High-Risk Substance Use in Kenyan Students

Abstract

This dissertation focuses on high-risk prevalence among Kenyan high school, college, and university students. International organizations and numerous researchers indicate that this problem is universal and especially acute for developing nations. Consequently, scientific evidence reveals that Kenya suffers from the situation, meaning that a study is needed to investigate this issue. The purpose of this study is to identify the correlates, trends, and prevalence of high-risk substance use among Kenyan youth to arrive at policy implications and recommendations. This aim further gives rise to four questions that guide the research process. In order to answer them, the dissertation relied on a qualitative methodology because a systematic literature review was conducted. The study used the PubMed database to locate relevant articles and analyze them. According to the inclusion criteria, the dissertation drew attention to the studies published in 2017-2021 and available in full text. In addition to that, Google Scholar was manually searched to enrich the dissertation with more relevant and credible resources. Nine suitable articles were located, and they allowed for making some valuable conclusions. Kenya suffers from increasing alcohol, cannabis, and cocaine abuse when compared to international data. Poor knowledge, easy access to high-risk substances, and the COVID-19 pandemic contribute to the problem. Kenya requires an immediate and comprehensive approach to address the issue identified. The Kenyan government, healthcare professionals, law enforcement agencies, and other responsible organizations can use the findings to see that high-risk substance abuse is severe in the African country. Consequently, the dissertation’s leading implication is that it can make responsible officials and organizations start mitigating the problem.

Introduction

Background

High-risk substances represent a significant challenge for the whole world. They include many dangerous materials, but alcohol and illicit drugs are the most typical among them. People from many world countries are subject to the issue under analysis. For example, approximately 21 million Americans have at least one form of addiction (Addiction Centre, 2021, para. 1). In particular, alcohol leads to about 88,000 deaths annually, while opioid overdose is a cause of 130 deaths per day (Addiction Centre, 2021, para. 2-3). Simultaneously, the worldwide addiction analysis demonstrates that European regions also experience a negative effect because alcohol dependence was 843.2 per 100,000 individuals, and cannabis dependence was 259.3 per 100,000 people (Peacock et al., 2018, p. 1905). At the same time, the scholars admit that the addiction rates are significantly higher for low- and middle-income countries (Peacock et al., 2018, p. 1905). The problem leads to adverse consequences among older adults (Morgan, Brosi and Brosi, 2011) and the youth (Madu and Matla, 2003). That is why it is possible to suggest that the problem is of significance for Kenya that is a lower-middle-income economy.

Sufficient background information justifies that there is some reasoning behind focusing on Kenya. In particular, South Africa is the region that significantly suffers from the issue under consideration. Thus, alcohol is considered the most widespread addiction source that is followed by methamphetamine, heroine and others (Pasche and Myers, 2012, p. 338). The problem affects many age groups, including adults and younger individuals. However, many studies demonstrate that addiction among adolescents should deserve more attention since this behaviour is a predisposing cause to a higher spread of the problem in the future. An article by Morojele, Brook and Kachieng’A (2006, p. 215) demonstrates that drugs’ reinforcing effects are leading drivers of this behaviour among South African youth and states that drug abuse leads to risky sexual behaviour. Consequently, it is impossible to undermine the importance of alcohol and drug abuse.

This state of affairs implies that the problem is of large scale, meaning that it is necessary to address it. Audet et al. (2017) stipulate that traditional healers often deal with treating substance abuse in rural South Africa. These individuals rely on conventional medicine, meaning that no modern medical practices are actively used to address the problem. Simultaneously, many other barriers result in the fact that no effective intervention can be proposed. According to Pasche and Myers (2012, p. 340), many alcohol and drug addicts cannot get adequate treatment because of high cost, the necessity to travel long distances to get treatment and a small number of treatment centres. That is why there is no doubt that the issue of high-risk substance overuse is insufficiently covered in South Africa.

It is possible to admit that the situation in Kenya is similar to that in the region. Sufficient evidence demonstrates that both adolescents and adults suffer from the issue (Muriungi et al., 2014; Ndetei et al., 2009; Secor et al., 2015). In particular, 84% of Kenyan private university students consume alcohol, while the cocaine use rate is 5% (Muriungi et al., 2014, p. 126). Ndetei et al. (2009, p. 73) also admit that many individuals start using drugs and alcohol when they are eleven years old. This information demonstrates that the problem is acute for the Kenyan society because its citizens become exposed to substance abuse from an early age, which adversely affects the nation and people. For example, a scholarly article indicates that substance abuse can motivate men to have sex with other men, which correspondingly leads to mental problems, including depression and others (Secor et al., 2015, p. S251). It denotes that high-risk substance overuse is not the final problem because it can be predecessors of other adverse phenomena among the Kenyan population.

It is also reasonable to explain that many factors can contribute to the spread of the issue. Individuals in Kenya engage in substance consumption for many reasons, including relaxation, stress relief, peer pressure, desire to experiment and many others (Muriungi et al., 2014, p. 132). Simultaneously, multiple life conditions such as financial difficulties, psychological challenges and others also make individuals look for solutions in alcohol and illicit drugs (Muriungi et al., 2014, p. 132). These findings demonstrate that high-risk substance abuse is a comprehensive and multi-faceted challenge in Kenya because it is a result of versatile risk factors, affects many social and age groups and leads to adverse consequences. Thus, scientific efforts to research this problem are welcomed and justified.

Proposed Study

This information presents the reasoned rationale for the proposed study. Since high-risk substance abuse is a worldwide challenge, and low- and middle-income states witness the most significant consequences, it is rational to draw sufficient scientific efforts to address the given issue. Since Kenya is an at-risk country, it is appropriate to research how the problem is represented in this South African nation. The literature review is a suitable methodology since this approach allows for collecting and synthesising relevant and credible data on the topic. The proposed study attempts to find reliable literature, identify the prevalence of the issue, find key risk factors, comment on the emerging trends and explain how these findings can affect policymaking and practice areas.

Research Aims

The purpose of this study is to identify the correlates, trends and prevalence of high-risk substance use among Kenyan high school, college and university students. A few separate actions are necessary to cope with the task above. (1) A narrative approach to reviewing the literature allows for locating published and unpublished materials from 2011 to 2021. (2) The identified research pieces are analysed, and the results of this process are critically examined and disseminated. (3) The final step is to formulate conclusions and offer reasonable recommendations for future research.

Research Questions

The aims above demonstrate that the study’s objective is to find the relevant articles that can present the required information. That is why the research looks for numerous studies that can reveal how the issue of substance abuse is presented in Kenya, who is the most affected in this nation and what further practice and theory implications it is possible to generate from the identified data.

A few specific questions guide this review, and they are presented below:

1. What is the prevalence of high-risk alcohol and drug use among Kenyan high school, college and university students?
2. What are the correlates of high-risk alcohol and drug use among Kenyan high school, college and university students?
3. What are the high-risk substance use emerging trends among Kenyan high school, college and university students?
4. What do the findings of the research mean to policy and practice?

Significance of the Study

The given review presents important information for the research field. Firstly, the study aims to determine how prevalent high-risk alcohol and drug use is in Kenya. This finding will demonstrate whether it will be necessary to take any measures to address the problem. In particular, the review can show that the problem is widespread in this country, meaning that authorities should mitigate it. Secondly, the research is expected to reveal what subpopulation groups are more at-risk. The information above indicates that adolescents and adults are affected (Morgan, Brosi and Brosi, 2011; Madu and Matla, 2003; Muriungi et al., 2014; Ndetei et al., 2009; Secor et al., 2015). However, a more detailed answer as to what groups are more in danger will help choose a more suitable response.

Finally, the review attempts to contribute to the existing body of knowledge because it looks for the current trends. For example, Muriungi et al. (2014, p. 126) admit that the vast majority of Kenyan students consume alcohol, while a cocaine consumption rate is 5%. These data reveal that there exists a threatening trend among the Kenyan youth. This information is valuable since it can demonstrate how the problem develops and what future issues it can bring. Consequently, a review’s practical implication is that it can help identify challenging phenomena and issues regarding high-risk substance use in Kenya.

Literature Review

The issue of alcohol and illicit drug abuse has always attracted the attention of many scholars. That is why numerous studies are devoted to how these addiction types affect individuals (Liu, Lien and Fenske, 2010; Pluddemann et al., 2007; Taplin et al., 2014; Diala, Muntaner and Walrath, 2004). Some of them focus on this behaviour’s adverse consequences, including the articles that admit impact on the skin (Liu, Lien and Fenske, 2010), neuropsychological outcomes (Fernández-Serrano et al., 2010) and genetic problems (Volkow and Li, 2005). Other scholars aim to determine how widespread the issue is to describe its epidemiology, and they research when and why people start using alcohol and drugs (Taplin et al., 2014; Feng, Zhang and Li, 2018; O’Malley, 2002). This information allows for concluding that the topic under investigation receives adequate attention in the scientific field.

However, it is still possible to claim that there are some gaps in this area, and they justify additional studies on the topic. That is why Chapter 2 is formatted in a way to reveal these gaps or insufficient evidence, which is further considered as a rationale to undertake the current review. In particular, the literature review section consists of four separate sections that cover the key themes.

High-Risk Substance Use

In the beginning, it is rational to explain what high-risk substances are, what consequences they bring and what high-risk substance use means. In an attempt to identify this information, this section mentions the findings from a few scholarly articles that focus on the same issue. Thus, the end of this section offers a specific definition of high-risk substances, and this step is necessary to explain and justify the focus on the given review.

At present, there is no agreement regarding any exhaustive list of all high-risk substances. For example, a large cohort study stipulates that these substances are alcohol and cannabis (Patton et al., 2007, p. 607). The researchers indicate that high-risk drinking is found when men consume 43 standard drinks per day, while 28 daily drinks indicate the limit for women (Patton et al., 2007, p. 608). The findings demonstrate that alcohol and cannabis use is widespread within the study’s sample. One can indicate that the given article offers high-quality evidence since it monitored the sample size for ten years and utilised a quantitative methodology to measure consumption behaviours. However, it is possible to admit a gap because the study does not draw attention to other drugs except for cannabis.

The study above is not the only one that focuses on the two substances. In particular, Thayer et al. (2015, p. 130) analyse the effect of alcohol and marijuana on individuals, and the scholars admit that alcoholic beverages adversely impact people’s decision-making abilities. This conclusion seems credible because the authors conducted an experiment to identify how the high-risk substances affect brain functionality. A quantitative methodology offers high-quality evidence and allows for concluding that alcohol worsens decision-making abilities, while marijuana use does not result in such consequences (Thayer et al., 2015, p. 130). A potential gap also refers to the fact that the study does not focus on many high-risk substances.

