

Nuwan Darshana posted a Review

The article try to give a brief account on Factors Influencing Youth Drug Abuse. Although authors tried to identify risk factors from review, article does not provide satisfactory scientific validity of results. In methodology several gaps were identified including article selection for review process. Manuscript mainly included information derived from very few articles, hence diversity of information is minimum. Moreover, findings from review just presented in point form without scientific evidence(no statistical evidence) through out the paper. Authors had missed recently publish research findings limiting getting recent research findings related to the area of interest. Conclusion and recommendation does not seems to derive from the findings of the study. Overall, the article has failed to provide a comprehensive account on Factors Influencing Youth Drug Abuse with scientific evidence with its inadequate methodology and unsatisfactory scientific writing. However, authors can improve the article by addressing given comments.

Hassana Shuaibu posted a Review

This is a good study, however there are several issues with the way it is written. 

Firstly, it is important to specify the selection criteris of the reviewed studies. Your review was only limited to Google and Google scholar which is insufficient as you may have missed several relevant. It is also important that you define youth. You also did not specify a time period or location. 

Next, what defines risk factors, contributing factors, predisposing factors, circumstances, causes? These all seem to overlap and thus the findings don't seem succinct or coherent. It might be better for you to have two headings; Risk factors of Youth Drug Use, and Risk Factors of Addiction. 

Thirdly, some of your listed points do not align with your sub-heading. For example, the write up under Causes and Effects does not contain any Effect whatsoever. The last paragraph in 3.2.1 talks about abuse and not addiction.  Also, one point to note; Concerns about Mental Health is not the risk factor, rather Mental Health is the risk factor. 

Also, in your introduction, you didn't mention that you would also look at the factors associated with addiction. 

Lastly, it will be important to include a brief overview of the studies included in your review. This allows for transparency. 

Overall, good job, but needs some more fine tuning. 

Behice Erci posted a Review

How many articles in total were taken from which databases, which of them were eliminated for what reason, and 18 articles remained at the end, these should be explained in detail. Inclusion criteria should be clearly written. important information should be presented in tables.

Saba Javed posted a Review

It looks nice article but overall it lacks coherence. The introduction part is't in detail and lacks information on various factors related to dug abuse. Secondly. methodology part does't have included different search engines.  The article does't justify the thematic approach. Need major improvements when you mention themes and sub themes. The discussion part does't encompass all the findings of 18 research articles. Conclusion and recommendation part don't seem relevant. They don't support what have been discussed in factors and causes mentioned above. 

Begum Ceren Yuksel posted a Review

Only composed of Google articles. Even though Google database is quite extensive, most articles do not have permission to access. And the number of articles remains limited/is not adequate to reach.

Grammar mistakes are common.

Introduction should be extended. The aim of the study and the gap in literature should be given in detail. Limited information was given.

The number of the articles is limited to reach these conclusions. External validity problem exists. 

Still, it is a well-organized article. Results are satisfactory. 

Vita Camellia posted a Review

Good article, i suggest that the authors should summarize the 18 literatures selected for this study in table form, as part of finding section. Thank you 

José Gabriel Soriano Sánchez posted a Review

ince some of them are not. In addition, it is necessary to put recent quotes on the subject addressed, as well as the current state of the matter. For this, I recommend reading the following manuscript, as a reference to improve this work: https://recyt.fecyt.es/index.php/retos/article/view/93114

2. Discussion: include in this section real references that support the ideas presented.

3. References: review according to APA 7.

Annatjie van der Wath posted a Review

The article do address a relevant public health issue of great concern. A literature review is a good idea to bring all relevant information together to summarize the most relevant findings and reach conclusions that practitioners may use in clinical practice. Research gaps and recommendations for future research emerge from a literature review. 

The literature review in this particular article requires a more rigorous method to ensure the conclusions are scientifically based. A recognised scientific method should be used. Seeing that the reviewers preferred to use grey literature as well, an integrative review could have been used to follow a proper method with replicable steps. The search did not use more than one databases with scientific literature such as EBSCOHost. Only Google and Google scholar were used. No parameters such as years of publication or inclusion criteria were specified to ensure inclusion of relevant publications with similar variables. There is no method specified through which quality of publications was ensured. The scientific methods used in the literature sources are not specified. Even if it is a report, and not research findings, it helps to mention such so that readers may understand if the findings are original or already interpreted by a particular report compiled by an organization. The data analysis method is not clear. 

