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Substance Abuse at Early Age as a Potential Risk Factor for Driving under the Influence of Substance in Jeddah, Saudi Arabia: A Cross-Sectional Study

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Objective: Worldwide, trauma is a major health problem and road traffic accidents (RTAs) are the primary killer of young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors. Methods: This is a cross sectional survey conducted between May and September 2016 at Al-Amal hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pre-tested questionnaire to collect data regarding socio-demographic and socio-economic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment and fatalities under the influence of an abused substance. Whenever possible, we compared the self-reported data with medical records and resolved any conflict by discussing with the patient. Results: A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused in 56.4% (n = 57) and 25.7% (n = 26) of the patients, respectively. As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of the participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate (OR = 0.86; 95%-CI = 0.75 – 0.99; p = 0.046) but not the multivariate (OR = 0.87; 95%-CI = 0.75 – 1.00; p = 0.056) regression, a younger age at the time of the first substance abuse was associated with a higher probability to drive under the influence of an abused substance. Conclusions: Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addiction to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.
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Traffic Injury Prevention
ISSN: 1538-9588 (Print) 1538-957X (Online) Journal homepage: https://www.tandfonline.com/loi/gcpi20
Substance abuse at early age as a potential risk
factor for driving under the influence of substance
in Jeddah, Saudi Arabia: A cross-sectional study
Yahya Almarhabi, Abdulrahman I. Mufti, Adel D. Almaymuni, Talib
Abdurahman, Ghamri Abdulaziz, Ahmed A. Alghamdi & Abdel Moniem
Mukhtar
To cite this article: Yahya Almarhabi, Abdulrahman I. Mufti, Adel D. Almaymuni, Talib
Abdurahman, Ghamri Abdulaziz, Ahmed A. Alghamdi & Abdel Moniem Mukhtar (2018) Substance
abuse at early age as a potential risk factor for driving under the influence of substance in
Jeddah, Saudi Arabia: A cross-sectional study, Traffic Injury Prevention, 19:7, 687-692, DOI:
10.1080/15389588.2018.1494828
To link to this article: https://doi.org/10.1080/15389588.2018.1494828
View supplementary material Accepted author version posted online: 24
Jul 2018.
Published online: 06 Nov 2018.
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Substance abuse at early age as a potential risk factor for driving under the
influence of substance in Jeddah, Saudi Arabia: A cross-sectional study
Yahya Almarhabi
a,b,c
, Abdulrahman I. Mufti
d
, Adel D. Almaymuni
d
, Talib Abdurahman
e
, Ghamri Abdulaziz
e
,
Ahmed A. Alghamdi
e
, and Abdel Moniem Mukhtar
f
a
Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia;
b
Center of Excellence in Trauma and
Accidents, King Abdulaziz University, Jeddah, Saudi Arabia;
c
Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi
Arabia;
d
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia;
e
Al-Amal Hospital, Ministry of Health, Jeddah, Saudi Arabia;
f
Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
ABSTRACT
Objective: Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the
primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate
the extent of driving under the influence of an abused substance in Saudi Arabia and to explore
the associated factors.
Methods: This is a cross-sectional survey conducted between May and September 2016 at Al-
Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients
who were admitted for additional education and rehabilitation and had no psychotic symptoms.
We used a standardized and pretested questionnaire to collect data regarding sociodemographic
and socioeconomic characteristics, history of and current substance abuse, driving under the influ-
ence of an abused substance, injuries, imprisonment, and fatalities under the influence of an
abused substance. Whenever possible, we compared self-reported data with medical records and
resolved any conflict by discussion with the patient.
Results: A total of 101 out of 112 invited patients participated in our study (90.2%). The mean
age of the participants was 33.28 years (SD ¼9.46 years). Of the total, 93.1% (n¼94) drove under
the influence of an abused substance. Amphetamines and alcohol were the first substance abused
(56.4% [n¼57] and 25.7% [n¼26] of patients, respectively). As currently abused substances,
amphetamines and cannabis were reported in 38.6% (n¼39) and 24.8% (n¼25) of participants,
respectively. The mean age at the time of the first substance abuse was 18.76 years (SD ¼4.99
years). In the univariate regression (odds ratio [OR] ¼0.86; 95% confidence interval [CI], 0.750.99;
P¼.046) but not the multivariate regression (OR ¼0.87; 95% CI, 0.751.00; P¼.056), a younger
age at the time of the first substance abuse was associated with a higher probability of driving
under the influence of an abused substance.
Conclusions: Our study showed that among individuals hospitalized due to substance abuse
problems, driving under the influence of drugs and alcohol was common. Preventive measures to
reduce driving under the influence should be introduced in addition to specialized hospitals.
Further research is required to investigate the factors associated with driving under the influence
of abused substances in Saudi Arabia.
