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Br Dent J 2017;222: 198–204 http://dx.doi.org/10.1038/sj.bdj.2017.124

Excessive alcohol and illicit substance abuse among dental students is frequently reported. Although various educational schemes have attempted to address substance abuse, the need to increase its teaching within dental programmes has been highlighted. To date, research has focused on the prevalence of these behaviours. This pilot study aimed to investigate the legal and moral perceptions of alcohol and illicit substance use amongst undergraduate students.

A questionnaire was administered to clinical and non-clinical undergraduates at a UK university. Participants anonymously reported on tobacco, alcohol and drug use. Opinions were sought on the UK drug classification system, relative punishments for illicit substance use, legalisation of controlled substances and perceived health risks of specific drugs. Moral attitudes were assessed by asking students how much they disapproved of specified activities such as 'taking ecstasy during a Friday night out', 'going into university hung-over' and 'going into a lecture high on cannabis'.

One hundred and seven valid questionnaires were analysed. More clinical (73%) than non-clinical students (66%) were found to drink alcohol regularly. The authors provided possible explanations for this including the consumption of alcohol as a form of stress-relief from the high intensity and lengthy clinical course. In contrast, non-clinical undergraduates were more likely to smoke and use cannabis. The authors suggested that as clinical undergraduates are expected to give appropriate advice to patients regarding smoking cessation and illicit drug use, they would be better informed, would have internalised the health messages and may also have observed the harmful effects among their patients.

Both groups perceived ecstasy, cocaine and ketamine as 'high risk' drugs. A third of both clinical and non-clinical students supported the legalisation of illicit drugs. The results suggested the legality of drugs might have a lesser influence over drug use behaviour for clinical students than for non-clinical students. The authors explained that as part of undergraduate teaching of 'professionalism', clinical students would have received messages about illicit drug use and would be aware of the serious consequences on their careers. Social perceptions of illicit substance users were similar for both clinical and non-clinical students.

The authors acknowledged the limitations of this study, which included the small sample size, unknown response rate, potential for selection bias and the lack of generalisability as the results were from a single university. Taking this into account, it was concluded that individual substance use behaviours may be influenced by legal perceptions of illicit substance use but personal values and social norms are also likely to be important.

By Reena Wadia (Research Insights Team)

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Author Q&A James Puryer Bristol Dental Hospital

What made you investigate this topic?

There is a wealth of published literature reporting that dental and medical undergraduates, as well as junior dentists and doctors, participate in excessive alcohol and illicit substance abuse, despite being aware of the risks to both their health and professional status. Our pilot study set out to investigate if there were any differences between clinical and non-clinical undergraduates' attitudes towards legal and moral perceptions of alcohol and illicit substance use, and whether or not these attitudes affected behaviour. In addition, from a logistical basis, we were looking for a research topic that could be used for a Year-4 undergraduate Elective Project.

Did any of the results surprise you?

Not really. We would have expected that clinical students were less likely to smoke or use illicit substances than non-clinical students. In addition, we were not surprised by the high numbers of clinical students who regularly consumed alcohol as this has been found in other recent studies. Furthermore, we would have expected that more clinical than non-clinical students were deterred from using illicit substances due to their legality and possible risk to livelihood.

What further research would you like to do?

As this was a pilot study, we would like to repeat the study on a larger scale to include undergraduates from other UK universities. This would help to ensure that results are representative of all undergraduates and less affected by variations in numbers of mature students or ethnic minorities. It would also be sensible to differentiate 'clinical' undergraduates into 'dental' and 'medical' to determine if there are any differences in attitudes between groups. If results of this larger study supported findings that clinical students consume excessive amounts of alcohol, smoke or use illicit substances, we would like to research why this is the case despite possible consequences to health or livelihood.

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Undergraduates views on drugs and alcohol - does it make a difference if you’re a clinical student?

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Alcohol and drug misuse amongst undergraduate students has long since been a concern at UK universities. Indeed, in the second line of this pilot report we have evidence that junior doctors and dentists – and similarly medical and dental students – participate in excessive alcohol and illicit drug activities.

For clinicians and clinical students the consequences of such activity can significant. The General Dental Council's guidance for decision makers on the impact of clinical convictions and cautions1 makes salutary reading; ultimately a charge of serious professional misconduct can arise as a consequence of drunkenness or misuse of drugs.

Here the authors are focussing on the perceptions, both legal and moral, of clinical students and those following non-clinical degrees regarding substance abuse. Clearly this work is twinned with Puryer and Wignall's more substantial 2016 paper2 which determines the prevalence of tobacco, alcohol and substance misuse in UK dental students.

In this report clinical students seem to differ in attitude quite significantly from their non-clinical peers in certain key areas. We know that alcohol use is prevalent in university students, but it is higher in clinical students. There are perhaps many reasons for this and the authors highlight the length and intensity of medical and dental programmes as one possible explanation.

On a positive note clinical students were more likely to be non-smokers and less likely to use illicit substances, although paradoxically less than half of the clinical students who completed the questionnaire saw tobacco as a high risk drug. This is perhaps explained by the fact that this is a small scale pilot study.

Interestingly, and perhaps of significant concern, is the finding that almost a half of non-clinical and one third of clinical students would change their substance use behaviour (ie use more) if legislation in this area was relaxed. That said, as far as dental students are concerned, Puryer and Wignall2 reassuringly reported just last year that they observed reduced levels of drinking, smoking and illicit substance use in comparison with four previous studies. So it isn't all doom and gloom.

Finally I'm not sure that veterinary science students would consider themselves non-clinical!

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Expert view Lyndon Cabot Associate Dean – Undergraduate Clinical Education, King's College London Dental Institute