Socio-Demographic Characteristics of participants
The data from table 1 revealed that people who use drugs start at an early age, between 14 and 18 years of age. The data further revealed that about 80% of males use substances as against 20% of females. Most of the drugs are illegal, and it takes people who are brave to use them. Men are considered as risk-takers in Ghanaian societies, while women are considered vulnerable besides, it is very shameful for a woman to use drugs in public . The data revealed that most of the women who use drugs hide doing it, and they use the drugs to be able to manage certain disorders. Some participants also shared that a person's religious background can deter them from using drugs. In addition, a person's marital and employment status can either deter or influence their drug use.
“… madam, I started using drugs when I was unemployed; I became frustrated, especially whenever my parents insult me and tell me to find a job to do. I started to use drugs to forget my frustrations…” (Male participant individual interview).
“…all the guys in my area who do drugs are single, and they have no meaningful job. I only see a few guys who are married and still do drugs…” (Male participant, focus group discussion).
“… I and my squad take drugs sometimes to prove who is a guy... when you cough it means you are a woman…’’ (Male participant, individual interview).
“…women feel shy to smoke or drink outside… they usually send their children to buy alcohol for them to gain an appetite for food…” (Male participant, focus group discussion).
Types of drugs and substances used by the youth
Most participants identified the following as drugs commonly used by the youth: ''wee'' (Marijuana), ''Akpeteshie’’ (alcohol), cigarette, cocaine, pethidine, heroin, diazepam, tramadol, super glue, and gasoline products. Almost all the male participants agreed they had used one or more of the above drugs before. In addition, all the participants claimed that they know people who constantly use at least one of the above drugs.
“..I have smoked wee before, and I know many people who mix alcohol with wee, tramadol… they drink all the time; some also inhale the gas and dried faeces.” (Male participant, individual interview).
“… my father will kill me if I ever use any drug; I know some guys in my area who sniff cocaine, and I have heard that some also inject pethidine whiles others inhale super glue …” (Male participant, individual interview).
Drugs and substance use affects the individual’s dressing and composure. The majority of the participants perceived drugs and substance users as ''mad'' people who have lost self-control and meaning in life. They openly admitted that they would not associate with drugs and substance users for fear that they may end up being like them. However, some of the participants who were drugs and substance users had a different opinion about themselves.
“…as for me, I cannot befriend someone who is a drug addict…they can easily hurt you besides my parents will not even approve our relationship if we should fall in love” (Female participant, focus group discussion).
“ ...sis! What are they saying…I have been taking tramadol and marijuana for years now, look at me, am I shabbily dressed?” (Male participant, focus group discussion).
“I know a lot of people who use substances, yet they're perfectly okay when you are not told you won't notice it…” (Male participant, focus group discussion).
Causes of Drugs and substance use and among the youth
The findings revealed that the use and use of drugs among the youth stem from social and economic factors. These factors are categorized under poor parental support, bereavement, peer influence and curiosity, strenuous work, job loss, unemployment issues, academic performance enhancement, overcoming stage fright, and imitating role models and health or medical reasons.
Poor parental support
The findings revealed that most parents lack basic parenting skills. Therefore there is little or no bond between them and their children, especially when the care of the child becomes one parent's responsibility due to divorce.
“…sister, it's not easy to be separated from your parents… I and my senior brother were brought up by our stepmother, who doesn't care about our movements, and as a result, my brother joined bad friends. My brother cannot live a day without wee, and I know it's because of my parents' separation” (Female participant, individual interview).
“……Most young people join friends to use tramadol and other drugs because their parents don't check their movement and besides there is no good relationship between them and their children” (Female participant, focus group discussion).
The participants shared that the bereavement of a loved one increases the desire for alcohol and other drug use, and dependence becomes a coping mechanism.
“I … know a young guy who lost his family through a motor accident and he could not bear the pain and started drinking alcohol to forget his pain, and now he uses alcohol, wee, and tramadol” (Female participant, individual interview).
“I … lost my mom almost two years ago, and during that time … I couldn't accept she was gone like that, I thought of taking my life whenever I was alone and I started drinking alcohol to forget my pain.” (Male participant, individual interview).