ARTICLE HISTORY
Received 18 January 2018
Accepted 26 June 2018
KEYWORDS
Trauma; driving under drug
influence; road traffic
accidents; alcohol
Introduction
Globally, trauma is the ninth most common cause of disabil-
ity-adjusted life years for all age and gender groups (World
Health Organization [WHO] 2013). Approximately 50 mil-
lion people were injured and 1.3 million died prematurely
due to road traffic accidents (RTAs) worldwide (WHO 2009,
2010,2013). Moreover, if no preventive measures are taken,
RTAs will be the seventh leading cause of death in 2030
(WHO 2010).
The fatality rate of RTAs in Saudi Arabia is estimated to
be 4.7%, which is higher than the rate of 1.7% in the UK, the
United States, and Australia (Ansari et al. 2000).
The incidence rate of fatal RTAs in Saudi Arabia is 24 per
100,000 individuals, which is higher than that in developed
countries and exhibits an increasing trend (Mansuri et al.
2015). According to the WHO (2015), Saudi Arabia has the
highest road traffic mortality rate among high-income nations
and RTAs are the primary cause of death among young adult
men. The Saudi Ministry of Health reported that more than
20% of their bed occupancy was dedicated to trauma victims
and more than 81% of in-hospital deaths were due to RTAs
(Ansari et al. 2000). Moreover, 20 deaths per day were caused
by RTAs, most of which affect young and economically active
adults (Ansari et al. 2000; Mansuri et al. 2015). In other
CONTACT Yahya Almarhabi Yalmarhabi@kau.edu.sa Department of Surgery, Faculty of Medicine, King Abdulaziz University, Medical Campus-Male Building
10, Level 1, Room 1015, P.O. Box 80200, Jeddah, JED 21589, Saudi Arabia.
Associate Editor Kathy Stewart oversaw the review of this article.
Supplemental data for this article can be accessed on the publishers website.
ß2018 Taylor & Francis Group, LLC
TRAFFIC INJURY PREVENTION
2018, VOL. 19, NO. 7, 687692
https://doi.org/10.1080/15389588.2018.1494828
developed countries, the gross loss due to trauma is less than
2% of the national income, whereas this figure is more than 9%
in Saudi Arabia (Al Turki 2014;WHO2015).
According to the WHO, RTAs have 5 main pillars that are
related to the road system, driver behavior, and the vehicles
(Peden et al. 2004;WHO2013). Factors related to driver
behavior include speeding, nonuse of safety belts, and alcohol
abuse. An analysis of 12,743 patients who were admitted
between 1986 and 2006 to a specialized addiction hospital in
the eastern region of Saudi Arabia found that the majority
were young, single, and had attained low education.
Approximately one third of the patients used cannabis, her-
oin, and amphetamines, and more than one quarter abused
alcohol (AbuMadini 2008). An Australian study that included
573 patients with a substance abuse problem found that
approximately half of nonalcohol drug users and two fifths of
alcohol users drove under the influence of an abused sub-
stance. Moreover, the more frequent the use of a substance,
the greater the perception of a low likelihood of having an
accident and being apprehended by police (Matthews et al.
2009). Furthermore, in an Australian study, younger age and
male sex were significantly associated with driving under the
influence of an abused substance (Matthews et al. 2009).
A systemic review showed that driver behaviors (e.g.,
speeding, wrong turns, and failing to comply with traffic
regulations) were the most common factors associated with
RTAs in Saudi Arabia. An investigation performed by the
Central Department of Statistics and Information between
1995 and 1996 claimed that though alcohol toxicity was
rarely found to be a factor in RTAs, data collection was in
its infancy (Ansari et al. 2000).
Nevertheless, the association between alcohol consump-
tion and RTAs has been proven in many studies (Albery
et al. 2000; Drummer et al. 2003; Robertson and Drummer
1994). Hartman and Huestis (2013) showed that driving
under the influence of drugs was associated with impaired
concentration, reduced reaction time, increased lane weav-
ing, and poor judgment during driving. In addition, the U.S.
National Survey on Drug Use and Health indicated that
driving under the influence of illegal drugs was common
(Substance Abuse and Mental Health Administration 2012).
Many types of substances consumed while driving were
associated with fatal and nonfatal RTAs; these include
amphetamines, cannabis, heroin, alcohol, benzodiazepines,
cocaine, and opiates, which are often used in combination
with alcohol. Alcohol has a wide range of effects on driving
ability and judgment and can have fatal consequences
(Berghaus et al. 1995; Borkenstein et al. 1974; Drummer
et al. 2004). A blood alcohol level of >0.05 g/dL is associated
with a 3 times greater risk of an RTA. Western countries
have applied strong measures against drunk drivers, which
results in greater control of RTAs in certain countries
(Peden et al. 2004; WHO 2010).
Unfortunately, the implication of psychoactive substances
in RTAs in developing countries does not garner substantial
attention; however, a systematic review showed that in
India, where RTAs and related mortalities were reported to
be the highest in the world, psychoactive substances were
implicated in up to 48% of trauma victims (Das et al. 2012).