It is necessary to admit that high-risk substances do not only hurt individuals who use them. Alcohol and drugs adversely affect families, and children experience the most damaging consequences. For example, it is believed that when parents overuse these high-risk substances, their children are more likely to experience abuse or neglect (Sandau-Beckler, Devall and de la Rosa, 2002, p. 305). The scholars rely on a qualitative methodology to arrive at this conclusion, meaning that a quantitative study is necessary to test the authors’ hypothesis. In addition to the selected methodological framework, the article is limited because it only focuses on two high-risk substances.

A few studies focus on more high-risk substances in addition to alcohol and marijuana or cannabis. For example, a quantitative article used many assessment periods to identify how alcohol, heroin and cocaine consumption affected individuals (Raj et al., 2007). The authors concluded that cocaine use resulted in the fact that individuals became more sexually active and engaged in selling sex behaviours (Raj et al., 2007, p. 169). It is possible to state that the article has a gap because it does not draw attention to what people groups are subject to this adverse impact.

A qualitative article is suitable to assess how the problem is presented in an African context. In particular, a study in Mpumalanga, South Africa, found that alcohol and other drug abuse are a fundamental problem in the community (Oladeinde et al., 2020, p. 1). The authors communicated with 48 stakeholders from rural areas to identify how the issue affects them. The consequences of alcohol and drug abuse included “unemployment, poverty, stress, peer pressure, criminal activity, corruption and a proliferating number of taverns” (Oladeinde et al., 2020, p. 1). This information denotes that people from Mpumalanga significantly suffered from the problem, but the focus on people from rural areas makes it challenging to generalise the findings to other populations.

High-risk substance abuse is such a significant problem in South Africa that professionals from various fields draw attention to this fact. Thus, statisticians and mathematicians are among these experts, and they focus on a connection between drug abuse and crime rates in Western Cape (Nyabadza and Coetzee, 2017). These researchers highlight that high-risk substance use is a significant problem, which leads to increased crime rates in the area (Nyabadza and Coetzee, 2017, para. 3). That is why the authors emphasise the necessity to use specific theoretical models to forecast the issue and develop effective interventions. The study’s gap refers to the fact that it offers a single model to deal with various drugs.

Some researchers indicate that various substances can lead to highly adverse consequences. Thus, a study of 161 men and 108 women from South Africa revealed that methamphetamine use contributed to severe depressive symptoms (Berg et al., 2017, p. 493). Furthermore, the authors indicated that this drug abuse was associated with childhood sexual abuse (Berg et al., 2017, p. 493). This finding demonstrates that methamphetamine use is a crucial challenge in South Africa, but further studies are necessary to determine how the issue is presented in other African countries, including Kenya.

A significant part of the research field focuses on what outcomes high-risk substances bring. For example, a prospective cohort study using a quantitative methodology focused on alcohol and drugs as the most typical high-risk substances (Levy et al., 2009). These researchers focused on adolescents and identified that there was a positive correlation between alcohol and drug consumption and risky sexual behaviours (Levy et al., 2009, p. 1). The scientific and credible approach to the problem demonstrates that the authors offer high-quality evidence. However, it is reasonable to admit the study’s gap because it focuses on a limited population group and fails to disclose how specific substances affect teenagers’ behaviour.

Simultaneously, it is helpful to identify whether a randomised controlled trial addresses such a topic. The article by Kurtz et al. (2013) satisfies this criterion, and the authors focus on the correlation between high-risk substance abuse and the sexual behaviour of men having sex with men. The scholars stipulate that high-risk substances refer to crack, cocaine, methamphetamine, sedatives, opioids, alcohol, and others (Kurtz et al., 2013, p. 2919). The randomised controlled trial generates credible evidence indicating that substance abuse subjects this population group to having HIV (Kurtz et al., 2013, p. 2914). An evidence gap refers to the fact that the study only focuses on a single facility, meaning that other contexts can produce different results.

A qualitative study can also offer valuable information regarding the topic under consideration. Such an approach is suitable for focusing on what mental consequences come from consuming alcohol, cocaine, heroin, and others (Bradizza and Stasiewicz, 2003). The authors demonstrate that individuals experience many adverse symptoms, including paranoia, loss of appetite, nervousness and anxiety (Bradizza and Stasiewicz, 2003, p. 160). Structured qualitative data analysis allows for concluding that the findings are of high quality. However, there exists a methodological gap in evidence, meaning that it can be reasonable to undertake further quantitative research to identify how prevalent these symptoms are.

In conclusion, the information above allows for offering a definition of high-risk substances. They are alcohol, cannabis, amphetamine-type stimulants, opioids, inhalants, sedatives, hallucinogens and other substances that adversely affect human organisms and contribute to risk-taking behaviours. The heterogeneity in methodology helped investigate the issue from different aspects and arrive at high-quality evidence. However, it is also essential to stipulate that some evidence gaps exist in the literature. In particular, it refers to the fact that the reviewed studies focus on limited contexts and fail to compare how different population groups are affected. Consequently, the following themes in Chapter 2 will address the identified limitations.

High-Risk Substance Use Prevalence

In the beginning, it is rational to investigate the global epidemiology of the issue under analysis. According to Peacock et al. (2018, p. 1905), more than 18% of the adult population were subject to heavy episodic alcohol use, over 15% were exposed to tobacco smoking, 3.8% used cannabis, and 0.77% consumed amphetamine. These statistical data make it clear that substance dependence and substance-attributed mortality rates are relatively high globally. These conclusions are of the highest quality because the researchers dealt with the official information provided by the World Health Organisation (WHO). Even though the current piece of research offers a credible and reliable conclusion, further studies are necessary to identify the regional and social representation of the problem.

A significant body of research is devoted to high-risk substance abuse in sub-Saharan Africa. A systematic review of 71 studies focused on data from 1983 to 2017 (Kuteesa et al., 2019, p. 3199). The authors found that alcohol abuse prevalence was more than 32% (Kuteesa et al., 2019, p. 3199). As for drug overuse, the data were versatile, and they differed for multiple substances. For example, the prevalence for injection drugs was 0.1%, while that for khat was more than 97% (Kuteesa et al., 2019, p. 3199). This information reveals that the problem of high-risk substance abuse is widespread in sub-Saharan Africa, which allows for supposing that the state of affairs is not better in Kenya.

Various studies demonstrate that high-risk substance abuse is prevalent in specific countries. For example, diverse population groups in Malawi suffer from alcohol and drug overuse. On the one hand, more than 50% of respondents in a mixed-methods study reported hazardous alcohol use (Lancaster et al., 2018, p. 782). These authors focused on female sex workers, and this finding was not a surprise because that population was subject to deviant behaviour. On the other hand, the issue under analysis is prevalent in the Malawi defence force because, among 944 male and female service members, 24% reported hazardous alcohol drinking and 6% used cannabis (Tran et al., 2018, p. 2851). This finding demonstrates that Malawi significantly suffers from the problem, but these results are limited to particular population groups, meaning that further research is necessary.

Sufficient attention is also devoted to various individuals in Ethiopia. A systematic review and meta-analysis of 676 studies assessed the lifetime prevalence of alcohol and drugs among Ethiopian students (Roba et al., 2019). The researchers have found that alcohol prevalence was over 46%, while substance abuse was more than 52% (Roba et al., 2019, para. 3). Simultaneously, a cross-sectional study of 1,588 adults revealed that more than 48% suffered from alcohol abuse (Getif, Azale and Niguise, 2019, para. 3). These findings demonstrate that the problem under analysis is relatively widespread in Ethiopia because the results are consistent for various populations. This fact allows for concluding that the problem is similarly represented in Kenya because the two countries have similar cultures, but further studies are necessary to identify whether it is true.

In addition to that, pregnant women draw scientists’ attention when it comes to drug and alcohol prevalence. For example, a quantitative study by Vythilingum et al. (2012) assesses the prevalence of alcohol and drug abuse among pregnant women in South Africa. The scientists recruited 323 women and asked them to complete questionnaires; the results indicated that “36.8% of women smoked, 20.2% used alcohol and 4% used substances” during pregnancy (Vythilingum et al., 2012, p. 851). Simultaneously, another article using interviews of 376 pregnant women obtained the following results (Onah et al., 2016, para. 2). Of these respondents, 18% reported current alcohol and other drug use, which typically results in essential health issues for mothers and their children (Onah et al., 2016, para. 3). The utilised methodologies presented credible data, but it is necessary to admit that the reliance on participants’ self-reports can result in an evidence gap.

High-risk substance abuse is widespread in many African countries, and Ethiopia is no exception. A quantitative cross-sectional survey focuses on the prevalence of the issue under analysis among Ethiopian students (Tesema et al., 2020). The scientists included 1,214 participants to identify how many individuals deal with the issue and found that “the lifetime prevalence of psychoactive substance use was 66.5%” (Tesema et al., 2020, p. 847). This finding demonstrates that the nation is among those developing countries that significantly suffer from high-risk substance abuse among the youth. The study’s findings can be applied to other African countries, but it is still necessary to remember that it focuses on the specific context, meaning that the results should be interpreted with caution.

The previous article is not unique in commenting on how the problem under consideration is represented in Ethiopia. A cross-sectional study using a self-administered questionnaire also researched the prevalence of alcohol consumption among Ethiopian students (Deressa and Azazh, 2011, para. 2). These authors managed to identify that 22% of all the respondents (622 members) consumed alcohol in the previous twelve months (Deressa and Azazh, 2011, para. 2). These findings can reveal a crucial problem for the country, but it is also necessary to understand that the results rely on self-administered questionnaires, meaning that the finding is subject to participants’ biases. Simultaneously, a cross-sectional study focused on high-school students from Ethiopia and obtained approximately the same results (Reda et al., 2012). The scientists assess the data from 1,721 students and concluded that more than 22% overused alcohol (Reda et al., 2012, para. 3). These findings reveal that Ethiopia significantly suffers from the issue, which allows for supposing that a similar situation is in Kenya.

One of the previous articles has already commented on South Africa, but it had a limited focus on pregnant women. That is why it is rational to introduce the findings of a scientific paper by Parry et al. (2004), who assess the trends in adolescent alcohol use. The researchers indicate that the proportion of adolescents in abuse treatment centres increased from 5-7% in 1997 to 22-24% in 2001 (Parry et al., 2004, p. 432). Even though these findings are credible, they are limited to a specific context, making it impossible to generalise the results to other countries and populations.