The findings list factors responsible, circumstances that contribute to youth drug abuse, risk factors, predisposing factors, personal factors, contributing factors and causes and effects. These themes/categories are not mutually exclusive, therefore the findings overlap, and similar issues are not grouped together under a heading that captures the core of the particular group of findings. It is therefore not possible to draw a meaningful conclusion from the findings. The settings of the research sources are not specified. Findings may be affected by different contexts, such as low-and-middle-income countries, African countries etc. where different circumstances and environments play a role in drug abuse causes. The findings are not integrated to bring results from different sources and contexts together so that some sort of interpretation or new insights are generated.       

The article is easy to read, but unfortunately lacks well-integrated discussions. 

Filipe Andrade posted a Review

Thank you for the opportunity to review the article titled “Factors Influencing Youth Drug Abuse: A Review Study”. This study sought to review literature suggesting links between Youth and Drug use/abuse. I commend the author(s) for their interest in an important topic, that is the study of drug use during adolescence. However, there are several areas of this article that dampen my enthusiasm.

1. There are few statements in the introduction that I believes need refining. For example, the importance of the definition of ‘’drug abuse'' and ''drug dependence''. Please watch for outdated language. Drug abuse for instance should be replaced with “substance use disorder”.

2. It seems as though there are a vast number of studies missing from this review. Relations among drug use and adolescence are very common, and it is unclear to this reviewer why these aren’t included. See just a few below. While I commend the authors on undertaking such a large task, I’m unsure what it is a narrative review in this method.

3. A clearer method would be very important, such as the date of the search and other databases other than Google Scholar, and the language. 

4.  You included “ethnicity” in the biology factors in section 3.2. Try to use concepts. 

5. In section ‘’Recommendations", I really like this section, however it is better if try to use the perspective of cultures and society, and bring more real examples in communities for solve this problem.

6. In general, it is well written and some sections are very explanatory, which makes it easy to read and realistically reachable for people in society, not just for scientists. I really liked it!

Dominic Willmott posted a Review

Overall this is a well written and interesting manuscript reviewing prior work surrounding correlates and causal influences of drug abuse among youths. The manuscript has areas of strength and weakness as indicated in more depth below, though the key area for improvement is the need to expand on what is already included within each section, as is convention within review studies such as this (see examples below).

Intro – Overall the introduction of this manuscript is well written and provides a succinct account of key statistics and global prevalence figures underpinning the problem of youth drug abuse. That said, the review of prior empirical literature here is sparse and doesn't persuasively build towards a clear study rationale. As such, the authors are advised to develop their review of prior literature further to such an extent that the rationale for this study (which also requires development) is clear and compelling. Effectively expand on the need and urgency for this work.

Methods and Findings – The authors explain that the paper adopts a ‘thematic approach to the narrative review' though this needs expanding further and situating in the broader context of the methodological approach. Be clear about what exactly this means in practice and why this approach was adopted instead of more rigid alternatives such as a systematic literature review (SLR) or rapid evidence assessment (REA). The authors should also outline why only google scholar was searched and not other subscription and non-subscription based empirical databases, as is convention. Whilst none systematised searches were conducted within this review, the level of detail provided surrounding such search procedures was too brief overall. The authors are advised to review SLR's conducted by Hudspith et al (2022) and Debowska et al (2017) to examine the depth of discussion such papers included within their method and findings sections and expand accordingly within the current work. A stronger and more consistent summary of findings (making use of tabular data) would strengthen the presentation and robust nature of the results. 

Discussion – The authors provide a list of recommendations and a conclusion but these should be embedded within a much more substantive discussion section where study limits (and strengths), implications and future research are expanded on as well as a more detailed and comprehensive list of recommendations. 

Tulio Suárez-Maldonado posted a Review

The article is a good overall panorama on the factors associated with drug use in young populations. However, from my point of view, there are a number of limitations to it that, if addressed, could improve the manuscript's quality. My comments and questions are the following:   

Major limitations  1. In the first line of paragraph one in the Introduction section, I suggest that you define what you mean by “Drug abuse”. Is it as defined in the DSM? or is it the ICD? or are you defining it in any other way? Further in the results section, you also mention “drug addiction”, is it referring to drug dependence? 