The aim of this study was to examine the factors associ-
ated with driving under the influence of an abused sub-
stance in Saudi Arabia.
Methods
We followed the Strengthening the Reporting of
Observational studies in Epidemiology guidelines for report-
ing our study methods and results (Von Elm et al. 2014).
Study design
This study had a cross-sectional design.
Study setting and location
We conducted our study at Al-Amal Hospital in Jeddah.
Illicit drug abuse and consumption of alcohol are religious
sins and social taboos in the culture of Saudi Arabia, which
make it very sensitive to study. Therefore, Al-Amal Hospital,
which is a specialized center to which patients in the west-
ern region of Saudi Arabia with substance abuse problems
are referred, was chosen for this study. It is one of the larg-
est specialized hospitals in the region with more than 200
beds. Two major types of care are provided: (1)
Detoxification and acute care, which are provided in ward
A, and (2) education and rehabilitation, which are provided
in wards B, C, and D. Jeddah is a coastal city on the Red
Sea with a population of approximately 3,431,000.
Study participants
We included all adult patients 18 years who were admitted
to Al-Amal Hospital between May and September 2016 for
education and rehabilitation and who had no psychotic
symptoms. We excluded patients who were admitted to
ward A at the hospital for detoxification and acute care. We
also excluded patients who had mental disorders or were
medically compromised. Women were not included in our
study, because they are not allowed to drive in Saudi Arabia.
Data sources and measurement
We used a standardized and pretested questionnaire to col-
lect data. We applied the questionnaire in face-to-face inter-
views. Using a consecutive sample of the first 30 patients,
we tested the validity of our questionnaire using 3 questions,
namely, educational level, age at first substance abuse, and
current abused substance. Responses from our questionnaire
were compared to the information available in the patients
medical records. The overall agreement rate was 81%. In
order to reduce interrater variability, 3 jointly trained physi-
cians conducted the interviews following predefined standar-
dized operating procedures. Any concerns or questions
during the interviews were resolved by discussion.
688 Y. ALMARHABI ET AL.
Whenever possible, we compared the self-reported data with
the medical records and resolved conflicts by discussion
with the patient.
Study variables
We collected data on age, marital status, educational level,
occupational status, monthly income, first substance abused,
age at first substance abuse, driving under the influence of
an abused substance, attitude toward driving under the
influence of an abused substance, effect of driving under the
influence of an abused substance on increased aggressive
behavior toward drivers of other vehicles, use of a seat belt
when driving under the influence of an abused substance,
exceeding the allowed speed limit when driving under the
influence of an abused substance, imprisonment for viola-
tion of driving rules or RTAs, carrying weapons in the car,
and number and type of injuries and fatalities when driving
under the influence of an abused substance.
Study size
According to prior data (Matthews et al. 2009), we expected
a 40% prevalence of driving under the influence of an
abused substance. According to the formula to calculate the
sample size for nonstratified cross-sectional studies
(Kraemer and Blasey 2015), at least 92 patients is required
to estimate prevalence of driving under the influence of an
abused substance with a precision of 0.1. We included 101
patients in this study.
Statistical methods
To describe our study population, we used frequencies and
absolute numbers for categorical variables and mean, stand-
ard deviation, median, and interquartile range for continu-
ous variables. We examined differences between those who
drove and those who did not drive under the influence of
an abused substance. Between-group differences in 2 cat-
egorical variables were assessed using chi-square or Fishers
exact test when the data were sparse. Between-group differ-
ences in continuous variables were examined using Students
ttest for unpaired samples or one-way analysis of variance
when there were more than 2 groups. For all statistical tests,
aPvalue <.05 was defined as significant. In order to inves-
tigate factors associated with driving under the influence of
an abused substance, we used uni- and multivariate binary
logistic regression models. The dependent variable in the
regression models was driving under the influence of an
abused substance. The independent variables were all other
variables mentioned in the Study Variables subsection. We
included the variables in the regression model using a back-
ward elimination procedure. We used the Statistical Package
for Social Sciences Ver. 21 for data analysis.
Risk of bias
In order to reduce selection bias, we included all adult
patients admitted to Al-Amal Hospital for education and
rehabilitation and who had no psychotic symptoms. We pre-
tested the questionnaire and cross-validated its findings with
the medical records to minimize measurement bias.
Ethical considerations
The study protocol was reviewed and approved by the
Ethics Committee at Al-Amal Hospital and the Biomedical
Research Ethics Unit at King Abdulaziz University.
Participation was voluntary, data confidentiality was assured,
and informed consent was obtained from all participants.
