SUBSTANCE ABUSE AND MENTAL HEALTH OUTCOMES AMONG YOUTH IN URBAN SLUMS: A CASE STUDY OF AJEROMI GENERAL HOSPITAL

CHAPTER ONE

INTRODUCTION

Abstract

Substance abuse among young people in Nigerian urban slums represents a complex public health emergency shaped by poverty, unemployment, conflict exposure, peer influence, and weak regulatory frameworks. In Lagos, communities such as Ajegunle, within the Ajeromi-Ifelodun Local Government Area, are recognized as high-prevalence zones for psychoactive substance use, including cannabis, opioids, tramadol, codeine, and emerging synthetic drugs. This chapter provides the background, problem statement, objectives, research questions, hypotheses, significance, scope, and key definitions for a study examining the relationship between substance abuse and mental health outcomes among youth presenting at Ajeromi General Hospital.

1.1 Background to the Study

Substance abuse is a worldwide health problem and is especially prevalent among low-income and urban youth. According to the World Health Organization, substance use is the harmful or hazardous use of a psychoactive substance, such as alcohol and illegal drugs, that poses significant risk of mental disorders (Kolawole, Ogunyemi & Lucas, 2025). The issue is serious and alarming in Nigeria. UNODC (2018) estimated that Nigeria has one of the highest prevalence of drug abuse among its population in the continent of Africa, with 14.3 million people aged 15–64 using psychoactive substances (14.4% of the population). However, the last few surveys indicate that this number may be on the increase, especially for young people in urban areas.
A systematic review of data from 32 studies from 2014 to 2024 found the overall prevalence of drug abuse in Nigeria to be 14.4% among all individuals aged 15–64, with varying prevalence rates across different regions. In urban environments, addiction to opioids is more common among youths due to poverty and availability (Chibuike et al., 2025). The most frequently abused drugs include cannabis, tramadol, codeine and heroin while methamphetamine (also known as ‘mkpurummiri’) has become a major epidemic in the South East of Nigeria since 2020. In fact, a 2022 survey revealed that 37% of university students used tramadol or codeine in a way they shouldn't.In Lagos, for instance, a survey carried out in 2022 indicated that 37% of university students misused tramadol or codeine.
Lagos slums, including those in the areas of Ajegunle (a part of the Ajeromi-Ifelodun Local Government Area which is served by Ajeromi General Hospital) are typified by extreme poverty, overcrowding, unemployment, substandard housing, and lack of access to quality education and health care. These structural conditions cause situations where individuals crave the use of substances as a coping mechanism, part of a social dynamic, or a source of livelihood in drug trading. The prevalence rate of any psychoactive substance use in Nigeria has been estimated to be 14% which is double the world average of 5.6%, with youth between 13 and 35 years old being the most at risk, (Nigerian Observer, 2024).
The impact of drug abuse on the health and functioning of young people in cities is significant and can be far-reaching. Depression, anxiety, psychosis and antisocial personality disorders are identified in the literature as common co-occurring disorders among substance users in Nigeria (Chibuike et al., 2025). The impact is not only on the individual, but on his or her family, and on the incidence of high crime rates, failure to achieve education, economic struggle and heightened risk of contracting HIV/AIDS due to needle sharing and unsafe sex. Substance abuse also places an increased burden on health care systems with emergency department presentations and psychiatric admissions associated with SUDs and substance abuse contributing to the high cost of under-resourced urban health care systems.
The socio-economic drivers are of great influence. Self-medication, escapism and involvement in the drug trade constitute alternative livelihoods driven by unemployment (33% of the nation's youth are without jobs) and multidimensional poverty (63% of Nigerians are impacted by poverty) (Chibuike et al., 2025). Peer pressure, media portrayals of substance use and its glamour, lack of supervision at home, and unregulated availability of opioids and cannabis within the local community exacerbates these weaknesses. The lack of effective drug law enforcement and poor public education efforts also help make drug use behaviors possible in slum settlements in Lagos.
Ajeromi General Hospital is the main tertiary hospital for Ajegunle and neighbouring communities. The hospital sees adolescents and young adults on a regular basis with substance induced psychosis, overdose, psychiatric co-morbidities, and injuries resulting from violence/conflict related to drug use. However, there is lack of evidence documenting the prevalence pattern of substance abuse and substance abuse related mental health outcomes of the Ajeromi population specifically. This study does remedy that.