2. The method section is loosely reported. You did state that the review process was not systematic, but I think you could explain the process in more depth. For example, I believe that “youth” should be more specifically defined. Is it people from 12 to 18 years old? or is it anyone from 0 to 21? What is it? What was your criteria when you were selecting articles for the review? Are the included studies from any country in the world? 

3. The structure of the results section is odd. What is the difference between section 3.1 and 3.2? What is the difference between sections 3.2.1, 3.2.2 and 3.2.3? It is not very clear, the headings in these sections are not clearly differentiated from each other. It appears that you are using the terms “drug abuse” and “drug addiction” interchangeably. If this is the case, then it should be clear from the beggining of the manuscript. If it is not the case, in my opinion, “drug abuse” is a very specific outcome which might be influenced by factors other than those that affect drug addiction (or drug dependece). In this sense, I suggest that the manuscript would be benefited from making a section for the risk factors for drug abuse and another for drug dependence.  

Minor limitations 

• Acronyms should be defined the first time they are used in the manuscript. For example: (United Nations Office on Drugs and Crime [UNODC], 2014).
• In the first paragraph of the introduction section you wrote “[…] nearly one in every 20 individuals between the ages of 15 and 64 worldwide were confirmed drug users […]”. If your subjects of inclusion are young people, I think this argument should be replaced or followed by a statistic that include specifically young people.
• In section 3.1, I suggest you include references for each of the factors, not just curiosity and thrill-seeking. 
• You included “ethnicity” in the biology factors in section 3.2. Ethnicity is not a biological factor; it is a cultural factor. Maybe that word could be replaced by “race” in the manuscript. 
• In section 3.2.2 I noticed that the head of this sub-section is named Personal Factors Influencing Addiction , but then in the end of the first paragraph of this section you wrote “[…] certain factors can increase the likelihood of drug abuse […]". This is why I suggest that you could make a section for risk factors for drug addiction (or dependence), and another for risk factors for drug abuse. 

A Review on: Drug Abuse Among Youth

• Amate Shraddha Balasaheb Pharmacy
• Dongare Rohini Suryabhan . Pharmacy
• Amrute Tejas Uddhav Pharmacy

Drug abuse and drug menace refer to the illegal, non-medical use of a limited number of chemicals, the majority of which has the property of altering a person's mental state in ways that are deemed improper, undesirable, unpleasant, and hazardous to the user's life and the lives of others. Alcohol, heroin, cocaine, opium, and marijuana are some of the narcotics that are overused.  Adolescents appear to be the primary focus of this drug threat and abuse. The immediate causes of drug addiction among youth are curiosity, peer pressure, and the availability of drugs such as cigarettes and alcohol. When friends are in the company of bad friends, especially in senior high schools, they are pressured to use drugs. On our television and radio stations, there is a "naked" advertisement for alcohol, cigarettes, and other non-medicated substances, these are dangerous medications that are being promoted as effective performance enhancers. These drugs are even advertised to the public as a laxative, and the most aggravating part is that locations, where they may be purchased in big numbers, are advertised. The availability of drugs to society's youth and society is both a cause of cancer. Today's youth are inquisitive. They want to see if whatever they see and hear is effective. This insatiable curiosity can sometimes be dangerous, even lethal. Some people become addicted to drugs as a result of their curiosity. The author of this paper intends to look into the causes, effects, and control of this problem, as well as the social and cultural aspects of drug usage.

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A study on substance abuse among young people (10-24 years) in urban slums of Jorhat, Assam

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Objective: To find out the substances abused by the people in urban slums and also find factors contributing to it. Also to recommend suggestions based on the study

Material and Methods: It was a community based cross sectional study and data was collected using Interviewers Performa after getting approved by the Institutional Ethics Committee. A sample size of 174 was calculated . Young People (10 to 24yrs) who were willing to participate were included and whose not ready to take part were opted out.

Results: It was found that males usually 22 to 24yrs used abusive substances than females. Tobacco was the most common substance abused followed by alcohol and majority had been introduced to the substances by their peers between 17 to 24 yrs. Most people consumed the drug multiple times daily followed by weekly and had procured the drug from local retailers. These substances gave them a sense of hallucination and euphoria on consumption. Among the side effects oral problems like ulcers and malignancy topped the list. Respiratory and gastrointestinal issues along with inability  to concentrate on work were other side effects.

Conclusions: Based on the results several recommendations were made especially awareness workshops and camps. These programs mainly stressed upon the necessity to create social awareness among the people and their families about the ill effects of substance abuse. All the results were tabulated.

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