Exploring the Impacts of Help-seekers’ Knowledge, Belief, and Attitude on the Choice of Treatment for Substance Use Disorder

doi:10.21203/rs.3.rs-5252406/v1

Background: Recently, Abia State, like other states in Nigeria, has been experiencinga growing number of deaths due to substance use, leading to substance use disorders and comorbidities. Family members and relatives usually seek treatment for those who, in some cases, do not have insight. However, their knowledge of how the substance affects, erroneous beliefs, and attitudes can reasonably impact theirchoice of treatment when a family member is affected.

Aim: Thisstudy investigated people's knowledge, beliefs, and attitudes and how they affect their treatment choices.

Method: A purposive sampling technique was employed to recruit 1,200 participants from a cross-sectional survey of three LGAs in Abia State. The35-item Knowledge, Beliefs, and Attitude Toward Treatment Questionnaire (KBATQ) was utilized to measure the study variables. Three hypotheses were advanced, and the data were analyzedvia IBM SPSS-23.

Results: Descriptive results revealeda high proportion of patients with poor knowledge of drug use disorders (up to 53.7%) as an issue that requiresmedical and therapeutic intervention. Multiple regression analyses indicated that having good knowledge, belief, and attitude toward drug use as a disorder predicted a high level of evidence-based treatment options for relatives of drug users (F (3, 1199) = 177.23, p<0.05). The study also revealed poor availability of rehabilitation centers.

Conclusion: In line with these findings, we concluded that the Abia State government should, as a matter of urgency, intensify drug use sensitization programs andlook into building more rehabilitation centers and that professionals, such as psychiatrists, clinical psychologists, and those who have completed universal treatment curriculum (UTC) courses,should be employed to provide evidence-based treatments for substance users. Relevant policies and interventions should target underlying socioculturalissues, such as stigma, lack of awareness, and cultural acceptance of substance use, to ensure greater effectiveness of interventions. Healthcare professionals, policymakers, and researchers have a crucial role in implementing these recommendations and improving the situation in Abia State.

Psychology

Attitude

Belief

Knowledge

Treatment choice

Rehabilitation

Substance use disorder

Drug use has escalated into a critical global issue, demanding urgent attention from researchers, policymakers, and stakeholders. This is not a localized concern, as even Abia State grapples with its repercussions. The widespread misuse of drugs among adolescents and youths is akin to a spreading wildfire, affecting not only individuals but also their families in profound and often devastating ways. The urgency of addressing this issue on a global scale cannot be overstated, and immediate action is imperative.

Drug abuse among the younger generation, popularly known as Generation Z (Gen Z), is becoming a grave concern, with younger adults and adolescents being the most hooked on it. The increasing trend of drug abuse is evidenced by the number of people on the street and by the presence of viral videos of youths who are supposedly affected by drugs. This increase in drug misuse could be attributed to the fact that users are not aware of the adverse effects of drugs on brain chemistry and behaviors. Often, users rely on the immediate gratification they obtain from using drugs, such as a compensatory mechanism against stress and even depression (Aalsam et al., 2023). Abikoye (2015) observed that substance abuse has become a significant public health concern due to its association with reduced quality of life as well as substance-related morbidity and mortality. He noted that substance use disorders take a heavy toll on patients, in terms of personal suffering, families because of the burden of care and lifetime lost productivity, and society at large.

According to Psychiatry's Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), for a user to be diagnosed with a drug use problem, the person's drug use must interfere with essential life functions such as parenting, work, and intimate relationships. This use must continue despite ongoing negative consequences, taking up a great deal of time and mental energy and persisting in the face of repeated attempts to stop or cut back. The intervention may also include the experience of needing more of the drug to achieve the same effect (tolerance) and suffering from withdrawal symptoms if use suddenly ceases. This can then lead to the inability to quit, despite adverse consequences, and even relapse after rehabilitation.