1.2 Statement of the Problem
Inappropriate use of drugs and alcohol, and mental health conditions, are an important, but little studied, public health problem among adolescents in urban slums of Lagos. The community-level evidence, such as Ajeromi General Hospital is still limited, although national data provide a valid picture of the problem of drug/alcohol dependence in Nigeria. This gap hinders the ability to create specific prevention, early intervention, and treatment programs for this particular population served by this facility.
What's more, addictions and mental health disorders often overlap and lead to complex clinical scenarios that are poorly managed in resource-constrained urban hospitals where no specific psychiatric staff is designated to manage addictions. Effective resource planning, staff training, and community outreach is constrained by the lack of systematic local prevalence data. This study seeks to fill these gaps by providing baseline epidemiological data on prevalence of substance abuse and related mental health outcomes among youth in Ajeromi-General Hospital.

1.3 Objectives of the Study

The general objective is to examine the relationship between substance abuse and mental health outcomes among youth presenting at Ajeromi General Hospital, Lagos.

The specific objectives are:

1. To determine the prevalence and patterns of substance abuse among youth (aged 15–35) attending Ajeromi General Hospital.
2. To assess the types of mental health disorders co-occurring with substance use in the study population.
3. To examine the association between substance type, frequency of use, and severity of mental health outcomes.
4. To identify sociodemographic and environmental risk factors for substance abuse and co-occurring mental illness in urban slum settings.
5. To recommend evidence-based interventions for substance abuse prevention and mental health support in Ajeromi-Ifelodun.

1.4 Research Questions

1. What is the prevalence and pattern of substance abuse among youth attending Ajeromi General Hospital?
2. What mental health disorders are most commonly associated with substance abuse in the study population?
3. Is there a significant association between substance type, frequency of use, and the severity of mental health outcomes?
4. What sociodemographic and environmental factors predict substance abuse and co-occurring mental illness among urban youth?
5. What interventions are most effective for reducing substance abuse and improving mental health outcomes in urban slum communities?

1.5 Research Hypotheses

H1: There is a statistically significant association between substance abuse and the prevalence of mental disorders among youth at Ajeromi General Hospital.

H2: Youth from households with lower socioeconomic status exhibit significantly higher rates of both substance abuse and associated mental health conditions.

H3: Polydrug use is associated with more severe psychiatric morbidity than single-substance use in the study population.

1.6 Significance of the Study

The study is also clinically important, public health significant and of social policy relevance. The findings will help the Ajeromi General Hospital management to establish or strengthen a dedicated Unit of substance use and Mental health in the hospital. The study provides information for the health authorities in Lagos state to guide their community-based drug prevention programmes and psychiatric outreach services in Ajegunle. For national policy, it helps fill gaps in the growing evidence base for the scaling up of the treatment capacity for drug and alcohol addiction and integration of mental health into primary care in Nigeria. Given that eight of every ten admissions at some Nigerian psychiatric facilities
The use of hospital-level data to inform clinical practice is clear cut.

1.7 scope of this study.
The study is focused on youth age group (15 to 35 years) who presented to Ajeromi General Hospital over a period of one year. Participation will be recruited for both outpatient and inpatient. Validated instruments will be used for mental health assessments, such as General Health Questionnaire-28 (GHQ-28) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Some of these include stigma regarding the disclosure of alcohol or drug use, the ability to measure substance use during a single assessment, and the fact that the substance use disclosure was self-reported.

1.8 Definition of Terms

Substance Abuse:

The harmful or hazardous use of psychoactive substances including alcohol, cannabis, opioids, and stimulants in a pattern that leads to significant impairment or distress (WHO, 2018).

Mental Health Outcome:

The measurable change in an individual's mental health status resulting from exposure to a specific condition or intervention, including changes in the presence, severity, or type of psychiatric disorder.

Urban Slum:

A densely populated informal settlement characterized by substandard housing, inadequate access to water and sanitation, insecure tenure, poverty, and limited social services (UN-Habitat, 2020).

Youth:

Individuals aged 15 to 35 years, as operationalized within the National Youth Policy of Nigeria (2019), encompassing adolescents and young adults.

Polydrug Use:

The concurrent or sequential use of two or more psychoactive substances, which is associated with compounded health risks and more severe psychiatric morbidity.

Co-occurring Disorders:

The simultaneous presence of a substance use disorder and one or more independent mental health conditions in the same individual, also referred to as dual diagnosis or comorbidity.

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