Results
One hundred twelve patients fulfilled the inclusion criteria
and were invited to participate in the study; 101 patients
accepted and were interviewed, resulting in a response rate
of 90.2%. The mean and median ages of the participants
were 33.28 years (SD ¼9.46 years) and 32 years (interquartile
range ¼13 years), respectively. In addition, 51.5% (n¼52)
were single, 21.8% (n¼22) were divorced, and 26.7% (n¼
27) were married. Furthermore, 87.1% (n¼88) and 9.9% (n
¼10) had visited school and had a bachelors degree, respect-
ively. The first abused substance was amphetamines, alcohol,
heroin, and cannabis in 56.4% (n¼57), 25.7% (n¼26),
14.9% (n¼15), and 1.0% (n¼1) of participants, respect-
ively. The current abused substance was amphetamines, can-
nabis, heroin, and alcohol in 38.6% (n¼39), 24.8% (n¼25),
7.9% (n¼8), and 6.9% (n¼7) of the patients, respectively.
Furthermore, 21.8% (n¼22) of the patients reported cur-
rently using more than one of the previously mentioned sub-
stances. The mean age at first substance abuse was 18.76 years
(SD ¼4.99 years). Moreover, 93.1% (n¼94) of patients
admitted to driving under the influence of an abused substance,
43.6% (n¼44) found this normal and acceptable, and 44.6%
(n¼45) believed that it had no effect on aggressive behavior
toward drivers of other vehicles. RTAs, fistfights, stab wounds,
and gunshot wounds were the cause of injury in, respectively,
51.5% (n¼34), 18.2% (n¼12), 6.1% (n¼4), and 3.0% (n
¼2) of those injured when driving under the influence of an
abused substance. In addition, 10.3% (n ¼6) of those injured
when driving under the influence of an abused substance
Table 1. General characteristics of study participants (n¼101).
Variable Mean (SD) Median (IQR)
Age in years 33.28 (9.46) 32 (13)
Age at first substance abuse (years) 18.76 (4.99) 18 (5)
Driving under the influence of
an abused substance, % (n)
Yes
No
93.1 (94) 5.9 (6)
Injured when driving under the
influence of an abused substance, % (n)
Yes
No
65.3 (66)
34.7 (35)
SD ¼Standard deviation. IQR ¼Inter-quartile range.
TRAFFIC INJURY PREVENTION 689
reported a fatality among the victims. The descriptive statistics
of the participants in this study are shown in Table 1 (see also
Table 1 in the supplementary Appendix available online).
Compared to those who did not drive under the influ-
ence of an abused substance, patients who drove under the
influence of an abused substance rarely or never used seat
belts (P¼.002), showed a tendency toward believing that
driving under the influence of an abused substance had no
effect on aggressive behavior toward drivers of other
vehicles (P¼.06), more often carried weapons in their cars
(P¼.06), and reported higher fatality rates when injured
(P¼.06). Table 2 (see also Table 2 in the supplementary
Appendix available online) compares participants who drove
under the influence of an abused substance with those who
did not.
Using univariate regression, the only factor that was stat-
istically associated with driving under the influence of an
abused substance was age at first substance abuse (odds
ratio [OR] ¼0.86; 95% confidence interval [CI], 0.750.99;
P¼.046). However, in multivariate regression, no signifi-
cant association was found between age at first substance
abuse and driving under the influence of an abused sub-
stance (OR ¼0.87; 95% CI, 0.751.00; P¼.056; Table 3
(see also Table 3 in the supplementary Appendix available
online). We found no significant association between driving
under the influence of an abused substance and age, marital
status, education level, occupational status, monthly income,
first substance abused, attitude toward driving under the
influence of an abused substance, effect of driving under the
influence of an abused substance on increased aggressive
behavior toward drivers of other vehicles, use of a seat belt
when driving under the influence of an abused substance,
exceeding the allowed speed limit when driving under the
influence of an abused substance, imprisonment for viola-
tion of driving rules or RTAs, carrying weapons in the car,
and number and type of injuries and fatalities when driving
under the influence of an abused substance.
Discussion
Our findings demonstrate that among individuals hospital-
ized due to substance abuse problems, driving under the
influence of drugs and alcohol was extremely common
(93%). Moreover, we found that the majority of hospitalized
patients with substance abuse problems at Al-Amal Hospital
were young adults, had low education and income levels,
were unmarried, and started abusing drugs during adoles-
cence. In comparison to our study participants, 12,743
patients admitted in the past 2 decades to the Al-Amal spe-
cialized addiction hospital in Damamm in the eastern region
of Saudi Arabia exhibited a younger mean age (30.21 years;
SD ¼8.27 years), a higher proportion of unmarried subjects
(60.5%), higher education (94.9%), and a lower proportion
of subjects who abused more than one substance (36.6%).
Amphetamines and cannabis, followed by alcohol and her-
oin, were the most commonly used substances in the past
decade in Damamm and Jeddah (AbuMadini et al. 2008).
An Australian study (Matthews et al. 2009) that included
573 patients with a substance abuse problem found that
approximately half of nonalcohol drug users and two fifths
of alcohol users drove under the influence of an abused sub-
stance. This is a substantially lower rate of drunk driving than
we found in our study (93%); only 5% of the Australian
patients had a custodial sentence (Matthews et al. 2009),
whereas 30% of our study participants were imprisoned.