Drug use has continued to be high worldwide. In 2021, it was estimated that 296 million people (5.8% of the global population aged 15–64) had used various kinds of drugs (NBS, 2022). Among these individuals, it was estimated that 39.5 million people worldwide were suffering from drug use disorders in 2021 and that only 1 in 5 people with drug use disorders received proper drug treatment. In South America, more than half of those in drug treatment are under 25 years old, and in Africa, 70% are under 35 years of age (UNODC, 2018). In Nigeria, there is no reliable or comprehensive information on the drug situation or drug treatment status because we cannot obtain data from remote areas, and treatment choices vary in line with people's knowledge, beliefs, and attitudes. There are multiple barriers to accessing proper treatment, and there is a clear gap in the need for treatment and care for people with drug use disorders. Only a few high-risk drug users reported a self-perceived need for drug treatment. Approximately 40% of those reported that they had wanted to receive drug treatment but were unable to access such services. Most often, the cost of treatment, as well as the stigma associated with substance use in general and the unavailability of adequate drug treatment services, are significant barriers to accessing drug treatment in Nigeria (UNODC, 2018).

The need for treatment could also be affected by what people know about the etiology of a particular health problem. In this case, knowledge about drugs and possible health/behavioral changes associated with drug use was obtained. Many people seem to be aware of the dangers of drugs, particularly among youths. However, there could be a lack of understanding about the nature of addiction as a disease, which could lead to misconceptions. Eluke and Mbazie (n.d.) observed that people who use certain psychoactive drugs are often unable to sleep, are violent, and exhibit antisocial behaviors arising from paranoia and hallucinations. There are other comorbid mental health problems associated with drug misuse. When individual users, as well as family members, fail to understand that there are many psychological, behavioral, and mental health shifts associated with drug use, this poor knowledge may, in turn, affect their treatment choice. Additionally, people's religious beliefs may affect treatment options. Many Nigerians believe that any health issues that are not mainly medical could be spiritual. Hence, that belief can influence the choice of treatment. They may think that traditional practices and remedies are more effective at addressing drug use disorders than evidence-based practices and remedies are. Ohemu et al. (2021) reported that traditional medicine (TM) is more widely available to people in developing countries than modern medicine because it readily blends with the sociocultural life of people.

When people understand that substance misuse is a disease and not a sign of inadequacy or behavioral failure, it will change their attitude and lead to support and proper treatment. Hence, the choice of treatment that individual families may choose when they have a case of substance use disorder may be dependent mainly on their knowledge, beliefs, and attitudes (Bryan et al., 2000). The accuracy of drug-related knowledge is important because inaccurate information may influence the support and kind of treatment that relatives may choose for their family member who is affected by a substance use disorder. Previous research has examined public attitudes toward illegal drug use, its prevalence, the stigma associated with drug use, and prevention (Bakare, 2016; Abdulkareem, et al, 2016). However, to the best of the researcher’s knowledge, there is limited research on the factors affecting treatment choice. Against this background, this study seeks to investigate the knowledge, attitudes, and beliefs of people as factors affecting treatment options for individuals with substance use disorders. The objectives of the study were to investigate people’s level of knowledge about substance use disorders, (2) explore their beliefs in terms of religion and tradition, and (3) determine the extent to which their attitude could affect treatment choices they may opt for if they have a substance user. We hypothesized that knowledge, beliefs, and attitudes are strongly associated with the choice of treatment people choose when they have a relative who is affected by substance use disorders.

Design and Settings

A cross-sectional survey design was used to purposively recruit 1,200 participants sampled from three local governments in Abia State. Respondents were selected from Isuikwuato, Arochukwu, and Ohafia LGA. Among the 17 LGA governments in Abia State, these three LGA are rich in cultural heritage, traditional medicine, and hospitality. No federal or state hospital in any of the three LGAs has a foundation in drug treatment or psychiatry, which enforced their choice in the present study. The field assistants played a crucial role, spending four weeks each to gather data from their respective LGA. Each field assistant collected four (400) hundred well-filled questionnaires and presented them to the researchers of this study.

Participants

The researchers recruited one thousand two hundred (1,200) participants aged between 18 and 69 years from the local area. Participants were fully briefed on the study's objectives, and their consent was obtained before administering the questionnaire. The inclusion criteria were transparent, encompassing both genders, marital status, and residency within the study area. The exclusion criteria were equally clear, ensuring that only those who consented and were available during the questionnaire distribution were included. For further details on the participants, please refer to Table 1.

