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Effect of Substance Use Screening on Early Detection of Substance Use Problems among University Students in Nigeria

Abstract

Substance use among university students is an important public health concern because the use of alcohol, tobacco, cannabis, prescription medicines for non-medical purposes, and other psychoactive substances may contribute to dependence, mental health difficulties, academic problems, injuries, risky behaviours, interpersonal difficulties, and other adverse outcomes. University students may be exposed to substance use through peer influence, academic pressure, social environments, availability of substances, and other personal or environmental factors. However, substance use problems may remain undetected when students do not voluntarily seek help or when symptoms are not recognized at an early stage. Substance use screening provides an opportunity to identify students who may be experiencing risky or problematic substance use and facilitate appropriate counselling, brief intervention, referral, and further assessment. Against this background, this study investigates the effect of substance use screening on early detection of substance use problems among university students in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Screening Theory. The Health Belief Model explains how students' perceptions of their susceptibility to substance-related problems, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in substance use screening. The Social Ecological Model emphasizes the interaction between individual, peer, family, university, community, and broader environmental factors in shaping substance use and access to preventive services. Screening Theory provides a framework for understanding the importance of systematic identification of health problems at an early stage, particularly among individuals who may not yet seek professional assistance. Collectively, these theoretical perspectives provide a suitable framework for explaining how substance use screening may influence early detection of substance use problems among university students in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise undergraduate students enrolled in selected public and private universities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, universities, faculties or departments, and eligible students. Substance use screening will be assessed using indicators such as availability of screening services, screening coverage, frequency of screening, use of standardized screening tools, confidentiality and privacy during screening, trained screening personnel, screening procedures, referral arrangements, brief intervention services, and follow-up mechanisms. Early detection of substance use problems will be assessed using indicators such as identification of risky substance use, hazardous use, possible substance-related dependence, patterns of frequent use, use associated with academic or social difficulties, self-reported substance-related problems, positive screening results, referral for further assessment, and linkage to appropriate counselling or treatment services. Data will be collected using structured questionnaires, validated substance use screening instruments such as appropriate standardized screening tools, university health records, counselling records where ethically and appropriately accessible, screening registers, referral records, and relevant student health programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, substance use patterns, and detection outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of substance use screening on early detection of substance use problems. Where a quasi-experimental design is adopted, detection rates before and after implementation of substance use screening programmes may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that substance use screening has a significant positive effect on the early detection of substance use problems among university students in Nigeria. Students who participate in systematic and confidential screening are expected to have a higher likelihood of having risky or problematic substance use identified than students without access to routine screening. Early identification may create opportunities for brief interventions, counselling, psychosocial support, further assessment, referral, and appropriate treatment before substance use problems become more severe. Confidential screening conducted in university health or counselling settings may also reduce barriers associated with stigma and fear of judgment. However, concerns about confidentiality, fear of disciplinary action, stigma, inadequate screening personnel, limited counselling and treatment services, low student participation, and insufficient follow-up may reduce the effectiveness of screening programmes. The study therefore expects confidential, non-judgmental, accessible, and appropriately implemented substance use screening programmes to contribute significantly to improved early detection of substance use problems among university students in Nigeria. The study is expected to contribute to the literature on substance use screening, early detection of substance use problems, university student health, substance-use prevention, mental health, health screening, counselling, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Drug Law Enforcement Agency, universities, university health services, counselling centres, mental health professionals, public health practitioners, student organizations, development partners, and policymakers regarding strategies for improving early identification and management of substance use problems among young adults. The study will also provide evidence-based recommendations for integrating confidential substance use screening into university health services, strengthening brief intervention and referral systems, improving counsellor and healthcare worker training, reducing stigma, protecting student confidentiality, and developing sustainable substance-use prevention and early intervention programmes across Nigerian universities.

Keywords: Substance use screening, early detection, substance use problems, university students, substance-use prevention, screening services, counselling, mental health, student health, Nigeria, public health.