Moreover, the more frequent the use of a substance, the
greater the perception of a low likelihood of having an acci-
dent and being apprehended by the police (Matthews et al.
2009). In addition, a younger age and male sex were signifi-
cantly associated with driving under the influence of an
abused substance in the Australian study (Matthews et al.
2009). In our study, driving under the influence of an abused
substance was more common in patients who were younger at
the time of their first substance abuse, who failed to wear a
seat belt, who perceived no effect related to aggressive traffic
behavior, who carried weapons in their vehicle, and who had
an increased associated fatality if injured. The variability
between the Australian study (Matthews et al. 2009) and the
present study could be explained by the fact that our study is
based on data from a single institution experience compared
to the population-based Australian study.
The present study also lacked a low risk perception
toward the seriousness of driving under the influence of an
abused substance and its consequences. Indeed, 43.6% of the
participants expressed a positive attitude toward driving
under the influence of psychoactive drugs. Thus,
Table 2. Characteristics of study participants stratified by driving under the influence of an abused substance.
Variable
Driving under the influence of an
abused substance
Not driving under the influence of an
abused substance Pvalue
Age (years), % (n)
1830 97.8 (44) 2.2 (1) .14
'3156 90.6 (48) 9.4 (5)
Age at first substance abuse
1017 95.7 (45) 4.3 (2) .68
1833 92.3 (48) 7.7 (4)
Use of seat belt when driving under
the influence of an abused substance,
%(n)
Always or sometimes 86.2 (25) 13.8 (4) .002
Rarely or never 100.0 (68) 0.0 (0)
Injured when under the influence of an
abused substance, % (n)
Yes 100.0 (26) 0.0 (0) .22
No 94.3 (33) 5.7 (2)
690 Y. ALMARHABI ET AL.
stakeholders and policymakers must direct additional educa-
tional and preventive measures toward patients hospitalized
due to substance abuse problems. Moreover, police and traf-
fic control agencies should be equipped with the necessary
tools to identify drivers who drive under the influence of
alcohol and psychoactive drugs (Elder et al. 2002; Peek-Asa
1999; Shults et al. 2001).
This study has several strengths. It included all patients
admitted for rehabilitation from a drug addiction in a major
specialized center in the region and achieved a high
response rate. To the best of our knowledge, this study rep-
resents the first investigation of driving under the influence
of alcohol in Saudi Arabia.
Our study also has several limitations. The cross-sectional
study design does not permit an evaluation of causes of driv-
ing under the influence of psychoactive drugs and the associ-
ated risk factors. In addition, the small sample size limited the
power of our study to identify further issues associated with
driving under the influence of an abused substance.
Moreover, our study was not a population-based study, which
limits the ability to estimate the prevalence of driving under
the influence of psychoactive drugs in Saudi Arabia.
The use of an interview-based method of data collection
might have biased the responses due to the fact that our
study questions were not socially desirable; however, we
carefully developed and pretested the questionnaire, trained
the interviewers, and cross-validated the responses with the
patientsmedical records. The expected effect of social desir-
ability bias in our study was an underestimation of risk per-
ception and behavior; however, low risk perception and
high-risk behavior were identified in our analyses.
Driving under the influence of drugs was highly prevalent
among patients with a substance abuse problem who were
admitted to a specialized addiction hospital in Jeddah, Saudi
Arabia. In our single-center study, we observed a low risk
perception and high probability of initiation of substance
abuse during adolescence. Prevention programs against driv-
ing under the influence of an abused substance among hos-
pitalized patients in Saudi Arabia should be developed,
implemented, and evaluated. Further research is required to
investigate factors associated with driving under the influ-
ence of abused substances in Saudi Arabia.
Competing interests
The authors declare that they have no competing interests.
Author contributions
Yahya Almarhabi, Adel D. Almaymuni, Abdulrahman Mufti, Talib
Abdulrahman, and Ghamri Abdulaziz designed the study. Yahya
Almarhabi, AbdulRahman Mufti, Adel D. Almaymuni, Talib
AbdulRahman, Ahmed A. Alghamdi, and Ghamri Abdulaziz acquired
and analyzed the data, which Yahya Almarhabi and Mukhtar, Abdel
Moniem Mukhtar also analyzed. Yahya Almarhabi, Adel D.
Almaymuni, Abdulrahman Mufti, Talib Abdulrahman, Ghamri
Abdulaziz, and Abdel Moniem Mukhtar wrote the article, which all
authors reviewed and approved for publication.
Funding
This project was funded by the Deanship of Scientific Research (DSR)
at King Abdulaziz University, Jeddah (Grant No. RG-3-140-38). The
authors gratefully acknowledge the DSR for technical and financial
support. The DSR had no role in the design of the study, data collec-
tion, data analysis, interpretation of data, or writing of the article.
Availability of data and materials
The data sets used and/or analyzed during the current study are avail-
able from the corresponding author upon request.