Instruments

The study instrument comprised four sections. Section A is for demographic variables; section B is for knowledge of drug use; section C is for beliefs; and section D encapsulates attitudes and knowledge of the availability of evidence-based treatment centers in Abia State.

This questionnaire was adopted from the Attitude Toward Drug Abuse subscale of the Ireland Drug Related Knowledge, Attitude and Beliefs Scale (KAB), and a study-developed 35-item Knowledge, Beliefs, and Attitude Toward Treatment Questionnaire (KBATQ) emerged. The scale comprises five dimensions:

A 10-item Knowledge of Drug Use Disorder Scale

An 8-item Belief in Drug Use Disorders Scale

An 11-item Attitude Scale for Drug Use Disorders

A 4-item treatment choice inventory

A 2-item drug use disorder rehabilitation rating scale

The validation process was thorough and comprehensive, instilling confidence in the instrument's reliability. Face and content validity were first assessed to standardize the instrument before determining the validity of the KABTQ. Exploratory factor analysis (EFA) was employed to measure the underlying factor structure of the scale (Beavers et al., 2013). The model fit using the chi-square ratio to degrees of freedom was satisfactory. According to the Kaiser–Meyer–Olkin (KMO) criterion, the value was .806, while Bartlett's test of sphericity was significant [X2 (df = 406) = 4113.61, p < .001], indicating that the relationships between the KABTQ items were sufficient (Tabachnick & Fidell, 2013). After examining the scree plot, nine factors accounted for 28.20% of the total variance and provided a factor structure solution. To ensure the applicability of the instrument to the participants, a pilot study was conducted using Ugwunanagbo, Obingwa, and Umunneochi LGA participants to assess the internal consistency and reliability of the instrument. The Cronbach's alpha value for the Knowledge of Drug Use Disorders dimension was α = 0.89, while the Belief factor reported a Cronbach's alpha value of α = 0.88, the Attitude of Drug Use Disorders factor reported a reliability score of α = 0.85, and the Treatment Choice subscale reported a Cronbach's alpha value of α = 0.75—all showing firm internal consistency among instrument items.

Procedure

The researchers, in a commitment to community involvement, engaged and trained three male field assistants. These assistants, all HND students from Abia State Polytechnic, Aba, were indigenes of the selected areas. Their local roots enabled them to connect with participants using their native dialects, fostering a sense of familiarity. They introduced themselves, explained the study's background and significance, and emphasized the voluntary nature of participation and the freedom to withdraw without repercussions, reassuring the participants and respecting their autonomy.

Respondents were allowed to provide their consent by ticking on the 'I Agree' box after reading the consent page and understanding the purpose of the questionnaire. This transparent process, which respects the participants' autonomy, was designed to ensure that they were fully informed and willing to participate. This research, by its nature, does not elicit psychological trauma. Nevertheless, each participant was given the phone number of the clinical psychologist who was part of this study. This professional was available in the case of any emotional distress due to brief intervention and for proper referral for rehabilitation if needed. Their names and photographs were not included, and the information they gave in the questionnaire was not provided to any third party not part of the study. The following ethical considerations were made at the cost of this study. Informed consent, nonmaleficence, anonymity, confidentiality, and beneficence were included. After the data collection, two other research assistants were employed to help code and input the data via IBM SPSS-23, where the data were ultimately analyzed.

Data Analyses

Finally, the data of the one hundred and two participants were collated and sorted before being organized and analyzed via IBM SPSS version 23 software. Descriptive and inferential statistics were employed. Frequent means, standard deviations, and correlations were calculated for descriptive purposes. For inferential statistics, multilinear regression was used to test the three hypotheses at the p < 0.05 significance level.