Since Nigeria is in relatively close proximity to the African countries above, it is not a surprise that high-risk substance abuse is also topic there. That is why a cross-sectional descriptive study by Bassi et al. (2017) focuses on the prevalence of the issue among secondary school adolescents. Among 400 respondents, the most commonly used substances included “alcohol (52.58%), analgesics (33.7%), marijuana (2.59%)” and others (Bassi et al., 2017, p. 11). These findings support the thought above that the spread of high-risk substances is similar among neighbouring African states. However, it is necessary to remember that the findings come from a particular geographic region, meaning that it is impossible to generalise the results to the whole nation.

In addition to that, some researchers focus on how prevalent high-risk substance abuse is among undergraduate students. Thus, a cross-sectional descriptive study by Johnson et al. (2017, p. 11) focuses on 350 individuals. The authors identified that psychoactive substance prevalence was 27.5%, with alcohol, codeine and tramadol being the most commonly used substances (Johnson et al., 2017, p. 11). This information demonstrates that the issue under analysis is widespread among Nigerian students, meaning that appropriate actions are necessary to address the problem. Thus, further research is essential to investigate how high-risk substance abuse affects other population groups.

Finally, it is rational to focus on substance abuse among other populations of this African country. Olowo (2020) considers whether drug abuse is prevalent among Nigerian pre-service teachers. The author concludes that almost one-third of the study respondents had positive attitudes toward drug abuse (Olowo, 2020, p. 507). The scholar relied on a descriptive design to arrive at such a conclusion, meaning that a quantitative methodology should be utilised to check the results.

In conclusion, the given theme has demonstrated that high-risk substance use is a significant problem globally. Millions of people from different countries, including Nigeria, South Africa, Malawi, Ethiopia and others, suffer from alcohol and drug abuse, and credible evidence supports this claim. Furthermore, the narrative above has revealed an essential aspect regarding the fact that evidence gaps can affect the quality of studies that rely on respondents’ self-reports.

High-Risk Substance Use Correlates

Since the previous theme has explained that high-risk substance use is a widespread problem, it is reasonable to research what factors contribute to this state of affairs. In fact, multiple correlates can result in the fact that people are more or less subject to overusing alcohol and various drugs. Quantitative and qualitative studies represent this theme, meaning that scholars arrive at conclusions by focusing on statistics and working with qualitative data.

Since it has been found that South Africa significant suffers from high-risk substance abuse, it is necessary to consider what factors are associated with this deviant behaviour. A quantitative study of 547 subjects focuses on how the issue is represented among schizophrenia patients (Koen, Jonathan and Niehaus, 2009, p. 8). The authors found that being a man and using substances in the teenage years contributed to alcohol and marijuana abuse in adult years (Koen, Jonathan and Niehaus, 2009, p. 8). This study offers findings that are specific to the South African context, but further research is also necessary to identify what correlates exist when it comes to high-risk substance use by adolescents.

The article above is not unique in addressing South Africa. A quantitative study of 2,930 students focuses on how the issue is represented among schizophrenia patients (Flisher et al., 2003, p. 58). The scholars demonstrate that various issues contributed to the spread of the problem. For example, repeating a grade led to alcohol use, cigarette and alcohol use was associated with cannabis overuse, while the absence of at least one parent subjected female students to marijuana overuse (Flisher et al., 2003, 2009, p. 58). The focus on adolescents means that the findings cannot be generalised to other populations.

Many scholars also focus on Nigeria to understand what factors contribute to the spread of high-risk substance use in this country. Thus, a quantitative study focuses on 443 students to identify what correlates make them consume alcohol (Abayomi et al., 2013, p. 320). The Alcohol Use Disorders Identification Test allowed the researchers to determine that alcohol abuse was a significant problem for the population, while a male gender, higher paternal education, and psychological distress were the correlates (Abayomi et al., 2013, p. 320). These findings can be considered relevant, but it is also necessary to remember that they are limited to a specific population from a particular geographical area.

It is reasonable to consider other studies to see what correlates are associated with the problem under consideration. Thus, a survey of 860 senior secondary school students using a modified WHO Student Drug Use Questionnaire is appropriate (Igwe et al., 2009, p. 277). These authors identified that age and gender could be considered leading correlates. The rationale behind this statement is that male students and those of 14-16 years old are more subject to high-risk substance abuse (Igwe et al., 2009, p. 280). These findings demonstrate uncontrollable processes contribute to the problem among adolescents, but the results are limited to a specific population group.

It is reasonable to look at a more recent study that focused on the same problem and environment. That is why a quantitative survey by Ajayi and Somefun (2020, p. e0232964) is suitable because the authors investigate drug abuse among 784 male and female Nigerian university students. On the one hand, the scholars found that being a man was associated with high recreational drug use rates (Ajayi and Somefun, 2020, p. e0232964). On the other hand, the researchers determined that living with one’s mother, having adequate family support and religiosity contribute to a lower probability of using recreational drugs (Ajayi and Somefun, 2020, p. e0232964). These authors offer information that can be used as a guide to combat the problem under consideration.

Different population groups are under focus in this literature review, and many articles focus on college students. In particular, it also refers to a cross-sectional study that analyses the Nigerian context (Ajayi, Owolabi and Olajire, 2019). The researchers investigate how high-risk substances are represented among the selected population. They stipulate that alcohol and drug abuse correlates include male sex, being over 19 years old, less frequent involvement in religious rituals and others (Ajayi, Owolabi and Olajire, 2019, p. 1). These high-quality data reveal that many factors contribute to the spread of alcohol and drug abuse in Nigeria.

Other studies also have similar findings regarding high-risk substance use correlates. A quantitative survey by Brunette et al. (2018) focused on individuals in first-episode psychosis to identify what characteristic features predetermine abuse. The scholars stipulated that widespread correlates included male sex, white race, hyperactivity, depression, and others (Brunette et al., 2018, p. 4). The appropriate methodology leads to an increased value of the findings, but it is reasonable to admit that the study focuses on a limited context, which makes it impossible to generalise the results.

Many scientists decide to focus on a limited population group to identify how the problem is presented among these people. Thus, Neupert et al. (2017, p. 315) conducted “a daily diary study using Interactive Voice Response (IVR) technology” with 117 men who were on probation. The researchers stipulated that daily stressors could be considered essential correlates of alcohol and drug abuse (Neupert et al., 2017, p. 323). The article presents high-quality evidence, but a gap is present because the sample size is relatively small and includes representatives of a highly specific group.

There are also some correlates that refer to cocaine abuse. Kerridge et al. (2019) focused on this issue and conducted an analysis of the data from epidemiological surveys. The authors stipulated that cocaine abuse had many correlates, including older age, lower income, living in urban areas, being white and others (Kerridge et al., 2019, p. 250). The researchers processed secondary data and arrived at a credible conclusion, but the focus on the United States resulted in an important evidence gap.

Drinking behaviours are also widespread among different populations and age groups. Thus, a quantitative study by Han et al. (2018) demonstrates that many factors contribute to this problem among men of 50 years old and higher. In particular, the list of correlates consists of higher income, illegal drug use and past-month tobacco use (Han et al., 2018, p. 48). The quality of evidence is compromised because the scholars relied on participants’ self-reports, which means that the results can lack trustworthiness.

Zimbabwe is also among those nations that suffer from cannabis abuse. In particular, the problem significantly affects adolescents, and many correlates are associated with this deviant behaviour. A descriptive cross-sectional study by Chivandire and January (2016, p. 53) focuses on the problem and found that alcohol consumption, cigarette smoking and sexual experience are associated with overusing cannabis. Even though the authors support their conclusions with statistical calculations, it is reasonable to remember that the results are limited to a specific setting.

In conclusion, the findings from this theme have demonstrated that high-risk substance abuse can have numerous correlates. They can include social status, age, income level, gender, origin, residence place and many others. In particular, the synthesised evidence from the theme has revealed that these correlates are specific for different contexts. This information demonstrates that the selected articles have a gap because their findings are only relevant to a particular population group or geographical location. This statement justifies the need to study the Kenyan context in this dissertation.

High-Risk Substance Abuse Treatment

The information above has demonstrated that alcohol and drug abuse is a severe problem that affects many individuals in multiple world countries. Many factors contribute to the spread of the issue, which means that a sensitive topic is to consider how and whether it is possible to treat addictions. That is why available evidence on treatment approaches and outcomes in different nations will be presented below.

The information above makes it clear that Nigeria requires adequate actions to be taken to provide addicted people with assistance. A quantitative study by Joseph et al. (2019, p. 29) focuses on 40 students from a faith-based university and stipulates that psychosocial, spiritual and medical treatment interventions are possible. The authors conclude that psychosocial treatment is the most effective approach because 100% of members participated in it and reported positive changes (Joseph et al., 2019, p. 30). These findings are relevant, but they cannot be generalised to other population groups or settings because the researchers considered highly specific populations.

Not all African countries can impress with successful outcomes of alcohol treatment programmes. In particular, a cross-sectional survey of 1,500 adults from Ethiopia revealed that numerous people did not participate in treatment activities (Zewdu et al., 2019, para. 2). The researchers stipulate that 87% of alcohol addicts did not receive help. The reasons were that they “wanted to handle the problem on their own, believing that it would get better by itself and being unsure about where to go” (Zewdu et al., 2019, para. 3). This information allows for supposing that treatment ineffectiveness can be found in neighbouring African states.

Evidence from South Africa also demonstrates the inefficiencies of treatment. A study by Morojele and Ramsoomar (2016) enumerates multiple pharmacological treatment methods that can be used to address alcohol overuse. Possible medicines include disulfiram, various antidepressants and others, but their use is limited in South Africa (Morojele and Ramsoomar, 2016, para. 15). In particular, the researchers highlight the fact that the country has few treatment centres, which results in a low number of individuals receiving such assistance (Morojele and Ramsoomar, 2016, para. 16). Consequently, these findings reveal that additional attention should be drawn to treating alcohol overuse in South Africa.

It is possible to admit that high-risk substance abuse treatment is not a stable approach because it experiences some changed attitudes. Thus, a review by Blanco-Gandía and Rodríguez-Arias (2018) focused on the development of pharmacological treatments for opiate and alcohol addiction. According to the authors, “for alcohol use disorders, acamprosate, nalmefene and naltrexone are replacing disulfiram prescription” (Blanco-Gandía and Rodríguez-Arias, 2018, p. 89). This study highlights the existing gap because it is necessary to keep conducting research to find more effective treatment approaches.

