Curbing Adolescent Illicit Drug Use in Owerri Metropolis, Nigeria: A Public Perceptive

Background: To reduce the rate of illicit drug use, the public has an important role to play, therefore how they perceive illicit drug use among youths must be ascertained. This study seeks to ascertain the public perception of strategies for curbing adolescent drug use. Methods: A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods. The study population consisted of members of the public aged 18 years and above, residing in Owerri metropolis at the time of the study. A total of 10 communities were selected randomly in all: four communities from the 16 communities that make up Owerri West, ve communities from the 18 communities that make up Owerri North and one community from the ve communities that make up Owerri Municipal. A total of 16 respondents were purposively selected for in-depth interviews. Results: The quantitative ndings show that 70.7% of respondents believe that the use of illicit drugs by adolescents can be controlled. The ndings also show that one of the public’s perception to control adolescent drug use is to establish stringent anti-illicit drugs consumption laws/policies (20.4%) amongst others. The qualitative ndings report that in order to curb the use of drugs by adolescents, the following activities and bodies need to be implored: health promotion, raising more awareness and sensitization campaigns, creation of remand homes for juveniles, the involvement of parents, school authorities and religious organizations and rehabilitation programmes. However, raising awareness, according to the study was reported as a reliable way of eliminating drug use among adolescents. Conclusion: To curb illicit drug use, proper funding of drug enforcement agencies, sensitization campaigns, strict laws on drug prescription, provision and use and health education etc. are very necessary for reducing adolescents’ illicit drug consumption.


Background
The use of illicit drugs is associated with a lot of harmful behaviours and has the tendency to cause both short-and long-term health problems (1). Adolescents who use illicit drugs are more likely than other adolescents to engage in risky sexual behaviour or be involved in delinquency and crime (1). Additionally, students using illicit drugs often have problems in school, although it is not easy to determine which comes rst-the drug use, or the school problems (2). These school problems include low attendance, poor academic performance, and a greater likelihood of dropping out or being expelled (3).
Efforts have been made by many concerned organizations and individuals to curb this social problem (4, 5) e.g. the anti-narcotic decree that led to the setting up of the National Drug Law Enforcement Agency (NDLEA), public awareness campaigns, etc. (6). However, despite the efforts that have been made to curb the social problem, it remains a problem (7). Drug intervention strategies have been seen as a solutionoriented process and are structured, to persuade individuals (adolescents) who are using drugs to seek help in overcoming their addiction or continual use (8). A successful intervention strategy presents an opportunity for an addicted person to accept help in taking the rst step toward recovery (8).
In curbing drug use, the National Institute on Drug Abuse (NIDA) (9) highlighted 16 principles planning principles that are evidence-based. Among these principles are principle 1 which says that to improve effectiveness, prevention programmes should be tailored to address risks that are speci c to population characteristics such as ethnicity, gender and age; Principle 5 which says that family-based prevention programmes should enhance family bonding, parenting skills and relationships amongst other things; principles 6,7 and 8 that says that schools should be targeted and nally, principles 9 to 13 which addresses prevention at the community level.
Furthermore, intervention strategies should involve peer education, schools, non-governmental organizations (NGO) and family (8). Strategies, as mentioned by Mamman, Othman & Lian (6) and Fareo (10) are public awareness campaign, liaison between research and non-governmental organization, designing curricula on drug education, establishing counselling centres for drug control and National Drug Law Enforcement Agency (NDLEA) should also intensify their campaigns on anti-drug. There have been contextual studies/success stories (4, 5,9,[11][12][13][14][15][16] that have been documented such as a clinical trial study by Wagenaar (11) on Communities mobilizing for change on alcohol. This study was a grouprandomized trial that implemented and evaluated the organizing efforts of a community to change its policies and practices to reduce access to alcohol for youths. The results from the study suggested that a community-organizing approach to limit the access of alcohol to youths may be effective for some subgroups.
In order to ensure that the prevention strategies and interventions put in place for curbing drug use among adolescents, witnesses a high success rate, public perception needs to be ascertained. The public's mindset towards the subject matter needs to be put into prevention and intervention plans for curbing drug use. To reduce the rate of illicit drug use, the public has an important role to play, how they perceive illicit drug use among youths must be ascertained. Moreover, how the public perceives an issue may reveal the level of attention it gets and the best strategies of addressing it. Because perception is shaped by things such as experience, cultural expectations, motivations, moods, needs and attitudes (17,18). Ignoring public perception on issues that require modifying public policy or public behaviour, might result in the failure of technically good innovations (19). This study seeks to ascertain public perception on strategies to curbing the adolescent drug use and what might be done to change such perception where and if necessary.

Research questions
1. Can illicit drug use by adolescents be controlled? 2. Are you aware of any sensitization efforts made in your community? 3. What strategies can be used to curb adolescent drug use?