Peer influence and curiosity to implement
The findings further revealed that some of the youth join their peers to use drugs to fit in whilst others just want to experiment with dazedness. Some people also use drugs out of frustration.
“… I started smoking marijuana out of curiosity. I had often heard people say that the weed can make you feel high, and I wanted to experience that…” (Male participant, focus group discussion).
“… l know some guys who are doing drugs because their friends introduced them, and there are others too once you join their squad you will have to smoke wee and drink alcohol by all means” (Female participant, focus group discussion).
Some of the participants revealed that some physical activities are very demanding and therefore many people turn to use different types of drugs to carry out the activities. Carving, Construction work, Sexual activity, Galampsey (manual mining), and Weaving are all examples of physical activities in which many people need drugs to boost their stamina. The following cites indicate participants shared opinions:
“…I once took quick action tablet to gain more energy to sit for a long time to weave many pieces of kente but I noticed I was becoming addicted and so I stopped, but some of my colleagues mix it with tramadol and other substances” (Male participant, individual interview).
“…some of us take tramadol and alcoholic drinks to gain stamina and to enhance sexual activities.” (Male participant, focus group discussion).
Loss of job and unemployment issues
The findings also revealed that some youth who have either lost their job or are unemployed get frustrated and join other drugs and substance users in ghettos to run away from responsibilities and avoid family members who constantly remind them to look for a job.
“…my uncle was laid off permanently and after a while he became frustrated. He could no longer take care of his family. He spends most of the time smoking weed with his friends in ghettos and eventually his wife divorced him…” (Female participant, individual interview).
Enhancement of academic performance
The majority of the participants revealed that they used substances to enhance academic performance. They were of the view that substances like stimulants make them feel more alert and confident. It also helps them in long hours of studies without feeling tired. However, some of them also shared that drugs can make students go mad and end up performing poorly.
“… I have been smoking marijuana since Junior High School. and I cannot study without a puff… it helps me to study” (Male participant, focus group discussion).
“…in school, I had a friend who could take 3 bottles of energy drinks mixed with marijuana at a time to stay active and study overnight… his Cumulative Weighted Averate dropped at the end and he started saying weird things and had to defer the course for treatment…” (Male participant, focus group discussion).
Overcoming Stage Fright and Imitating Role Models
The majority of the participants admitted that stage fright and role modelling lead to drugs and substance use and use. They explained that some celebrities cannot perform on stage without taking drugs. Some of these celebrities whom the youth look up to consistently post pictures of themselves drinking and getting high on various social media platforms. The youth who have some of these celebrities as their role models turn to use drugs intending to be like them (their role models). That notwithstanding, some also believe that certain advertisements on social media can lead to drugs and substance use among the youth. However, other participants did not see anything wrong with alcohol and drugs advertisement because it involves celebrities.
“… most of our upcoming celebrities are shy in nature and cannot take shows without taking drugs… some of the youth copy them blindly…” (Female participant, focus group discussion).
“Sister, as for me I can’t stand the sight of beer advert on Television oo, especially when they pour it into the glass I start salivating…” (Male participant, focus group discussion).
“ If alcoholic drinks are bad why do celebrities advertise on Television …it means it’s good and I can’t stop drinking it.” (Male participant, focus group discussion).
Health or Medical Reasons
Some participants also revealed that some people with disorders such as anxiety, depression, and sickle cell use drugs intending to alleviate psychiatric symptoms and pain; however, they end up abusing the drug due to its constant use. They further indicated that when one takes a particular drug for some time, the body becomes immune to it, and the individual increases the dosage to have the same effect.
“…some of my colleagues with sickle cell have been spending all their salaries injecting pethidine and at times they steal that of other patients’ because they have become addicted.” (Female participant, focus group discussion).
Effects of drugs and substance use
The data revealed that drugs and substance use has several effects ranging from health, social, and economic with dire implications on the individual, their family, and society as a whole.