In addition to that, many articles focus on drug abuse treatment. Weiss et al. (2015, p. 112) conducted a quantitative study of 375 individuals to assess the effectiveness of a multi-site clinical trial that examined “different durations of buprenorphine-naloxone plus standard medical management.” The researchers managed to find significant improvement in drug abuse among some participants, but the presence of those individuals who strengthen their heroin and opioid use revealed a gap. It means that further research is necessary to find more effective treatment strategies.

A significant part of the research field demonstrates the positive effects of different interventions to reduce drug abuse. A study using quantitative secondary analyses of data of 803 stimulant abusers focuses on whether motivational incentives can help people refrain from using drugs (Stitzer, Petry and Peirce, 2010). The researchers identified that the possibility to earn $400 was a compelling drive for the participants to engage in abstinence (Stitzer, Petry and Peirce, 2010, p. S61). Even though the article offers significant findings, the results imply a gap because it can be challenging to provide all addicted individuals with financial incentives.

In addition to that, drug abuse treatment in South Africa is associated with many barriers. A mixed-methods study by Meade et al. (2015, p. 79) demonstrates that 90% of 360 methamphetamine addicts wanted to receive treatment, but they did not have an opportunity to do it. The possible barriers include “beliefs that treatment is ineffective and relapse is inevitable in their social context” (Meade et al., 2015, p. 79). Evidence from South Africa demonstrates that addressing the problem requires a comprehensive approach, but further research is necessary to assess this issue in other African states.

In conclusion, this theme has revealed that there exist different interventions to treat high-risk substance abuse. Possible options include pharmacologic therapy, motivational incentives and physical exercise, and the studies demonstrate various effectiveness levels. However, the identified evidence indicates that interventions typically lead to improvements, even if they are slight, which means that authorities should make efforts to address the problem. Consequently, the theme shows that it is necessary to accumulate knowledge on drug and alcohol abuse to understand the necessity to look for solutions.

Methodology

The purpose of the study was to identify the correlates, trends and prevalence of high-risk substance use among Kenyan high school, college and university students. That is why it was necessary to use appropriate methodology to ensure that the dissertation would answer the research questions and produce valuable results. The current study used a systematic review method, and the following information will explicitly explain why this methodology was chosen.

Defining the Methodology

A systematic review approach was chosen because it seemed suitable to research the identified problem. Systematic reviews can be defined as studies “to identify and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesise the results of this search” (Munn et al., 2018, p. 2). Simultaneously, this methodology can also refer to “a means of summarising and presenting overviews of knowledge, current and historical, derived from a body of literature” (Aromataris and Pearson, 2014, p. 53). Furthermore, systematic reviews are suitable to identify, appraise and analyse the relevant information to generate a conclusion that answers clinical questions (Harris et al., 2013, p. 2761). In other words, the literature review methodology was chosen because it allowed for locating, analysing and synthesising the available knowledge on the selected topic.

It is also reasonable to admit that the given methodology can be ideally used under particular conditions. Researchers should use systematic reviews to find general knowledge about a topic, identify existing gaps in the literature and many others (Aromataris and Pearson, 2014, p. 53). In this case, a systematic review allows for evaluating what point of view is more justified. Other researchers stipulate that literature reviews are appropriate to “uncover international evidence”, “identify and inform areas for future research” and so on (Munn et al., 2018, p. 2). In addition to that, this methodology is appropriate in those cases when many studies have conflicting conclusions regarding the same topic.

The given methodology was justified because it was appropriate to answer the identified questions. Since high-risk substance abuse is a severe problem for developing nations, including Kenya, the literature review approach was advantageous because it helped determine the existing knowledge, compare it, articulate the synthesised results and implications for the future. In addition to that, this methodology seemed appropriate because literature reviews were widespread in producing high-quality evidence for drug and alcohol abuse (Kazemi et al., 2017; Kruse et al., 2020; Khatib et al., 2018; Wlodarczyk et al., 2017; Sliedrecht et al., 2019; Zilverstand et al., 2018). The use of this methodology by other researchers also contributed to the selection of the given approach.

Inclusion and Exclusion Criteria

Specific criteria were used to determine whether a particular study should have been included in the systematic review. The inclusion criteria were as follows:

1. The dissertation dealt with epidemiological, social and behavioural studies using quantitative, qualitative or mixed methods. They were chosen because a quantitative methodology allowed for identifying a numeric representation of a problem, qualitative methods contributed to the accumulation of new knowledge, while mixed-methods research combined these two approaches (Creswell and Creswell, 2018; Rutberg and Bouikidis, 2018).
2. The literature review focused on studies that analysed high-risk substance abuse among high school, college and university students. As a rule, these are individuals of 17-22 years old. The focus on this population group was justified because high-risk substance abuse at young ages adversely affects health, which leads to cancer, suicides, depression, the spread of sexually transmitted diseases and others (Kiambi, 2018, p. 3).
3. The dissertation only focused on the studies that had been carried out in or had included data from Kenya. This selection is justified by the chosen theme of the work. Sufficient scientific literature demonstrates that the use of high-risk substances is a problem in this African country (Chege, Mungai and Oresi, 2017; Pasche and Myers, 2012; Morgan, Brosi and Brosi, 2011).

Simultaneously, it is reasonable to present, explain and justify the exclusion criteria that guided the process of literature selection. The specific requirements are mentioned below:

1. The dissertation did not review intervention studies and service evaluations. The rationale behind that decision was that such articles did not contain the information that was of interest to the current study. Such a conclusion was made because such studies typically consider how it is possible to address the problem without generating any first-hand data about how widespread it is. For example, man articles explain how it is possible to address alcohol and drug abuse and fail to produce new information regarding the problem’s trends, prevalence and correlates (Hawk and D’Onofrio, 2018; Babor, Del Boca and Bray, 2017; Carroll and Kiluk, 2017).
2. The literature review did not include the studies that considered the use of the substances that were not high-risk ones. In particular, some scholars focus on trends, correlates and prevalence of tobacco use among young individuals (Osibogun et al., 2018; Osibogun, Bursac and Maziak, 2020; Pierce et al., 2018). Such scholarly articles were not included and reviewed because they did not meet the scope of the present dissertation.
3. The dissertation excluded all the articles that did not include data from Kenya. The present study’s objective was to research prevalence, correlates and trends in high-risk substance use in Kenyan high school, college and university students. Chapter 2 has demonstrated that many scholars addressed how the topic was represented in various world nations. This statement means that it was obligatory to exclude all those academic papers that investigated the issue in different contexts.

Searching Strategy

Four questions guided the given dissertation, and it was necessary to use them to generate a set of keywords that were used to search for articles. Since the research study focused on the problems of alcohol and drug abuse among Kenyan students, alcohol, drug, Kenya and students represented the basis of this set. All the search terms included alcoholism, alcohol misuse, alcohol use, alcohol abuse, alcohol addiction, alcohol dependence, drug use, drug misuse, drug abuse, drug addiction, drug dependence, hard drugs, street drugs, Kenya and East Africa. The list is rather extensive, and it is necessary to explain that not all the terms were used simultaneously. Different combinations of the terms were inserted to find the relevant articles. It is required to admit that Boolean operators, including AND and OR, were used to make the search results more relevant to the dissertation questions (Aliyu, 2017, p. 2016). This information provided the basis of the searching strategy for the dissertation.

The dissertation focused on the articles that were retrieved from a single database. The PubMed database was chosen because it contains more than 32 million articles that cover an array of biomedical subjects (National Library of Medicine, n.d., para. 1). Furthermore, the given resource was selected because it either contains articles in full text or can provide links to publishers’ websites where full texts of the studies can be found. The dissertation focused on those articles that were written in English and between 2017-2021.

In addition to the work with the PubMed database, a manual searching technique was used. In particular, Google Scholar was used to find more credible and timely studies that were written in the English language to enrich the dissertation. This approach was chosen because Google Scholar provides access to many databases and scholarly journals to locate the relevant literature. The same combinations of key terms were used to find academic and peer-reviewed articles on the topic through this resource. Thus, the search results were limited to studies published in 2017-2021. That decision was necessary to ensure that the dissertation dealt with the current literature on the topic. However, the dissertation also included a study that had been published before 2017 to understand how the problem developed historically.

It is necessary to explain that the dissertation only looked for those articles that were available in full text. For example, even if the PubMed or Google Scholar search provided an article that was seemingly appropriate for the dissertation, it was not included if an abstract was only available. This requirement contributed to the fact that the dissertation dealt with complete articles, which eliminated possible bias.

Screening Strategy

Even though double screening is a conventional approach, the dissertation relied on a single screening. The difference between the two is that double screening implies that two experts independently review database results to determine whether every particular article should be included or excluded. While most studies deal with double screening, resource intensiveness is its leading disadvantage, which allows for using single screening that “is an appropriate methodological shortcut in rapid reviews” (Waffenschmidt et al., 2019, para. 1). The dissertation relied on the screening process that consisted of two stages. According to the Cornell University Library (2021a, para. 1), the purpose of screening is to remove inappropriate studies, and the first stage implied doing so after reading the titles and abstracts. This process was significant since it could demonstrate that a single study should have been excluded for a particular reason represented by the exclusion criteria.

The first stage resulted in the fact that many irrelevant articles were excluded. However, it did not mean that all the remaining studies should have been included in the review process. The rationale behind this statement is that it could be challenging to state whether the study should have been included after screening titles and abstracts. In this case, the second stage was implemented that referred to screening full texts (UT Health San Antonio, 2019, para. 2). This stage implied that it was necessary to review the full texts of the identified articles to determine whether they were suitable for the literature review (University of South Australia, 2021, para. 6). These two stages resulted in the fact that a few articles were excluded from the dissertation because they focused on irrelevant topics.

Data Extraction

Data extraction was the following essential step of the dissertation. It implied extracting the information that was suitable to answer the four questions that guided the given review. In particular, Mathes, Klassen and Pieper (2017, para. 7) explain that data extraction means collecting information from primary studies in a standardised form. This process is necessary to synthesise the findings, which creates the basis of the Results and Discussion sections (Mathes, Klassen and Pieper, 2017, para. 7). That is why a task is to find the most appropriate data extraction method. However, it can be a severe challenge because there is no publicly available gold-standard decision (Schmidt et al., 2021, para. 4). This state of affairs implied that it was necessary to balance the pros and cons of various approaches to find a suitable method for the dissertation.