Study design and study area
A descriptive cross-sectional research design was used for the study. The study adopted a mixed-method approach comprising quantitative and qualitative methods. The area of study was Imo state, and there are 27 local government areas in Imo state. However, only three that makeup Owerri metropolis were used for the study. The three local government areas that makeup Owerri metropolis include Owerri West, Owerri North and Owerri Municipal. The choice of this study area arose from the fact that there are undocumented reports of illicit drug use among young people in the region.

Study population and selection of study participants
The study population consisted of members of the public aged 18 years and above, residing in Owerri metropolis at the time of the study. To ensure that Owerri metropolis' urban and rural communities and their respondents were truly represented in the population, a cluster sampling procedure was adopted. The justi cation for this is because Owerri metropolis has a considerable landmass and it will be di cult and expensive to cover such a vast area. The 40 communities that comprise Owerri metropolis were represented with numbers and these numbers written on individual pieces of paper folded and shu ed (selection by balloting). They were selected one after the other randomly until the desired gure was reached. The same procedure was repeated for the three local governments. A total of 10 communities were selected randomly in all: four communities from the 16 communities that make up Owerri West, ve communities from the 18 communities that make up Owerri North and one community from the ve communities that make up Owerri Municipal. Simple random sampling technique of balloting without replacement was used to determine which communities get picked from the LGAs. Using Taro Yamane formula for determining the nite population, the sample size for the study was 624. In the four communities that were selected from Owerri West, 200 respondents were randomly selected. In the ve communities that were selected from Owerri North, 220 respondents were randomly selected. In the one community that was selected from Owerri Municipal, 204 respondents were randomly selected. Information was collected from students living in off-campus hostels, people in o ces, markets and people found on the street all of whom meet the age category for the study.

Instruments of data collection
The research instruments used for data collection were questionnaires and in-depth interview guide. The questionnaire contained semi-structured questions. The questionnaire was developed based on the objective of the study. The questionnaire elicited information on the respondents' perception of strategies to curb illicit drug use among adolescents in Owerri metropolis.
The interview guide contained structured questions on adolescent drug use, factors in uencing their involvement as well as strategies to curb them. A total of 16 respondents were purposively selected for indepth interviews. Three respondents from a Psychiatric unit at Owerri (a representative of the o ce of the director, a doctor and a nurse), by virtue of their profession as medical and health personnel, the researchers believe that they would be well informed of the issue under investigation. A representative of the social welfare, at Owerri [RepSW], was also selected because it was believed that he would possess knowledge about deviant behaviours of young people in the metropolis. Also, twelve other respondents (four from each LGA) comprising of an elder statesman and woman, youth leaders and other in uential community leaders were selected for the in-depth interview. The rationale for their selection was based on the assumption that they are knowledgeable about the subject matter and how it plays out in their respective communities.

Validity and reliability test of the instrument
The face validation of the instrument was determined by subjecting the instrument to the scrutiny of experts in the eld of Sociology from the Sociology/Anthropology of the University of Nigeria, Nsukka. A pilot study was conducted with 10% of the study sample size respondents chosen randomly from a local government with similar characteristics as the study area in terms of population and structure.

Data analysis
The data from questionnaires were collated and coded manually and entries put into the computer. The data were analyzed with the Statistical Package for Social Sciences (SPSS version 21). The analysis employed descriptive statistics such as frequencies and percentages to present the characteristics of the research subjects. In analyzing the qualitative data, the researcher began with a careful transcription of the data. The transcripts derived from the in-depth interviews were read and coded with the Nvivo 11 software according to emerging themes. Thematic methods were used in the analysis of the qualitative data. The emerging themes were further grouped into major recurring themes and then analyzed accordingly. Salient illustrative quotes were then pulled out to complement and elucidate the quantitative data in reporting the results.