Individual-level health effects of drugs and substance use
The majority of the participants revealed that constant use of drugs could lead to loss of appetite for food, trembling, addiction, mental illness, and lung and liver diseases. Again, some participants added that alcohol use could lead to making bad decisions such as drunk driving, resulting in serious motor vehicle accidents. Some of the drugs also make people lose self-control and engage in unprotected sex, which could lead to the spread of sexually transmitted diseases.
“I work in a hospital, and I know that most of the psychiatric cases we record are due to drug injection because it goes straight into the bloodstream and it can collapse the vein…” (Female participant, focus group discussion).
“…. My brother uses alcohol, and most of the time he doesn't eat; he is always shaking…” (Female participant, individual interview).
Health effects of drugs and substance use on the family and the society
Some participants added that the use of drugs could equally affect the users' families and society at large. For example, some families suffer from depression because of the stigma associated with addiction. Society also feels insecure because most drugs and substance users are perpetrators of violence. In addition, they engage in theft and robbery to be able to afford their drugs. Below are some of the quotes describing some of the participants' opinions on the health implications of drugs and substance use:
“My elderly sister died of lung cancer because she used alcohol and cigarette for a long time. My mother, who was a trader, spent her entire fortune treating her…my mother became depressed when she lost everything and finally died of stroke” (Female participant, individual interview).
“It is not easy to have a drugs and substance user in your family. We are from a wealthy family and my cousin uses tramadol and marijuana… he is always at the station trying to load passengers for coins. Sometimes I wish he is not living…” (Female participant, individual interview).
“… some wee smokers in our vicinity have been stealing people’s property…your heart is always on fire when you step out; for fear that they will come and break your door open…” (Female participant, individual interview).
“… it is very cheap to sleep with women in the ghetto… I and my friends sometimes do sex gala (competition)…” (Male participant, focus group discussion).
Socioeconomic Effect of drugs and substance use
The users experience family exclusion or rejection. Most drugs and substance users are not invited during family gatherings or deliberations, and even when they happen to be around, their opinions are not considered because they are seen as 'mad'.
“my family does not invite me when they’re discussing family issues…even when I am around, my views are not considered because they think that I’m under the influence of alcohol…” (Male participant, individual interview).
The data further revealed that drugs and substance use could lead to depletion of the users' income which, in effect, result in a lack of care for families and other responsibilities. Other participants also added that drugs and substance use leads to loss of jobs and unemployment due to the stigma associated with addiction.
“… my father spends all his money on alcohol…I have 3 siblings, and none of us was able to complete S.H.S.” (Female participant, individual interview).
“I used to work as a sales personnel in a certain company, but now I am jobless because I have been taking alcohol and my boss fired me…” (Male participant, individual interview).
The data also revealed that the use of substances among the youth could lead to low productivity in the country; because the users' performance at work is usually compromised by hangovers, health complications, and lack of focus. Moreover, the cost of treating Drugs and substance use related effects is very high, and drugs and substance use also increases pressure on state owed rehabilitation facilities. Therefore, families are compelled to send them to private rehabilitation centres, which are usually very expensive. Aside from spending huge sums of money on Drugs and substance use related effects treatment, the family also spends huge sums of money on settling crime issues.
“… the youth are the future leaders of its nation, and therefore losing them to addiction implies that the nation has no future…” (Male participant).
Intervention for drugs and substance use
Some of the participants indicated that the ultimate intervention for drug addiction is in-patient rehabilitation. They also indicated that drugs and substance use and addiction are well managed with psychosocial therapies in rehab centres; however, they are inadequate in the district. Other participants also added that even though rehabilitation is the best intervention for drugs and substance use, people in the rehab centres are usually labelled as ''abnormal,'' which impedes rehabilitation progress and deters other people from seeking help.
“I did my NSS in a rehab centre, and I learned that psychiatric cases are different from drugs and substance use… counselling is used to manage drug issues…unlike psychiatric issues which are managed with medicine…” (Male participant)
“ … I have been taking tramadol and wee, but I know it's not good for me. I want to stop, but I can't go for rehabilitation because people will start looking at me in some way…” (Male participant).
“…both drugs and substance users and people with mental illness are the same… they have all lost their mind and need to seek asylum…the treatment centres are very few that is why a lot of mad people are on the streets” (Male participant).