Self-Esteem, Peer Influence And Family Relationship As Predictors Of Tramadol Abuse Among Young People Undergoing Rehabilitation At A Private Facility In North Central Nigeria

Abstract

Tramadol abuse is a significant problem among young people especially those within and slightly above adolescent age. The rate of tramadol abuse among young people is increasingly high and is linked with numerous harmful effects. However, there is still dearth of studies exploring predictors of tramadol abuse among young people in Nigeria. Therefore, this study examined the predictive role of self-esteem, peer influence and family relationship in tramadol abuse among young people undergoing rehabilitation at Rescue City Medical Centre. A sample of 50 young people aged 21 to 35 with a mean age of 24.5 (min: 21years; max: 35years) were purposively selected at Rescue City Medical Centre Makurdi, Nigeria. Clients with symptoms of 65.5% met diagnostic criteria for tramadol abuse were recruited and completed clinician-rated; Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and self-report measures; Rosenberg self-esteem scale (RSES), Inventory of Parent and Peer Attachment (IPPA) and Index of Family Relationship (IFR). Results showed that self-esteem (β = -.412, t= -3.011, P<.05), peer influence (β=.341, t=2.752, P<.05) and family relationship (β= -.477, t= -3.904, P<.05) significantly and independently predicted tramadol abuse, with self-esteem and family relationship further demonstrating an inverse relationship with tramadol abuse. There was also a significant joint influence of the predictors on tramadol use [R= .641, R=.591, [F (3, 39) = 4.311, P<.01]. self-esteem, peer influence and family relationship jointly accounted for 59.1% of the variance in tramadol abuse symptoms among studied population. The study corroborate with documented studies on self-esteem, peer influence family relationship and tramadol abuse. Key word: Self-esteem, peer influence, family relationship tramadol abuse, rehabilitation International Journal of Scientific and Research Publications, Volume 11, Issue 6, June 2021 775 ISSN 2250-3153 This publication is licensed under Creative Commons Attribution CC BY. http://dx.doi.org/10.29322/IJSRP.11.06.2021.p114100 www.ijsrp.org Introduction Generally, Tramadol is an opioid analgesic used mainly for treatment of moderate to severe pain (United Nations office on Drugs and Crime, 2013; Miotto, Cho, Khalil, Blanco, Sasaki, & Rawson, 2017). However, due to its addictive potential which also increases its potential for misuse (Kertesz, 2017; World Health Organization, 2014) with imminent psychosocial, economic and medical complications (French &Martin 1996; Burke, 1988; World Health Organization, 2014; Kertesz, 2017), tramadol abuse has become a problem of national and international importance. According to the United Nations Office on Drugs and Crime (UNODC), more than 35 million young people use opioids such as tramadol, morphine, heroin, methadone, buprenorphine, codeine, (United Nations Office on Drugs and Crime, 2017), and these have been implicated to negative health impact, socio-economic problems and high mortality rate ranging between 70000 and 100000 deaths yearly (World Health Organization, 2014). Documented literature have found that tramadol remains one of the most abused opioids, especially among young people (Mohamed, Hamrawy, Shalaby, Bahy, & Allah, 2015; Kertesz, 2017).Reports from European countries such as Germany and Spain for instance, found high prevalence of tramadol abuse particularly among university students (Holloway, Bennett, Parry, & Gorden, 2014). This trend is even higher among African and Asian countries where majority of the young people indulge in high tramadol use for non-medical purpose (Salm-Reifferscheidt, 2018). For instance, a study in Egypt indicated that Tramadol is the most abused opioid (Mohamed, et al., 2015), while Nazarzadeh, Bidel, and Carson (2014) reported 4.8% lifetime prevalence of Tramadol misuse among Iranian population. In Nigeria, the use and abuse of tramadol has become a problem of National mental health and psychiatric significance (Ahmed, 2012). The 21st century Nigeria has witnessed changing trends in the patterns of psychoactive substance use with Tramadol emerging as a candidate drug particularly in the Northern region of the country (Ibrahim, Yerima, Pindar, Onyencho, Ahmed, Machina, Shehe, Rabbebe & Wakil, 2017). Although high prevalence of abuse of tramadol have been recorded among university students in other regions (53.4%) prevalence, Duru, Oluoha, Okafor, Diwe, and Iwu, 2017) affirmed that the rate of tramadol abuse in the northern Nigeria is simply alarming (Ahmed, 2012). In Kano, Northern Nigeria, a cross sectional study amongst commercial bus drivers reported that 85.2% of respondents misuse Tramadol (Yunusa, Bello, Idris, Haddad, & Adamu, 2017). Another cross sectional study in Borno Northern Nigeria, found astronomical rise in abuse among ‘Almajiris’ or street children (Abdulmalik, Omigbodun, Beida, & Adedokun, 2009). This suggests that tramadol abuse among young people in the region is increasing and more research is needed. This is expedient due to the imminent challenges that may accompany its abuse among young people. Tramadol misuse has several health consequences and also associated with mortality. In addition to the medical and socio-economic problems that abound, abuse of tramadol could affect academic progress, leads to unhealthy social groups such as cultism and indiscriminate sexual behaviour among young people. This will result in high school drop-out rate, unemployment and poverty with its attendant consequences. In addition, despite continuous efforts to prevent its abuse, the number of patients admitted to psychiatric hospitals due to drugs have increased considerably (Okoye, 2013), hence the need to identify possible risk factors to stem the tide. Previous studies have found that, low self-esteem (Chen, Dufour & Yi, 2005), youths’ perception of peer group influence ( Gaidhane, Zahiruddin, Waghmare, Shanbhag, Zodpey, & Joharapurkar,2008; Dankani, 2012; Jibril, Olayinka, Omeiza, & Babantunde,2008; Okwaraji, Ebigbo, & Akpala, 2009; Mohammad, 2014) and dissatisfaction with family relationship (Ledoux, Miller, Choquet & Plant, 2002) are factors that influence drug abuse among youths and young people. Also, Adamson, Ogunlesi, Morakinyo, Akinhami, Onifade, Erinosho, et al. (2015) stated that drug abuse could be accounted for by the demographic characteristics of the respondents as well as by socio-cultural variations. Self-esteem, which has to do with peoples’ assessment of who they are has been found to have a profound influence on drug use and abuse among young people (Chen, Dufour & Yi, 2005). International Journal of Scientific and Research Publications, Volume 11, Issue 6, June 2021 776 ISSN 2250-3153 This publication is licensed under Creative Commons Attribution CC BY. http://dx.doi.org/10.29322/IJSRP.11.06.2021.p114100 www.ijsrp.org Particularly, empirical studies have implicated drug abuse to low self-esteem among youths. However, there are still studies revealing weak association between self-esteem and illicit drug abuse (Mohamadpourasl, Fakhari, Rostami, Tabatabaei (2006). Also, available research evidence shows that the influence of peers is another factor to youth substance abuse. Yet again, poor family relationship characterized by low parental support or monitoring is associated with high rates of substance use (Piko, 2000). A plethora of studies have consistently associated drug abuse among young people with the social environment in which they live. For example, Thakore, Ismail, Jarvis Keetbaas, Payne and Rothenburg (2009) found that majority of the college students who indulged in alcohol drinking attributed it to peer pressure. Peer influence play a great role in initiation, continuation and abuse of drugs, and this is largely responsible for reasons why youths, including university students abuse drugs (Ahmed, 2012). Similarly, Ledoux et al., (2002) reported that most students who are dissatisfied with family relationship and those who are less closely monitored, are more likely to be heavy substance users than other students. Dysfunctional family relationship increases the risk for youths substance use. Despite, the relative high frequency of the abuse of Tramadol in Northern Nigeria, this is the first study based on available literature in this clime that attempts to look at this drug from the perspective of addiction among young people under rehabilitation. Also, based on literature search, there is still paucity of research on the influence of self-esteem and peer pressure in tramadol abuse among university population. The only study conducted by Ahmed (2012) considered general population and did not examine the joint influence of the variables captured in the present study. The objectives of the study are to: i. determine the role of self-esteem, peer pressure and family relationship in tramadol abuse among young people receiving treatment for tramadol abuse