ORCID
Yahya Almarhabi https://orcid.org/0000-0001-7638-5144
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Table 3. Factors associated with driving under the influence: Results of univariate regression.
Variable OR (95% CI) Pvalue
Age at first substance abuse (years) 0.86 (0.750.99) .046
Current substance abused
Amphetamines or cannabis (reference)
Alcohol or heroin
Other and more than one of the above
1
0.33 (0.052.15)
1.05 (0.1010.65)
.24
.97
Attitude toward driving under the influence of abused substance
Abnormal and inacceptable (reference)
Normal and acceptable
1
4.22 (0.4737.48)
.20
Injured when under the influence of an abused substance
No (reference)
Yes
1
a
.99
a
Confidence interval could not be calculated due to sparse data.
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692 Y. ALMARHABI ET AL.
... Of the 23 eligible studies, 19 (83%) were cross-sectional and 4 (17%) were case-control [7,9,17,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]. The first study on SUD was published in 1992, and the successive three decades since then (i.e., 1992-2000, 2001-2010 and 2011-2019) saw approximately equal proportions of publications (33%). ...
... Of the total 23 studies, 12 described the demographic characteristics of SUD patients and the types of drugs they used [7, 17, 28-35, 46, 47]; 5 studies were about co-existent conditions of SUD patients, such as anxiety, depression and suicide [9,[41][42][43][44]; 5 studies evaluated blood samples of SUD patients in order to determine the prevalence of viral diseases (i.e., HBV, HCV, and HIV) and the accuracy of blood assays [36][37][38][39][40]; 1 study evaluated the psychometric properties of an Arabic version of the University of Rhode Island Change Assessment (URICA) scale with an SUD sample [45]. ...
... A total of 6 studies described the patterns of drug use among SUD patients [7,17,31,33,41,42]; of them, 5 were cross-sectional and 1 was case-control. These studies described the common types of substances being used, number of substances (single versus poly use), and method of administration (inhalation, ingestion, or injection). ...
Article
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Background: Substance use disorders (SUD) are mental health conditions that arise from chronic drug use. There is an increased recognition of this problem in Saudi Arabia. Objective: Conduct a comprehensive review of published literature on SUD to identify knowledge gaps and to guide future research. Methods: PubMed, Embase and Cochrane databases were searched with suitable keywords for SUD publications up to June 10, 2019. Eligible studies (primary research conducted in Saudi Arabia) were organized into three broad domains: (1) risk (or protective) factors of SUD, (2) perspectives on drug use of people who use drugs, and (3) impact on family. The quality of the included studies was assessed with the Newcastle-Ottawa Scale. Results: Of the 113 search records, 23 were eligible for analysis (19 cross-sectional and 4 case-control). All studies were conducted in clinical settings; all but two included males only. There were 4 studies about SUD risk factors, 6 studies about the perspectives of people who use drugs, and none about family impact. None of the cross-sectional studies (0%) and 25% of case-control studies were of good quality. Conclusions: The available studies were few in number, weak in methodology, and poor in quality. Quantitative as well as qualitative studies about SUD are warranted in each domain and should represent both genders.
... Dentists surveyed in this study were fresh graduates (dental interns) with BDS in dental medicine and surgery. The study was conducted in agreement with the Research Ethics Committee of the Faculty of Dentistry in KAU (51- [12][13][14][15][16][17][18][19]. A 21-item questionnaire was the primary mean of data collection. ...
... Cannabis and ecstasy were least known, this is not consistent with results indicating a high use of cannabis. Very little literature was published on the subject in Saudi and indicated that of the substances abused, cannabis and amphetamines are the most common ones used in Saudi, other substances are gradually emerging and slowly becoming popular, however trends of use change with time [16,17]. Regarding exposure to SUD patients, only a few participants reported encountering those patients in their practice, and mainly in university dental hospitals. ...
... In Tunisia, a study monitoring the prevalence rate of illicit drug use and its predictors in college students using a self-administrated questionnaire found that almost 5% of the participants were using cannabis and experiencing significant academic failure [12]. In Saudi Arabia, using cannabis while driving is equivalent to driving under the influence of alcohol [13]. Driving under the influence of cannabis is linked to other destructive behaviors including road rage and carrying weapons [13]. ...
... In Saudi Arabia, using cannabis while driving is equivalent to driving under the influence of alcohol [13]. Driving under the influence of cannabis is linked to other destructive behaviors including road rage and carrying weapons [13]. ...
Article
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Cannabis is the most used illicit drug in the world. It causes impaired executive functioning, psychosis, and schizophrenia, among other impairments. It also affects reaction time, awareness, and motivation. These side effects can lead to decreased academic performance as well as social setbacks. Variance in the interpretation of whether cannabis is forbidden fuels the ongoing debate on the religious stance of cannabis use among Muslim communities across the globe. Stigma is the biggest barrier for open discussion about cannabis usage and also acts as a barrier to the implementation of harm-reductive programs in the Islamic world. There is clear evidence that due to stigma, religious beliefs, and social factors, Muslim youth are at a higher risk than their adult counterparts and that they feel unable to seek help with regard to cannabis and other drug abuse. By reviewing studies on the harmful effects of cannabis use and comparing them against notions of what is considered forbidden in the Islamic tradition and other communities, this paper explores the best ways to reduce harm from cannabis usage in the global Muslim community.