In fact, it was possible to use multiple data extraction methods. For example, they were Excel spreadsheets, handwritten notes and various professional systematic review tools and programmes. Multiple sources confirm that professional software is more appropriate because these tools and programmes allow for automatic (or semiautomatic) and time-efficient collection of data (Health Sciences Library, 2021; Cornell University Library, 2021b). These factors result in the fact that this approach implies a lower probability of dealing with errors in scientific papers. However, the current dissertation did not rely on these methods because of a single disadvantage. The reasoning was that this software required some financial resources. Since the given study did not have a sufficient budget, the decision was to choose among free methods.

Excel documents, Google spreadsheets and handwritten notes were possible options. However, the current dissertation preferred the paper and pencil approach. Even though all the free methods were suitable for small reviews, the most significant advantage of the handwritten notes was that they implied writing down each study’s details on a single sheet of paper. This condition was advantageous because it allowed for moving the tables and grouping them to synthesise data in the most suitable manner. Thus, each handwritten table consisted of a few columns that contained valuable information. These columns included study publication details, methodology, population and outcomes. Once the tables were completed, the chief investigator checked each of them to ensure that no errors or misspellings were present. It was a significant and necessary step to make sure that the data were prepared for analysis and synthesis, and these details will be described in one of the following subsections.

Quality Appraisal

All the identified articles underwent a quality appraisal process to ensure that the dissertation dealt with high-quality studies. Among possible options, the dissertation relied on tools designed by the Critical Appraisal Skills Programme (CASP) (n.d.). According to Long, French and Brooks (2020, p. 31), these tools are the most commonly used “for quality appraisal in health-related qualitative evidence syntheses.” These tools are in the form of checklists that specifically cover the areas that are needed to assess the quality of individual articles (Nadelson and Nadelson, 2014, p. 344). According to the CASP’s (n.d., para. 1) official website, there exist specific checklists for different study designs, including systematic reviews, randomised controlled trials, quantitative studies, qualitative articles, cohort studies and others. Each of these checklists can be easily downloaded from the CASP’s (n.d.) official website, which makes the use of these tools accessible and affordable for many scholars.

The checklists offered specific questions, and answers to them demonstrated whether the selected studies showed solid or weak evidence. The use of these tools helped identify that the studies under review were of high quality. It denoted that numerous authors did their best to ensure that their studies met the requirements that were imposed on scientific papers. This statement referred to the articles that were identified through the PubMed database and Google Scholar. Consequently, the use of the CASP tools did not lead to the exclusion of any studies from the analysis. This state of affairs allowed for suggesting that the use of the selected databases helped find credible, reliable and high-quality articles that provided readers with all the information that should have been included. The quality appraisal process contributed to the fact that the given dissertation could be considered a more high-quality work.

Ethical Issues

A few ethical issues could affect the dissertation and how it was conducted. Firstly, since a single author performed the dissertation, it was possible to expect that personal judgment and experiences could impact the study. Such a bias is a typical phenomenon when the study results depend on how impartially and attentively an author can perform research. This issue was mitigated because the dissertation relied on predetermined searching, screening and analysis strategies, and this approach minimised the probability that the author’s personal thoughts and opinions influenced the results.

Secondly, an ethical issue could also emerge if studies of poor quality were included in the review. In this case, the dissertation outcomes would be compromised because low-quality studies could produce irrelevant conclusions. A specific effort was implemented to address the identified barrier. The use of the particular and predetermined system for quality appraisal appeared to address the problem. The CASP tools were applied to assess the quality of the articles under review to ensure that the dissertation dealt with credible and reliable data. That is why it is possible to mention that this ethical issue was successfully addressed, and no low-quality findings were included in the dissertation.

Thirdly, the final ethical issue came from the fact that most literature on the selected topic was written by Kenyan authors. This fact implies that not all scholars of this origin perfectly knew the English language. Consequently, language biases were expected because of that state of affairs. This statement demonstrates that the dissertation could suffer if it worked with study’s authors who could not deliver their thoughts unambiguously. This issue was mitigated by drawing more attention to interpret the study’s findings impartially and attentively.

Analysis

The current dissertation chose to use narrative synthesis to analyse data. That is why it is reasonable to explain why a meta-analysis was not applied. The reasoning behind this decision is that a meta-analysis approach is typically used when it is necessary to identify statistical significance for studies that offer conflicting results (Himmelfarb Health Sciences Library, 2019, para. 2). In other words, this method is only suitable to compare quantitative outcomes. Simultaneously, this approach is challenging because it invokes working with statistical data and tedious screening (Mikolajewicz and Komarova, 2019, para. 3). Thus, the implementation of the meta-analysis approach implies that a researcher should spend much time and make many efforts to ensure that this data analysis method generates reliable statistical results. This state of affairs appeared unsuitable for the dissertation, and there was made a decision to choose a different strategy.

A narrative analysis was selected because it focused on words and text, and this is what was the dissertation focus. Allen (2017, para. 1) clarifies that this approach allows for substantial and meaningful interpretations of what was mentioned in the text under analysis. This strategy was suitable for summarising the findings and synthesising them to ensure that the results formed valuable data sets. Hammond (2019, para. 3) also stipulates that the given approach allowed for analysing and evaluating qualitative data. Another advantage of this method was that it gave the reviewer much flexibility to structure the analysis process. The narrative analysis resulted in the fact that the dissertation separately dealt with each study under investigation. Once a data extraction table was complete, the reviewer determined which research question could be answered with obtained findings. When this information was identified for all the studies under review, the data were synthesised and interpreted in the Discussion section.

Results

This chapter is going to present what findings the dissertation has managed to retrieve. The information below will follow a specific structure to ensure that readers can quickly understand it. In the beginning, it will be necessary to mention the exact number of studies that are included in this review. Then, the findings will be introduced in a specific order so that the data will answer the research questions in the same order that they were presented above.

Thus, the first group of articles came from the PubMed database. A search relied on a few filters, including the timeframe of 2017-2021 and Free full text. This search request generated 32 results, and it was not a surprise that not all of them were appropriate for the dissertation. That is why the reviewer applied the inclusion and exclusion criteria to select the required studies. This process resulted in the fact that three articles were only included in the review from this database, while the rest of them were considered inappropriate. In particular, two papers were excluded because they did not have data on Kenya, 16 articles were not included since they did not focus on students and five studies were interventions. Six papers were also excluded because they failed to consider high-risk substances. In addition to that, the search on Google Scholar enriched the dissertation with six more scholarly papers. This step was required to ensure that the dissertation has sufficient data to address all the research questions and investigate the problem historically. Consequently, the given review presents and comments on the findings from nine credible and reliable papers.

The first question focuses on the prevalence of high-risk drug and alcohol abuse among Kenyan high school, college and university students. A quantitative study by Musyoka et al. (2020) attempted to investigate this adverse phenomenon. The researchers focused on 406 first-year students because these individuals enter a new stage in their life, which provides them with more independence and, therefore, can subject them to making wrong decisions. Thus, the authors asked the sample size to answer a questionnaire and found that 22% and 8% of the respondents used alcohol and cannabis, correspondingly (Musyoka et al., 2020, p. e0238170). In addition to that, 13% admitted that they suffered from polysubstance abuse, which implied more dangerous consequences (Musyoka et al., 2020, p. e0238170). This finding reveals that young individuals in Kenya are subject to high-risk substance addiction.

Another quantitative study focuses on representatives of sexual minorities among Kenyan youth. This article demonstrates that among 1,476 participants, 44% reported alcohol use, while 51% stated that they suffered from substance abuse (Korhonen et al., 2018, p. 1507). This finding demonstrates that representatives of sexual minorities also suffer from the problem. A quantitative cross-sectional paper by Kurui and Ogoncho (2021) investigate high-risk substance abuse among students of medical training colleges. Among 303 respondents (150 males and 153 females), more than 27% were current alcohol users, while 52.5% reported using alcohol at least once in their lives (Kurui and Ogonch, 2021, p. 21). These data reveal that students’ educational course does not lead to different results regarding the spread of high-risk substances.

One more research article confirms that substance abuse is a severe problem for the youth in Kenya. According to official statistical data, “84% of youth aged 16-24 years were involved in drug abuse” (Ndegwa et al., 2017, p. 102). That is why the researchers decided to focus on 255 respondents from Daystar University Nairobi and Athi River campuses, but 140 individuals were only included in the study (Ndegwa et al., 2017, pp. 102-103). Among all these participants, more than 57% consumed alcohol and were doing so in a dangerous manner (Ndegwa et al., 2017, p. 107). In addition to that, the authors demonstrate that there is a trend of increasing cannabis consumption among university students (Ndegwa et al., 2017, p. 106). These data indicate that alcohol and marijuana overuse is a widespread issue in Kenya because the two significantly affect the student population.

It is worth admitting that the dissertation included a quasi-experimental study. However, the focus was on data collection procedures at baseline rather than on intervention evaluations. In particular, this study recruited 473 first-year undergraduate students from two universities and asked them to fill in questionnaires (Mbuthia et al., 2017, p. 465). The researchers identified that the prevalence rates were more than 31% for alcohol, almost 5.1% for marijuana and approximately 1.5% for cocaine (Mbuthia et al., 2017, p. 467). These findings are appropriate for the dissertation because they reveal how many students suffer from high-risk substance abuse.

It seems reasonable to consider an older article to identify how the issue affected the target population earlier. Thus, a descriptive cross-sectional survey seems suitable for that purpose. This study focused on college students from western Kenya and investigated how many individuals abused alcohol and drugs (Atwoli et al., 2011). The researchers identified that the “lifetime prevalence of alcohol use was 51.9%” among 261 respondents (Atwoli et al., 2011, para. 3). Simultaneously, 2% of the participants abused cannabis, while less than 1% dealt with cocaine (Atwoli et al., 2011, para. 3). These statistical data demonstrate that high-risk substance abuse has been a significant problem for Kenya for an extended period of time. Consequently, it is not a surprise that a few experts draw their attention to the problem, which results in many scholarly articles on the topic.

The second research question draws attention to whether there are any correlates of substance abuse. This information is crucial because it can demonstrate what external or internal factors contribute to the problem spread. Thus, a positive correlation exists between high-risk substance use and being a male student and living in private hostels rather than on campuses (Musyoka et al., 2020, p. e0238170). At the same time, various relationship-level factors can contribute to the problem. For example, a qualitative study of ten interviews revealed that substance abuse by a family member or peer influence is an essential correlate of the issue under analysis (Ssewanyana et al., 2020, p. 1946). Simultaneously, a study by Korhonen et al. (2018, p. 1507) found a statically significant correlation between childhood trauma and substance abuse. Furthermore, transactional sex can be considered an essential correlate of alcohol abuse (Korhonen et al., 2018, p. 1507). The authors demonstrate that high-risk substance abuse is more prevalent among individuals with low moral qualities.