Results
Socio-Demographic data of the Respondents Table 1 highlights the distribution of respondents according to their sex, age, educational attainment, marital status and occupation. Can illicit drug use by adolescents be controlled?
According to data contained in Table 2, the majority (70.7%) of the respondents indicated that adolescents' use of illicit drugs can be controlled 22.4% and disagreed that such behaviour can be controlled while 6.9% don't know whether it can be controlled.  Table 3, respondents who answered in the a rmative in Table 2 were asked to state the ways through which the use of illicit drugs (e.g., cocaine, weed, etc) by adolescents can be controlled. The data contained in Table 3 shows 20.4% of the respondents indicated anti-illicit drugs and consumption laws/policies, 17.7% suggested demanding identi cation cards and doctor prescription before selling drugs to adolescents etc. According to the information contained in Table 4, respondents who believed that adolescents' use of illicit drugs cannot be controlled gave the following as reasons, adolescents are comfortable with drugs as a quick x (40.8%), adolescents are easily in uenced by peers to try anything (35.8%) and adolescent exuberance (23.3%). Are you aware of any sensitization efforts made in your community?
The data re ected in Table 5 show that a majority of the respondents (96.8%) were of the opinion that there have been sensitization efforts targeted towards the populace (Owerri metropolis) about the consequences of drug use. On the other hand, very few respondents either expressed a contrary view (0.6%) or said they did not know (2.6%) about such sensitization efforts. The data in Table 6 shows the form of sensitization efforts the respondents are aware of. The following forms of sensitization were identi ed: didactic drama and plays on the media (25.7%), outreach and outdoor campaigns (24.9%), efforts of religious organizations (21.4%), cues to action (e.g., warnings signs by the Federal Ministry of Health on illicit drugs) (15.8%) and Health Education (12.2%). What strategies can be used to curb adolescent drug use?
The data contained in Table 7 shows the distribution of respondents on their suggested strategies that can be used in curbing adolescents' use of illicit drugs. Overall, 41.7% of entire respondents suggested that the provision of employment opportunities for youths would reduce adolescents' drug use. Other suggestions include proper funding of drug enforcement agencies (18.9%); strict border control to check drug tra cking (11.9%), sensitization exercise (10.5%); strict laws on drug prescription (8.6%); purchase and use and health education (8.4%) respectively as remedies for reducing adolescents' drug use. Total 535(100) Corroborating the above, IDI respondents who were asked to suggest ways of curbing the use of drugs by adolescents suggested the following: health promotion, raising more awareness and sensitization campaigns, more (adequately built and functional) remand homes for juveniles, the involvement of parents, school authorities and religious organizations and rehabilitation programmes. To the majority of the respondents, raising awareness remains a reliable way of eliminating drug use among adolescents. They posited that awareness programmes done with the aim of preventing and not treatment would be particularly effective. They advised that such interventions be targeted towards primary school pupils. One of the respondents indicated that 'catching them young' should be the main focus as they (pupils) are still malleable and can be discouraged from consuming illicit drugs.
To this end, the respondent advocated for: "the development of a curriculum for drug education that should be taught at all levels of the educational system, starting from the primary school" (RepSW). However, for the set of respondents who were sceptical of the tenability of awareness programmes, they suggested the design and implementation of rehabilitation programmes. Although respondents expressed reservations because such a programme is capital intensive and foreign to the Nigerian environment, they encourage the government to make legislation that could make this innovation a success. As to how religious organization can contribute to this, respondents called on religious gures to continue to preach against illicit drug use and work with drug enforcement agents in dealing with drug issues.