... In Saudi Arabia, it was documented that amphetamine is the most common illicit drug abused by Saudis (ranging from 4% to 70.7%), and there was an increase in amphetamine abuse over time. 53,54 The present study revealed that 5.6% of patients were exposed to pesticide toxicity. It was most common in group I (6.5%). ...
... 57 Moreover, a strong correlation between alcohol abuse and car accidents was reported, where 25% of drivers were under the influence of alcohol while driving at the time of car accidents. 53 Regarding household chemicals, the present study revealed that 23.9% of patients were intoxicated with chemicals used for washing, cleaning floors and disinfecting. Clorox and Flash constituted the most common chemicals encountered, with Clorox responsible for toxicity in 59.2% of household toxicity and 14% of all toxicity cases. ...
Article
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Acute poisoning is considered one of the most important medical emergencies, resulting in severe morbidity and mortality, and is an economic burden on governments. This study aimed to determine the extent of acute adult intoxication among the population located in the Najran area, Saudi Arabia, over the last 3 years (from January 2017 to December 2019). The study is a hospital-based retrospective observational study. The data of all acutely intoxicated adult patients were collected from patients’ files of King Khalid Hospital, the main hospital in the Najran area. In this study, the total number of intoxicated patients was 852. Patients were divided into three groups according to their age: 15–25 years, 26–35 years and >35 years. Accidental intoxication was predominant (64.6%), especially with therapeutic drugs (60.2%), predominantly acetaminophen and amphetamine, which intoxicated 24.5% and 23.4% of the patients, respectively. Moreover, this study showed that 10.6% of patients were intoxicated with overdoses of alcohol, mostly among patients aged over 35 years. Furthermore, the present study revealed that 23.9% of patients were intoxicated with household chemicals, especially Clorox bleach or Flash. Patients presented with a wide range of symptoms; some were even asymptomatic. Overall, patients’ outcomes were good; mortalities were few (1.2%), and most fatalities were found in patients aged over 35 years (60%). The present study showed that pharmaceutical drugs constituted the most common causative agents in acute intoxication. Household chemicals, especially Clorox bleach, Flash and pesticides, are highly implicated in the acute toxicity problem. Drug abuse, especially amphetamine and alcohol, still represents a great threat facing people from the Najran region. It is crucial to deliver effective public health education programmes to increase community awareness about the predisposing risk factors of acute toxicity, whether as overdoses or suicide attempts.
... Another important factor related to drug driving is the age of first drug use. Cannabis is one of the most commonly reported drugs used at an early age and has been found to be associated with a higher likelihood of drug driving (Almarhabi et al., 2018;Beirness and Davis, 2006;Choi et al., 2019;Cuttler et al., 2018;Hammig et al., 2021;Le Strat et al., 2015). ...
Article
Drug driving is a serious problem worldwide that can increase the risk of road crashes. This systematic review seeks to identify factors associated with drug driving (i.e., driving after consuming drugs other than alcohol) to highlight gaps in existing knowledge and inform the design of more effective countermeasures. A search of the literature was conducted for the period January 1, 2005 to July 31, 2021 using six different databases. The search protocol followed PRISMA guidelines and was registered in PROSPERO (#CRD42021234616). Studies that met inclusion criteria compared drug drivers with either non-drug drivers, alcohol-only drivers or drug drivers from an earlier time period, to identify factors specifically associated with drug driving, rather than common to all drivers. Two hundred and nineteen publications met the inclusion criteria and were included within the review. Based on the findings, a logic model was developed that presents the factors associated with drug driving. Various sociodemographic, psychosocial and legal factors emerged as the main factors associated with illegal drug driving. At the sociodemographic and psychological levels, drug drivers were more likely to be single, young males who often drive after using cannabis and who score high on sensation-seeking and impul-sivity scales. The key social factor found to be associated with drug driving was peer acceptance/disapproval of the behaviour. At the legal level, the review suggested that the effectiveness of current enforcement approaches to drug driving vary among jurisdictions around the world due to differences in the level of perceived certainty of apprehension and the chances of punishment avoidance. Future research into the anticipated and actual rewards for drug driving is needed to inform the development of more effective countermeasures.
... Nevertheless, several cases of substance abuse are recorded every year. 39 The other factors that explained the variance were acceptance, denial, and use of emotional social support. These findings are in agreement with an early study from Turkey, where these factors were used to cope with anxiety in male nursing students. ...