Table 1: Summary of descriptive statistics showing demographic features of participants selected (n = 1200)

The descriptive results in Table I reveal the demographic variables based on the information obtained from 1200 participants recruited in the study. Notably, there were 783 males (65.3%) and 417 females (34.8%), with ages ranging from 18 to 69 years, a mean age of 42.57 years, and a standard deviation (SD) of 13.76 years. A significant finding was that 46.3% of participants reported knowledge of drug use, indicating that 53.7% of the participants had poor knowledge and beliefs about drug use disorders. This suggests a prevalent lack of understanding of drug use as a disorder requiring medical therapeutic interventions and a high belief in traditional/spiritual healing. Table 1 provides further details on the demographic features of the participants.

Table 2: Summary of the zero-order correlation matrix of the study variables exploring the impacts of help-seekers’ knowledge, beliefs, and attitudes on the choice of treatment for substance use disorders.

Variable	Sex	Age	MS	EDU	OC	KD	BE	ATD	TC	KA
Sex	1
Age	.02	1
MS	.02	.45**	1
EDU	.02	.05	.07*	1
OC	.04	.03	.05	.06*	1
KD	-.03	.05	.04	-.03	-.01	1
BE	-.05	.01	.05	-.03	-.01	.41**	1
ATD	-.05	.01	.03	-.01	.03	.46**	.56**	1
TC	-.03	-.00	-.00	.03	.06	.42**	.44**	.49**	1
KA	-.04	.01	.02	-.01	.02	.29**	.32**	.35**	.28**	1

Note: MS = marital status; EDU= education; OC = occupation; K = knowledge of drug use disorder; BE = belief in drug use; ATD = attitude toward drug use; TC = treatment choice; KA = knowledge of availability.

*Correlation significant at the 0.05 level

**Correlation significant at the 0.01 level

The matrix results in Table 2 indicate that marital status was directly related to age (r = .45; p<0.01), while educational status was directly associated with marital status (r = .07; p<0.05). Belief in substance use disorder was directly related to knowledge of substance use disorder (r = .41; p<0.01). This means that the greater their belief in substance use disorders is, the more their knowledge of substance use disorders will be reinforced and enhanced. An attitude toward substance use disorders was directly associated with knowledge of substance use disorders and belief in substance use disorders (r = .46; p<0.01; r = .56; p<0.01). The participants’ treatment choices were significantly and positively related to their knowledge, beliefs, and attitudes toward substance use disorders (r= .42; p<0.01; r = .44; p<0.01; r = .49; p<0.01, respectively). According to the results of the final analysis, the coefficient matrix indicated that knowledge of availability was positively associated with knowledge, beliefs, and attitudes about substance use disorders as well as with treatment choice (r = .29; p<0.01; r = .32; p<0.01; r = .35; p<0.01; r = .28; p<0.01). In conclusion, the correlation results of key variables underscore the predictive power of good knowledge of substance use as a disorder that requires medical and therapeutic intervention when choosing evidence-based treatment options and instilling confidence in decision-making.

Table 3: Summary of multiple regressions based on the predictive influence of help-seekers’ knowledge, beliefs, and attitudes toward drug use disorders on the choice of treatment in the abia State.

Hypothesis One: Knowledge of substance use disorders significantly predicts treatment choice among relatives of substance users.

In testing the first study hypotheses, multiple regressions were utilized to ascertain the predictive role of knowledge, beliefs, and attitudes of substance use disorder and choice of treatment among relatives of substance users. The results presented in Table 3 imply that people’s knowledge, beliefs, and attitudes toward substance use disorders yielded a coefficient of multiple correlation (R) of 0.555 and multiple correlation square (R2) of 0.308. Specifically, approximately 30.8% of the variance in treatment choice was explained by the combined effects of knowledge, beliefs, and attitudes toward substance use disorders. Empirical results also revealed that knowledge of substance use disorders was an independent predictor of choice of treatment (β = 0.21; t = 7.43; p<0.05). Therefore, the first hypothesis, which stated that knowledge of substance use disorders significantly predicts the choice of treatment among relatives of drug users, was confirmed. These findings have practical implications for the treatment of substance use disorders among relatives of drug users, providing a roadmap for effective interventions.

Hypothesis Two: Belief in substance use disorder will significantly predict the choice of treatment among relatives of substance users.