Furthermore, a qualitative study of 40 Kenyan students (20 males and 20 females) revealed many correlates of the problem under analysis. Mbuthia et al. (2020, p. 38) demonstrate that poor parenting, peer pressure and easy accessibility to drugs lead to the spread of alcohol and cannabis in the country. Furthermore, the authors stipulate that the African culture contributed to the existence of the issue because social drinking is an acceptable and even required practice in Kenya (Mbuthia et al., 2020, p. 43). This narrative highlights that high-risk substance abuse is a multi-root issue in the nation, which results in many young adults being affected.

When it comes to the correlates, one should also note that they can be internal and external. A quantitative study by Kurui and Ogonch (2021) found evidence that the latter group is more effective for medical students. In particular, the authors stipulate that the availability of alcohol within the colleges, proximity to selling premises, and alcohol-drinking friends were actual correlates of the issue (Kurui and Ogonch, 2021, p. 18). In particular, proximity to selling premises was the most effective because more than 44.5% responded drinking alcohol because of that reason (Kurui and Ogonch, 2021, p. 21). Consequently, it is challenging to deny the effect of the environment on the problem spread.

The study above is not unique in highlighting the effect of external correlates. A mixed-methods study using cross-sectional and phenomenological approaches focused on full-time university students in Kenya and recruited 300 individuals from this large population cohort (Pere and Yatich, 2017, para. 1). These authors stipulate that numerous issues contributed to the spread of the problem. In particular, having excess money, the availability of drugs, peer pressure, bad examples and poorly implemented governmental policies result in the fact that the problem was widespread among the selected population (Pere and Yatich, 2017, para. 12). In addition to that, many students responded that social and academic frustrations also contributed to involvement in the deviant behaviour under consideration (Pere and Yatich, 2017, para. 12). Consequently, numerous external forces result in the fact that drug abuse is a widespread phenomenon among students from Kenya.

Simultaneously, it is not necessary to ignore the influence of internal factors in causing high-risk substance overuse. A quantitative study by Ndegwa et al. (2017, pp. 110-111) reveals that there is a positive association between alcohol addiction and anxiety, depression and post-traumatic stress disorder (PTSD) symptoms. This information demonstrates that these mental disorders provide individuals with particular challenges, and people decide to use various drugs to manage these problems. Furthermore, the article under review generated a surprising outcome because “never seeing the mother use alcohol was significantly associated with higher mean alcohol intake scores” (Ndegwa et al., 2017, p. 105). This information reveals that those individuals who were not familiar with drinking behaviours in their families were more subject to have substance abuse issues compared to those people who witnessed alcohol consumption by their parents.

Some scholars simultaneously comment on internal and external factors in their works. A study by Atwoli et al. (2011) is among them because the authors indicate that multiple issues are in association with alcohol and drug overuse. On the one hand, more than 75% reported that they started consuming high-risk substances because their friends invited them, while a relative who is outside a nuclear family introduced the substances to 23.5% of the respondents (Atwoli et al., 2011, para. 3). On the other hand, more than 60% of the study participants stipulated that they relied on alcohol and drugs because they wanted to relax and relieve stress (Atwoli et al., 2011, para. 3). This scholarly article is among those resources that highlight the complex nature of the problem because versatile factors contribute to its spread among the target population.

Current trends in abusing alcohol and drugs form the focus of the third question. Today, many young people in Kenya abuse privately consumed alcohol, and this trend is dangerous because such substance is cheaper and can be easier accessed by Kenyan youth (Ssewanyana et al., 2020, p. 1949). An article by Mbuthia et al. (2020, p. 41) also confirms this finding, and the authors admit that students keep consuming local or homemade brew because it is “cheap and locally available.” However, it is also possible to suggest that this substance is more dangerous for bodies because its production does not typically follow any quality standards. Another emerging trend is that male students are more engaged in high-risk substance abuse because men are generally more willing to take risky behaviours (Mbuthia et al., 2020, p. 43). That is why men and women are not equally represented when it comes to substances overuse.

When it comes to the fourth question, the findings will be generally interpreted and discussed in Chapter 5. However, the present section is going to introduce recommendations and suggestions of the selected authors. Thus, Musyoka et al. (2020, p. e0238170) reveal that it is necessary to introduce pre-university interventions to reduce the volume of alcohol and drug addiction. Another suggestion is that the problem can be mitigated if it is possible to limit the access of young individuals to high-risk substances (Ssewanyana et al., 2020, p. 1940). Furthermore, high-risk substance abuse is considered a mental health problem, which means that individuals require psychological assistance to mitigate the situation (Korhonen et al., 2018, p. 1507). A study by Pere and Yatich (2017, para. 1) insists that it is necessary to invest efforts in increasing the population’s knowledge of the problem, and improving education is the most appropriate strategy. All the authors offer comprehensive recommendations on how it is possible to address the problem.

High-risk substance abuse is a severe problem for Kenyan students, and it requires specific actions. That is why it is necessary to provide universities and other educational establishments with requirements to develop specific programmes to address the problem. Simultaneously, the authors explicitly state that the government is also responsible for mitigating the issue by limiting the traffic of illicit substances in the country (Mbuthia et al., 2020, p. 39). These steps can be considered efficient to reduce the spread of alcohol and drug abuse in Kenya. Kurui and Ogonch (2021, p. 18) offer approximately the same recommendations. Since the environmental factors make students involved in alcohol drinking, it is necessary to limit their effect. An appropriate option can include mentorship from students’ tutors and peer education (Kurui and Ogonch, 2021, p. 18). In this case, the proposed efforts will be expected to minimise the impact of students on one another regarding the decision to consume alcohol.

The information in this chapter demonstrates that it is challenging to find a scholarly paper that is only devoted to answering a single research question of the dissertation. Instead of it, scientists typically follow a comprehensive approach to the problem, which makes them consider at least two aspects at once. The paper by Mbuthia et al. (2017) is the only source that answered one question. This state of affairs contributed to the fact that the same studies were used as sources of information to answer different questions. In particular, Table 1 below reveals which study answers which question.

Table 1: Questions covered in studies

Table 1 is also helpful because it presents an exhaustive list of the studies that were reviewed in the dissertation. This information reveals that current studies were mainly included, which results in the fact that timely evidence is considered. Furthermore, the table demonstrates that Questions 1 and 2 were covered by the majority of studies, while only two articles commented on Question 3. However, this fact does not mean that some aspects were insufficiently addressed, and the following chapter, Discussion, will interpret and explain all the findings.

Discussion

The purpose of the study was to identify the correlates, trends and prevalence of high-risk substance use among Kenyan high school, college and university students. For this task, a systematic review methodology was chosen because the issue is topical for Kenya and other developing nations, meaning that many scholars draw attention to the problem. For example, Muriungi et al. (2014, p. 126) stipulate that 84% of Kenyan private university students consumed alcohol, while the cocaine use rate was 5%. Simultaneously, Bassi et al. (2017, p. 11) admit that Nigeria suffers from prevalence rates of more than 52% for alcohol and more than 2.5% for marijuana use. That is why the goal was to locate relevant studies that comment on high-risk substance overuse in Kenya and extract relevant data.

Even though the current review is not unique in focusing on the selected research questions and choosing the methodology to answer them, it is significant and adds to the existing body of literature. The rationale behind this statement is that the dissertation intends to summarise the existing literature findings to reveal the current trends of how the problem is affecting Kenyan society. Furthermore, the work will compare the obtained results to the official data published by the WHO and the United Nations Organisation (UN). The reports by these establishments reveal how high-risk substance abuse affects numerous world countries, and the dissertation will comment on whether its findings are compatible with the official data. In particular, the focus will be on identifying challenges and opportunities in addressing the issue under consideration.

It is possible to mention that the dissertation has found sufficient evidence to answer the selected research questions. In particular, six studies provided data to comment on the prevalence of high-risk alcohol and drug use among Kenyan high school, college and university students. Since scholars focused on different samples, it is not a surprise that they arrived at varying conclusions. For example, the prevalence of alcohol consumption ranged from 22% in a study by Musyoka et al. (2020, p. e0238170) to 51.9% as per Atwoli et al. (2011, para. 3) and 57% according to Ndegwa et al. (2017, p. 107). A similar situation is found with cannabis and other drug use prevalence. According to Musyoka et al. (2020, p. e0238170), 8% of respondents suffered from cannabis abuse, while Mbuthia et al. (2017, p. 467) state that it is a problem for 5.1%. Moreover, Atwoli et al. (2011, para. 3) stipulate that 2% of respondents admitted abusing cannabis. However, both Mbuthia et al. (2017, p. 467) and Atwoli et al. (2011, para. 3) agree that cocaine abuse was an issue for approximately 1% of students. All the findings above explicitly answer the first research question.

Even though the studies under review generated different figures, it is impossible to ignore the fact that alcohol and drug abuse is present in Kenya. It is possible to justify various statistical data because the researchers focused on different samples. Even though all six articles considered Kenyan youth, various samples were included. In particular, Korhonen et al. (2018) focused on sexual minorities, while Kurui and Ogoncho (2021) assessed the prevalence of substance abuse among medical students. Furthermore, the selected articles dealt with individuals from different geographical areas of Kenya, which also contributed to variations in the findings. Even though it is challenging to use the results to claim the specific alcohol and drug abuse prevalence rate, it is evident that the problem affects the selected population, which answers the first research question.

The second research question focused on multiple correlates of high-risk alcohol and substance abuse. Among the selected articles, eight studies provided the dissertation with evidence that answered this question. The analysis of the findings allows for dividing the correlates into two large groups. Depending on whether a person’s individual characteristics or environment contributed to the deviant behaviour, the correlates can be divided into internal and external.

The list of internal factors consists of those aspects that come from a person’s inner world. They include physical and psychological conditions, underlying motives and others. In particular, Musyoka et al. (2020, p. e0238170) found that males were more subject to the problem. Simultaneously, some researchers admit that childhood experiences and mental health issues also make people abuse alcohol and other substances (Korhonen et al., 2018, p. 1507; Ndegwa et al., 2017, pp. 110-111). Some respondents admitted that they consumed high-risk substances because they wanted and liked to feel how they impacted them (Atwoli et al., 2011, para. 3). These findings demonstrate that people’s internal factors, beliefs and experiences can contribute to the spread of the problem.