Discussion
The study sought to ascertain the knowledge base of the public regarding ways of curbing the use of illicit drugs by adolescents. The knowledge base of the public, if ascertained, might be instrumental in informing policies, prevention and intervention strategies for curbing adolescents' illicit drug use. The larger society is also adversely affected by the increase in drug use by adolescents. It is therefore imperative that the public plays active roles in identifying strategies that are put in place to curb adolescent drug use. This study identi ed the public perception of strategies for curbing adolescents' illicit drug use.
The study found that the respondents believe that the use of drugs by adolescents can be controlled through the following means: rstly, stringent anti-illicit drugs consumption laws and bodies should be established, they believe these bodies will monitor the distribution of drugs that are usually abused. Secondly, before selling drugs to adolescents, identi cation cards and doctor prescriptions should be demanded from these adolescents. While there are arguments that drug laws are effective (20)(21)(22)(23)(24), there are also arguments that prohibition does not discourage drug use (25)(26)(27)(28). However, in Nigeria, no evidence suggests that these illicit drug use consumption laws have reduced the number of young people using drugs or helped those who are already using to stop (29). All it did was lead to a lot of human rights abuses by the anti-drug agencies and service providers amongst other things (29). Thirdly, they believe that young people should be educated on the dangers of illicit drug use. Fourthly, they also said that for the adolescents who are already addicted, rehabilitation programmes should organize (9). They also pointed out that ensuring that communities have their structures that will enforce these can go a long way in curbing this problem, one community at a time (9).
However, they pointed out that there are likely constraints in enforcing the suggested strategies. They include the following: that adolescents have grown comfortable with drugs as a quick x; they depend on these drugs to distract them from their problems and to feel high (30); there is the issue of peer pressure as adolescents are perceived to be easily in uenced by their peers to try anything. Furthermore, amongst the points listed by National Institute on Drug Abuse (NIDA) as ways to assess the level of risk in a community, was the need to assess community awareness of the problem (9). In the current study, respondents are aware of efforts that have been made to sensitize the adolescents on the dangers of illicit drug use. The sensitization efforts they are aware of, take the following forms: didactic drama and plays, outreach and outdoor campaigns, efforts by religious organizations and health education. This nding is in line with reports by NIDA (9) and Bah, (31).
The study also sought to identify the public perception of the likely strategies for curbing drug use among adolescents in Owerri metropolis. According to the result, the provision of employment opportunities for youths, strict border control to check drug tra cking, strict laws on drug prescription, purchase and use (no evidence supports that these works) would reduce adolescents' drug use. Other strategies are proper funding of drug enforcement agencies, sensitization campaigns, health education. This nding is consistent with ndings reported by the International Narcotics Control Board (INCB) (32) which also noted that the phenomenon of drug use requires societies to dedicate resources to evidence-based prevention, education and interventions, including treatment and rehabilitation. This is particularly crucial as research ndings clearly show that investment in treatment is cost-effective compared with the cost of untreated and continuing use. Research conducted in the United States of America reveals that every $1 invested in treatment yields a return of between $4 and $12 in reduced crime and health-care costs (32).
Thus, with regards to the design and implementation of rehabilitation programmes (for the already affected), legislations should be made and appropriate funding put in place with the aim of making all of this a success. That is if the in uence of corruption has been diminished.
Raising awareness remains instrumental in eliminating drug use among adolescents and even more instrumental are awareness programmes done to prevent illicit drug use instead of cure it. Such prevention and interventions should be targeted towards primary school pupils because they are still malleable and can easily be discouraged from consuming these drugs (9). A curriculum should be developed that encourages these to be taught at all levels of the education system (from primary, through to the university) and seasonal community awareness for the out-of-school. This corresponds to the ndings of Mamman (6) and Fareo (10). They found public awareness campaign, liaison between research and non-governmental organization, designing curricula on drug education, establishing counselling centres for drug control and intensi cation of National Drug Law Enforcement Agency (NDLEA) campaigns on anti-drugs as strategies for curbing drug use.
In a report by NIDA (9), to get a community to implement research-based prevention programmes, rstly, there should be individual and small group meetings with the aim of attracting support from those with great in uence in the community. Secondly, it may be imperative to create a community board comprising a coalition of key leaders from the public-and private-sector organizations. This coalition, according to the report, will hold community-wide meetings, create and possibly implement public education campaigns, attract sponsors for a comprehensive drug use prevention strategy while also presenting data that will support the need for a research-based prevention programme. However, in the communities of study, there are no coalitions of any sort, with a focus on curbing adolescent drug use or illicit drug use of any kind in the communities involved in this study. Neither are there any reported small group meetings that attract support from those with great in uence in the communities speci cally for illicit drug use problem. With this much disinterest in the communities, it will greatly affect any strategies employed.
Communities remain the epicentre of solutions to drug use, however, they are helpless (15). Families are no different. They are faced with the sense of hopelessness and despair on one side, ignorance and denial on the other side, thereby serving as enablers to substance use and abuse (15). Therefore, the primary focus of any prevention strategy or intervention by any institution should rst seek to build community and family interest and involvement before anything else (9).

Study Limitations
The study focused only on the strategies. The public's perception of the factors that in uence adolescent illicit drug use and the consequences were, however, not explored. Although, this has been presented in another version of this paper.

Conclusion And Recommendations
To curb illicit drug use, proper funding of drug enforcement agencies, sensitization campaigns, health education and involvement of parents is very necessary for reducing adolescents' illicit drug Page 13/16 consumption.

As a recommendation:
Greater availability of good educational activities, material and leadership opportunities for adolescents are necessary to keep the adolescents purposefully busy. This would help a great deal towards mitigating adolescents' illicit drug use.
The government should also set up more rehabilitation centres to aid victims of drug use.
The government should be committed to funding such a programme (due to its capital intensive nature) as it is capable of restoring victims of drug addiction and misuse back to society.
The schools and universities should formulate policies to prevent drug use and should also hold seminars for parents and families to alert them early to the symptoms of drug use in their children.
The government can also introduce a drug education curriculum which will target nursery and primary school pupils and above to dissuade them from illicit drug consumption later in adolescence.
Government and parents/guardians should also ensure monitoring and regulation of media, especially social media contents to limit the in uence of such environmental factors on adolescents' choice and behaviour with regards to illicit drugs.

Declarations
Ethics approval and consent to participate The study was approved by the ethics committee of the Department of Sociology/Anthropology, University of Nigeria, Nsukka. Informed consent was obtained from all subjects or, if subjects are under 18, from a parent and/or legal guardian. Also, all methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication
Not applicable.

Availability of data and materials
The datasets used and/or analyzed during the current study are available from the lead author on reasonable request.

Competing interest
The authors declare that there are no competing interests. Funding