Second, the results in Table 3 show that belief in substance use disorders predicted the choice of treatment among relatives of substance users (β = 0.19; t = 6.58; p<0.05). The direction of the regression indicates a positive relationship, which means that the greater the belief in substance use as a disorder that requires medical and therapeutic intervention is, the more evidence-based choice of treatment among relatives of substance users will improve positively in terms of seeking therapy. Based on this, the second hypothesis, which states that belief in substance use as a disorder significantly predicts the choice of treatment among relatives of substance users, was confirmed. This is also a pointer to the need for evidence-based treatment intervention.

Hypothesis Three: Patients’ attitudes toward substance use disorders will significantly predict their choice of treatment among their relatives.

Third, the results in Table 3 show that attitudes toward substance use disorders predicted treatment choice (β = 0.28; t = 9.27; p<0.05). The direction of the regression indicates a positive relationship, which means that the more objective a substance user is to be, the more likely he or she is to opt for mental health treatment options and vice versa. Given this, the third hypothesis, which states that attitudes toward substance use disorders significantly predict the choice of treatment among relatives of substance users, was confirmed. Finally, regression statistics showed a joint predictive influence of knowledge, beliefs, and attitudes toward substance use as a disorder on treatment choice, F (3, 1199) = 177.23, p<0.05. The regression again indicated a positive relationship among all the predictor variables, which implied that increased knowledge, beliefs, and attitudes toward substance use as a disorder among relatives of substance users were positive and that people were receiving pro-treatment/mental wellness. Additionally, their disposition toward the choice of treatment for their loved ones was more favorable, thereby helping them cheerleading the way toward tackling substance use disorders and comorbidities among young people. The study also revealed the poor availability of rehabilitation centers, which may have affected treatment options by limiting the choices available and potentially increasing the burden on existing facilities.

A stepwise regression was also conducted to determine the best-predicting variable out of the three independent variables. The results showed that attitude toward substance use disorders was the best predictor of treatment choice (F (1, 1199) = 368.99, p<0.05), accounting for 28.5% of the variance in choice of treatment out of the cumulative 30.8 percent obtained. In addition, knowledge of substance use disorder was the second-best predictor of treatment choice (F (1, 1199) = 235.84, p<0.05), with 4.8% variance out of the joint 30.8% reported, while belief in substance use disorder was the third-best predictor of treatment choice, with 2.5% variance in choice of treatment.

This study delved into the urgent need to address the impacts of help-seekers’ knowledge, beliefs, and attitudes on the choice of treatment for substance use disorders. The objectives were to investigate people’s level of knowledge about DUD, explore their beliefs in terms of religion and tradition, and determine the extent to which their attitude could affect treatment choices they may opt for if they have a substance user. Based on these findings, the main study hypothesis, which states that knowledge, beliefs, and attitudes significantly predict people’s choice of treatment when they have a relative who is affected by a substance use disorder, was tested. These findings partially align with those of the study conducted by Muzaffar et al. (2023), who assessed the knowledge, attitudes and practices of young people on substance use in a cross-sectional study of 270 youth and other things, which revealed that respondents had information about drug use and that they knew that euphoria, anxiety, aggressiveness, depression, and happiness can occur with substance abuse. The findings of this study also mirrored the findings of Ogochukwu et al. (2022), who evaluated the knowledge, attitudes, and practices of substance use among students and discovered that more than half of the participants had good knowledge of substance usage, but only 9.6% had a negative attitude toward drug use. A possible explanation for this finding is that most Africans are tribal beings and highly superstitious and religious. This disposition tends to rub off on them in virtually all facets of life and is capable of affecting their treatment choice for relatives with drug use disorders. Hence, this finding explains why knowledge of drug use disorders, beliefs, and attitudes jointly predicts treatment choice.

Other studies on the subject matter were not closely related, such as that of Shi et al. (2024), who indicated that male sex and low education level were significant factors affecting the lack of drug knowledge among residents. However, most of those empirical studies did not look at how knowledge, attitudes, or beliefs about traditional and spiritual aspects could play a role in the choice of treatment. To the best of our knowledge, this study is the first to investigate how the variables under study are related to treatment choice and to discover other militating factors, such as the lack of availability of evidence-based rehabilitation centers and poor knowledge of availability.