However, the dissertation identified that external correlates are more versatile and influential. For example, some researchers agreed that peer pressure was significantly associated with the spread of the problem (Kurui and Ogoncho, 2021, p. 18; Ssewanyana et al., 2020, p. 1946; Pere and Yatich, 2017, para. 12). This information demonstrates that young people in Kenya depend on others’ opinions, which makes them misbehave to meet people’s expectations. In addition to that, many authors identified that the availability of alcohol and drugs and close proximity to selling premises also make Kenyan youth abuse these substances (Kurui and Ogoncho, 2021, p. 18; Mbuthia et al., 2020, p. 43). Finally, it is necessary to add that the acceptability of social drinking is a significant correlate in Kenya (Mbuthia et al., 2020, p. 43).

The results above allow for concluding that both internal and external correlates contribute to the problem. Even though the dissertation has found more examples of external factors, it is impossible to mention that any of them is more influential than the others. Consequently, the second research question was successfully addressed, and the answer includes being a male, peer pressure, mental health issues, the accessibility to substances and others.

When it comes to the third question, the smallest number of articles under review have provided the dissertation with information to answer it. In particular, two studies only addressed the issue of high-risk substance use emerging trends among Kenyan high school, college and university students. On the one hand, the survey by Ssewanyana et al. (2020, p. 1949) mentioned that many participants admitted abusing privately consumed alcohol. Mbuthia et al. (2020, p. 41) supported this finding and concluded that individuals abuse this substance because it is cheap and locally available. Irrespective of the fact that a small number of studies represent this question, the results are of significance for the dissertation. The focus on local or homemade brew demonstrates that the substance becomes even more available for people. Since the information above has shown that the availability is a significant correlate, it is possible to suppose that this emerging trend will result in increased consumption rates in Kenya. That is why it is possible to mention that sufficient evidence has been located to answer the third research question.

Regarding the fourth question, four studies commented on some political and practical implications of their findings. In the beginning, it is reasonable to state that some findings from this area are aligned with the previously covered results. For example, Ssewanyana et al. (2020, p. 1940) stipulate that reasonable action is to limit the access of young individuals to alcohol and other high-risk substances. This suggestion is supported by other scholars who admit that the availability of substances and close proximity to their selling places are significant correlates of the problem under consideration (Kurui and Ogoncho, 2021, p. 18; Mbuthia et al., 2020, p. 43; Pere and Yatich, 2017, para. 12). Simultaneously, the suggestion by Korhonen et al. (2018, p. 1507) to provide psychological assistance to address high-risk substance abuse also has some reasoning. In particular, this practice implication refers to the fact that childhood traumas (Korhonen et al., 2018, p. 1507) as well as anxiety, depression and PTSD symptoms (Ndegwa et al., 2017, pp. 110-111) contribute to the problem’s spread. Consequently, it is logical that researchers offer some practical ways to mitigate the adverse impacts.

In addition to that, other political and practical implications did not find any support in the articles under review, but these suggestions seem deemed and appropriate. On the one hand, Musyoka et al. (2020, p. e0238170) mention that pre-university interventions are necessary to address the problem. This finding denotes that entering a college is not the leading factor making young individuals abuse high-risk substances. However, this stage of life implies that people receive greater freedom, which makes them prone to other correlates. On the other hand, Pere and Yatich (2017, para. 1) mention that high-risk substance abuse can be mitigated by increasing the population’s knowledge about the problem, its correlates and adverse consequences. This statement implies that young people from Kenya can overuse high-risk substances because they do not fully understand what outcomes can arise. As a result, it is necessary to educate youth in Kenya to ensure that they are fully aware of what consequences this deviant behaviour can bring.

Now, it is reasonable to discuss how the dissertation results fit in relation to existing literature. Firstly, it is necessary to compare and contrast the alcohol prevalence in Kenya (22%-57% as per the findings above) with that globally and in Africa. According to Peacock et al. (2018, p. 1905), 18% of the adult population worldwide suffer from alcohol abuse. The comparison of these figures demonstrates that Kenyan youth is more subject to the problem, which requires appropriate action. However, the analysis of evidence from other African countries reveals that Kenya is not unique. In particular, evidence from a few sub-Saharan countries, including Malawi and Ethiopia, provides similar results. Thus, Lancaster et al. (2018, p. 782) state that 50% of respondents from Malawi suffered from alcohol abuse, while Ethiopians showed the prevalence of 22% (Deressa and Azazh, 2011, para. 2) and 46% (Roba et al., 2019, para. 3). This information reveals that alcohol abuse is similarly represented in sub-Saharan states.

The situation is slightly different when it comes to assessing cannabis prevalence. According to the results, 2%-8% of Kenyan youth abuse this substance, and this problem is equally represented throughout the world. Peacock et al. (2018, p. 1905) state that 3.8% of the world population suffer from this abuse. Simultaneously, a study of a Nigerian context found the prevalence of 2.59% (Bassi et al., 2017, p. 11), while Tran et al. (2018, p. 2851) found that 6% of respondents from Malawi overused marijuana. Even though these figures fit within the range identified for Kenya, it is impossible to ignore the fact that none study has found a higher prevalence than it was for Kenya. This information also demonstrates that cannabis abuse in Kenya requires an appropriate response.

Finally, it is possible to mention that cocaine abuse in Kenya also deserves appropriate attention. The reasoning behind this claim is that the surveys of other African states did not demonstrate that their population suffered from this problem. That is why it is possible to mention that Kenyan youth is more exposed to this high-risk substance. Consequently, it is reasonable to look for effective ways to address the identified problem.

In addition to that, it is reasonable to consider how the dissertation findings relate to the data published by official organisations, including the WHO and UN. In particular, this comparison is necessary to identify the challenges and opportunities in addressing the problem under analysis. In the beginning, it is reasonable to focus on alcohol overuse because the dissertation has found more data on this topic. The WHO (2018) stipulates that this substance abuse can be detrimental for people. For example, this behaviour leads to three million deaths every year, is a cause of more than 200 diseases and injury conditions and contributes to 13.5% of global deaths in the age group 20-39 (World Health Organisation, 2018, para. 1). Moreover, alcohol overuse results in psychological, economic and social issues for individuals (World Health Organisation, 2018, para. 1). Consequently, there is no doubt that this substance adversely affects millions of people all over the world.

The discussion above reveals that alcohol abuse in Kenya results in a few challenges for the nation. The presence of the issue itself subjects the state and its population to detrimental consequences. However, the fact that Kenya suffers from a higher prevalence compared to the global data allows for supposing that the negative impacts are maximised in this African country. Increasing consumption rates of locally brewed or homemade alcoholic beverages is another fundamental challenge for Kenya. This problem demonstrates that Kenyan youth have easier access to low-quality substances, which contributes to a more detrimental impact on health.

According to the information above, it is evident that it is necessary to find some opportunities to address the issue. When it comes to the WHO, this body offers feasible and practical ways to mitigate the adverse consequences. Effective steps are to regulate the marketing campaigns, limit the availability of these beverages, impose higher taxation and pricing mechanisms to limit consumption rates, highlight the health problems, provide accessible treatment options and others (World Health Organisation, 2018, para. 13). Regarding the dissertation scope, it is possible to suggest that some of these steps can become opportunities for Kenya. For example, the sub-African state can benefit from limiting the availability of alcoholic beverages because this factor was considered an influential correlate contributing to increased abuse prevalence. Simultaneously, highlighting alcohol-attributable health problems is also an opportunity because this strategy can educate Kenyan youth about the harmful consequences of consuming alcohol, especially locally brewed or homemade beverages. However, the dissertation has not found any evidence that controlling marketing efforts, higher taxes or providing accessible treatment options can improve the situation in Kenya.

When it comes to cannabis abuse in Kenya, this problem also has some challenges and opportunities. On the one hand, the challenges become aware after consulting World Drug Report 2021 by the United Nations Office on Drugs and Crime (2021). According to this report, the number of drug users will increase by 30% by 2030 (United Nations Office on Drugs and Crime, 2021, p. 11). This forecast is made because fewer young people think that cannabis is a harmful substance (United Nations Office on Drugs and Crime, 2021, p. 10). Simultaneously, the COVID-19 pandemic has become an influential factor that promoted increased cannabis consumption globally (United Nations Office on Drugs and Crime, 2021, p. 14). Since the report findings focus on the international state of affairs, it is possible to claim that they are applicable to Kenya. This nation is not isolated from the rest of the world, meaning that various global processes find their reflection in this sub-Saharan country.

It is possible to comment on why the challenges above apply to Kenya. Underestimation of the negative consequences of cannabis consumption can be a suitable explanation for increasing marijuana consumption. Since young individuals do not entirely understand the possible outcomes of their deviant behaviour, they are less likely to avoid it. Some of the articles under review have been published in the COVID-19 era, and there is no doubt that they reflect how the pandemic has affected marijuana overuse.

The information above allows for identifying a few important opportunities for Kenya. The problem that fewer people see a connection between cannabis consumption and harmful consequences is severe, and it is possible to address it by promoting better knowledge among these individuals. In particular, specific educational interventions can be an effective solution to this issue. The reasoning behind this statement is that if people better understand the dangers of using marijuana, they will not involve in this deviant behaviour. Thus, Kenya can arrive at positive results if it manages to improve its population knowledge about cannabis adverse impacts on health. Simultaneously, another opportunity refers to finding the appropriate ways to enter the post-COVID-19 era. It denotes that future budgets should allocate sufficient resources to implement drug prevention programmes and interventions (United Nations Office on Drugs and Crime, 2021, p. 14). Thus, the Kenyan government should invest much time and effort to develop effective plans to overcome the pandemic issues in the economic, social and healthcare spheres.

In addition to that, it is rational to comment on challenges and opportunities regarding another high-risk substance abuse. According to the findings presented above, cocaine deserves some attention. According to the United Nations Office on Drugs and Crime (2021, p. 18), the global prevalence of this substance abuse was 0.4% in 2019. Thus, the figure of approximately 1% for Kenya denotes that this country is significantly affected by the issue even though the impact is not so severe as in Australia and New Zealand (2.7%) (United Nations Office on Drugs and Crime, 2021, p. 18). The primary challenge with this problem is that young people start using cocaine, being unaware of how this substance can affect them. Simultaneously, increasing cocaine trafficking volumes in northern and southern Africa also contribute to the fact that Kenya and other sub-Saharan states witness an influx of this substance (United Nations Office on Drugs and Crime, 2021, p. 17). Consequently, it is reasonable to address the problem to ensure that fewer individuals suffer from this drug.