The results showed that, generally, participants have poor knowledge about substance use as a disorder and believe more about spiritual/traditional treatment, with negative attitudes that make them view a user as someone with character flaws or spiritual problems and not a disorder that needs medical and psychosocial treatment. As such, when a user exhibits characteristics of substance use disorders and psychotic features, they may attribute this to character flaws and spiritual problems that require spiritual and traditional solutions rather than psychological help. Similarly, the participants believed in the spiritual cause of problems so much, thereby externalizing the problem. Hence, they will readily opt for religious, spiritual, and traditional healing when an individual user exhibits some form of psychotic or abnormal behavior associated with substance use disorder. The study also revealed that there is a shortage of standardized evidence-based rehabilitation centers in Abia State, and participants have poor knowledge of the availability of rehabilitation centers, which could be a contributing factor to the choice of treatment. This finding is consistent with the study of Matthew et al. (2023), who reported a significant difference in the availability and accessibility of evidence-based treatments (EBTs) for community substance use disorder (SUD) treatment.

Pointedly, very few previous studies have evaluated knowledge, beliefs, and attitudes as factors affecting treatment choice. Abikoye (2015), in his study on factors affecting the management of substance use disorders, reported that participants believed that a major factor militating against the effective management of substance use disorders was poor knowledge of available facilities for managing such problems and uncertainty about where to go for treatment, the unavailability of specialized centers and facilities to manage substance use disorders, attitudinal problems, and cultural issues. Hence, the study concluded that there is a significant level of awareness among Abians as regards substance abuse, but there is need for significant advocacy of evidence-based treatment options that will help them realize various psychotic and behavioral factors associated with substance use.

Recommendations

Based on the results of the study, the following recommendations were made:

1. The Abia State government should put more effort into sensitizing the public about the dangers and health issues associated with substance use. This will build their knowledge of substance use as a disorder that requires medical and therapeutic attention and not a characteristic flaw.

2. The Abia State government should intensify its plan to open more rehabilitation and drop-in centers, as doing so will increase people’s knowledge and reduce the patronizing of herbal practices and beliefs in spiritual healing.

3. Clinical psychologists, psychiatrists, and other drug addiction professionals should be employed to address the increasing number of drug use disorders in the State.

Limitations

There are few previous empirical studies on this topic. As such, the present study lacked empirical evidence to support its findings.
The questionnaire was unique and too much for the participants to complete. Hence, field assistants took the time to explain and encourage them by telling them how the research would eventually benefit them if the government of Abia State included the findings in their policy to build more rehabilitation centers.
The cross-sectional nature of the study poses the question of social desirability effects and thereby limits the generalization of the findings.

Author Contributions

CRN: Study conceptualization, theoretical review, methodology, and discussion INJ: Introduction, theoretical review, and general supervision. DOI: Data analysis, instrument validation, results interpretation, references, proofreading and editing. All the authors read and made input before approving the final manuscript.

Competing Interests

The authors declare that no competing interests exist.

Data availability statement

The data supporting the findings are coded and stored in statistical software, which can be made available by the lead author upon reasonable request.

Ethical considerations

Ethical clearance was obtained from the Ethics Committee, Department of University Teaching Hospital, Aba, Abia State, while informed consent was obtained from respondents before administering the questionnaires.

Funding

The authors did not receive any financial support for this study.

ORCID iD

Chiamaka R. Nwaoru https://orcid.org/0009-0008-8940-8649

David O. Iloma https://orcid.org/0000-0002-4370-437x.

Ignatius N. Ijere https://orcid.org/0000-0002-2400-9806

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The authors declare no competing interests.

Exploring the Impacts of Help-seekers’ Knowledge, Belief, and Attitude on the Choice of Treatment for Substance Use Disorder

Status:

Version 1

Abstract

INTRODUCTION

METHOD

Design and Settings

Participants

Instruments

Procedure

Data Analyses

RESULTS

Discussion and Conclusions

Declarations

References

Additional Declarations

Status:

Version 1