Based on the identified evidence, it is possible to comment on a few opportunities that Kenya has to address the problem. On the one hand, the fact that improving the population’s knowledge can contribute to reduced alcohol and cannabis prevalence allows for suggesting that the same intervention will lead to positive outcomes regarding cocaine abuse. The identified evidence demonstrates that educational interventions are necessary to ensure that the Kenyan youth perfectly understand the harmful consequences of abusing various high-risk substances. On the other hand, the potential influx of cocaine from different African regions denotes that the Kenyan government should develop specific policies and procedures to control and prevent the penetration of drugs from abroad. It is possible to suggest that if Kenya draws sufficient attention to these two opportunities, the country can witness a reduced prevalence of cocaine abuse among the young population.

Now, it is reasonable to comment on what implications the given dissertation has. The purpose of the study is to identify the correlates, trends and prevalence of high-risk substance use among Kenyan high school, college and university students. Consequently, it is reasonable to expect that the results demonstrate how the issue of high-risk substance abuse is represented in this sub-Saharan nation. Indeed, the findings have shown the prevalence of alcohol, cannabis and cocaine abuse in Kenya, what factors contribute to the problem and what trends are emerging. The dissertation has reviewed relevant literature to arrive at these statistical and narrative results.

Thus, the study offers valuable and helpful data for various spheres. On the one hand, it is challenging to overestimate the significance of the dissertation for the healthcare industry. The findings reveal that high-risk substance abuse is a fundamental challenge affecting up to 57% of the Kenyan population. Since scientific evidence and common sense prove that this behaviour results in damaging health consequences, medical professionals and organisations should use the study as an action call to address the situation. If no interventions are implemented, Kenya will witness a significant health crisis in the future because many young individuals are undermining their health today.

On the other hand, it is evident that the healthcare industry will not manage to achieve any significant improvements if it is left alone. This statement denotes that a comprehensive approach is necessary to address the issue of high-risk substance abuse in Kenya, and appropriate political efforts are required. The dissertation has identified that positive consequences can be achieved if the Kenyan youth has improved knowledge about the substances and their impact on health. Consequently, the entire Kenyan educational system needs appropriate changes to meet the needs. Even though the dissertation focuses on high school, college and university students, there is no doubt that interventions should also affect primary and secondary education systems. If children and adolescents understand all the dangers of abusing high-risk substances, there will be a decreased probability that they will involve in this deviant behaviour in their adulthood.

In addition to that, the dissertation highlights the necessity of government involvement in addressing cocaine abuse. Since it has been found that other African countries from neighbouring regions of the continent have high cocaine trafficking rates, there is no doubt that Kenya should make a specific effort to protect its citizens from the negative impact. The dissertation is valuable for government officials to identify that high-risk substance abuse is not solely an internal issue of the country. Even though many people start using alcohol and drugs because they are unaware of possible dangers, the results section has determined that external factors also contribute to the spread of the problem. Among these correlates, the availability of high-risk substances is the leading factor that makes people abuse alcohol or drugs. Thus, the influx of cocaine from neighbouring countries can make it possible for Kenyan youth to access and abuse this substance. Consequently, the government should make an effort to prevent this situation.

The study has some limitations that need consideration while evaluating the findings. Firstly, it is reasonable to admit that the dissertation has focused on a limited number of articles for review. Even though the selected nine studies provided much evidence on the topic, there exists an opportunity that they represent a biased or one-sided approach to analysing high-risk substance abuse in Kenya. However, the issue was mitigated by drawing more attention to the articles under review. As a result, this number of articles allows for making a deep analysis within a limited timeframe.

Secondly, the study results are limited because the dissertation relied on single screening and one reviewer dealt with data extraction and analysis. As a rule, double screening is used to ensure that a reviewer does not miss any relevant studies or information pieces. However, it has already been stated that a single screening approach was chosen because it requires less time and financial effort. Consequently, it is reasonable to keep in mind that the dissertation results can be subject to data collection bias.

Thirdly, one should admit that the findings are limited in the national context because a single population group was selected for analysis. Even though the dissertation offers valuable insights into high-risk substance abuse among Kenyan high school, college and university students, it is impossible to generalise the findings for the whole nation. The rationale behind this statement is that the problem can also affect children, adolescents, older adults, and the elderly. Thus, the inclusion of all these groups in the review is necessary to arrive at generalised conclusions.

Simultaneously, the dissertation also had some strengths that make its results significant and valuable. The obtained results are considered relevant because they came from timely studies. In particular, the focus on the articles published within 2017-2021 denotes that the dissertation dealt with timely and current data. In addition to that, the inclusion of a study made in 2011 allowed for identifying how the problem developed over many years. Consequently, the dissertation represents a systematic overview of the issue in Kenya.

Cost, time and resource-effectiveness is another essential strength of the study. On the one hand, the dissertation did not require any financial resources to review the articles. The articles for review were selected from a free database, and the reviewer did not rely on any paid methods or instruments to extract and analyse data. Simultaneously, all the dissertation steps were performed by a single reviewer. This fact denotes that the analysis procedures were performed within a short period of time.

Finally, the selected methodology also contributed to a significant strength. A qualitative method resulted in the fact that the dissertation arrived at unexpected and valuable conclusions. In particular, the finding that an increasing number of individuals involved in consuming local or homemade brew represents a significant challenge for Kenya. Simultaneously, the selected methodology helped determine that specific efforts to improve the population’s knowledge can result in positive outcomes. Thus, the given strength is associated with obtaining new information.

Conclusion

The dissertation focused on the issue of high-risk substance abuse in Kenya. Four research questions guided the study, and they focused on the prevalence, correlates and emerging trends of alcohol, cannabis and cocaine abuse among Kenyan high school, college and university students. Simultaneously, the dissertation attempted to identify what policy and practice implications could be obtained from the results. It was appropriate to address these questions because substance abuse is a fundamental problem globally, and developing nations are no exception. In particular, the United Nations Office on Drugs and Crime (2021, p. 11) stipulates that the number of drug users will increase by 30% by 2030. Simultaneously, the World Health Organisation (2018, para. 1) states that alcohol overuse leads to three million deaths every year. Many studies also demonstrate that substance abuse is a significant problem for Kenya (Pasche and Myers, 2012; Morojele, Brook and Kachieng’A, 2006; Musyoka et al., 2020). Thus, there was a robust rationale behind focusing on the topic.

The questions above denoted that it was necessary to utilise an appropriate methodology to find answers. For the purposes of this study, the literature review, a qualitative method, was chosen to conduct research. A systematic review approach was selected because it is used “to identify and retrieve international evidence that is relevant to a particular question or questions and to appraise and synthesise the results of this search” (Munn et al., 2018, p. 2). Simultaneously, the methodology was appropriate because it allowed for locating the existing knowledge, identifying gaps and arriving at specific implications.

The analysis of the data identified a few essential findings. In particular, it was found that Kenya more significantly suffered from high-risk substance abuse compared to international data. The prevalence of alcohol, cannabis and cocaine abusers in Kenya is higher than that globally as per the United Nations Organisation and World Health Organisation. In addition to that, the dissertation arrived at some emerging trends that represent challenges for this African country. On the one hand, it was identified that availability of alcohol, peer pressure and psychological conditions result in increased alcohol consumption. Consuming local or homemade brew in higher volumes fits these findings because this fact demonstrates that Kenyan youth find more affordable substances to abuse. On the other hand, the dissertation concluded that many people involved in the deviant behaviour under analysis because they had insufficient knowledge about the possible consequences of these actions.

Based on the information above, the dissertation offered a few essential implications. Firstly, it is necessary to highlight an obvious need to improve the population’s knowledge about high-risk substances and their dangers. The youth should understand that cocaine, alcohol and cannabis imply harmful consequences, especially if they are consumed in large amounts. This issue can be addressed if the Kenyan government takes specific steps to develop educational interventions that could help people understand that required information. Simultaneously, representatives of the healthcare industry should also contribute because one of their tasks is to educate people about health and health conditions.

Secondly, one should clarify that additional political actions are required to address the situation. Since it has been identified that the availability of alcohol and drugs is closely associated with rising prevalence, it is necessary to limit access. For example, a helpful approach is to confine marketing efforts to ensure that aggressive advertising does not contribute to the problem. Simultaneously, law enforcement agencies should control that illegal substances are not available to the general public. Regarding this case, it is reasonable to emphasise the dissertation finding that cocaine trafficking volumes are high in other countries from neighbouring regions of the African continent. That is why responsible bodies should ensure that this high-risk substance does not enter Kenya from abroad.

Thirdly, the study found that the COVID-19 pandemic contributed to a higher prevalence of drug abuse globally, including in Kenya. That is why the Kenyan government should rely on this finding to understand that post-COVID-19 budgets should allocate sufficient resources to addressing the problem. Consequently, these three implications demonstrate that a comprehensive approach involving the Kenyan government, healthcare industry, law enforcement agencies and others is necessary to achieve positive outcomes regarding the problem under consideration.

The given dissertation can be a start for follow-up research studies. A suitable approach is to conduct a more massive review, including a higher number of articles. This step is necessary to accumulate more data to answer the research questions. In this case, it will be suitable to use larger timeframes to find more relevant studies. It also seems reasonable to determine how and whether high-risk substance abuse is represented among other population layers, including children, adolescents, older adults and the elderly. This focus will show whether the problem under analysis can be generalised for Kenya or whether some groups are more subject to the issues compared to the others.

I can claim that the dissertation allowed me to learn much about how Kenyan youth suffer from high-risk substance abuse. Even though the findings relate to this African nation, I believe that the state of affairs is not much different in other developing states. In these countries, people face approximately the same challenges and barriers that make them abuse alcohol, cannabis and other substances. I also learned that a comprehensive approach is necessary to address the problem and achieve any positive outcomes. That is why I can mention that the dissertation helped me perform a deep investigation of the problem under consideration.

Finally, it is possible to mention that the study offered essential conclusions for Kenya. Even though a few limitations have been identified, the findings should become an action call for the entire nation to make some efforts to address the problem. The Kenyan government, healthcare organisations and law enforcement agencies can benefit from reviewing the findings and addressing the issues identified. The dissertation offers specific interventions that can lead to significant improvement, and responsible bodies and officials can use them. If no actions are taken, it is reasonable to expect that the issue of high-risk substance abuse will keep deteriorating and bringing adverse consequences to the nation.

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