Article
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Background: Anxiety is seen among students even during normal times. The Covid19 pandemic is believed to have increased anxiety and depression among the students. Purpose: An investigation was done to assess the anxiety levels and coping strategies of nursing students in Saudi Arabia. The influence of demographics on the anxiety levels and coping strategies were also determined. Methods: A cross-sectional study was conducted using a questionnaire through Google forms. The questionnaire had items related to demographics such as age, sex, etc., along with a question to know about the confidence of students to work as nurses. A GAD7 scale was used to assess anxiety levels and BriefCope was used to determine coping strategies. Statistics were performed using non-parametric tests, factorial analysis, and linear regression. Results: More than half of the participating students experienced moderate to severe anxiety. The anxiety levels were not influenced significantly by demographics except the young age. More than 50% of the students were reluctant to work as nurses and this affected the anxiety score significantly. Factorial analysis grouped variables into six factors. Linear regression showed a positive correlation of these factors with anxiety. Conclusion: Anxiety score revealed that Saudi nursing students had moderate to severe anxiety. The combined number of students reluctant or scared to work was more than those who were confident to work as nurses. A positive association was observed between factor variables with mild and moderate anxiety.
... Amphetamines are psychostimulant drugs abused worldwide [3,4]. In Saudi Arabia, amphetamines are reported to be the most frequently abused substance (4-70.7%) in the treatment setting [5] and is, jointly with alcohol, detected in 56.4% of cases hospitalized due to substance abuse [6]. ...
Article
Full-text available
Cardio- and neurotoxicity of amphetamines play an important role in worsening morbidity, making the initial evaluation of the patient’s status a potentially lifesaving action. The current study hypothesized that the S-100β serum level could predict the severity of acute amphetamine toxicity and the in-hospital outcome. The current study is a prospective cohort study conducted on 77 patients diagnosed with acute amphetamine exposure and referred to Aseer Poison Control Center, Saudi Arabia. The patients admitted to ICU showed significantly higher serum levels of S-100β in comparison to those not admitted (p < 0.05). Moreover, the S-100β level was significantly elevated among patients with prolonged QTc intervals. Receiver-operating characteristic curve of S-100β serum level as an in-hospital outcome predictor showed that at a cutoff value > 0.430 ug/L, the sensitivity of S-100β serum level as severity predictor was 100%, and the specificity was 74.1%. In conclusion, the current study revealed that the S-100β serum level could be used as an outcome predictor in hospital admission cases due to toxic amphetamine exposure and offers an idea about the cardiac and neuronal involvement. This can help select patients who will benefit most from ICU admission and early management and assess the severity of cases in settings where GC–MS is not available.
... [4] The published literature on SUD in Saudi Arabia is deficient in terms of methodology as well as the coverage and depth of issues pertaining to addicts themselves and to their family members. For example, most studies on SUD enrolled only patients and did not have a control group, [5][6][7][8][9] which limited them from identifying risk factors for SUD. Studies from elsewhere in the world show that family aspects (e.g., parents' marital status, parental drug use, child abuse, parenting style, relationship quality, and communication between parents and child) and religiosity play important roles in the substance use of adolescents and young adults. ...
Article
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Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
Article
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To identify the changing trends and crucial preventive approaches to road traffic accidents (RTAs) adopted in the Kingdom of Saudi Arabia (KSA) over the last 2.5 decades, and to analyze aspects previously overlooked. This systematic review was based on evidence of RTAs in KSA. All articles published during the last 25 years on road traffic accident in KSA were analyzed. This study was carried out from December 2013 to May 2014 in the Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawwarah, KSA. Road traffic accidents accounted for 83.4% of all trauma admissions in 1984-1989, and no such overall trend was studied thereafter. The most frequently injured body regions as reported in the latest studies were head and neck, followed by upper and lower extremities, which was found to be opposite to that of the studies reported earlier. Hospital data showed an 8% non-significant increase in road accident mortalities in contrast to police records of a 27% significant reduction during the years 2005-2010. Excessive speeding was the most common cause reported in all recent and past studies. Disparity was common in the type of reporting of RTAs, outcome measures, and possible causes over a period of 2.5 decade. All research exclusively looked into the drivers' faults. A sentinel surveillance of road crashes should be kept in place in the secondary and tertiary care hospitals for all regions of KSA.
Article
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The goal of sobriety checkpoints is to deter drinking and driving by systematically stopping drivers for assessment of alcohol impairment, thus increasing the perceived risk of arrest for alcohol-impaired driving. This review examines the effectiveness of random breath testing (RBT) checkpoints, at which all drivers stopped are given breath tests for blood alcohol levels, and selective breath testing (SBT) checkpoints, at which police must have reason to suspect the driver has been drinking before demanding a breath test. A systematic review of the effectiveness of sobriety checkpoints in reducing alcohol-involved crashes and associated injuries and fatalities was conducted using the methodology developed for the Guide to Community Preventive Services (Community Guide) . Substantial reductions in crashes were observed for both checkpoint types across various outcome measures and time periods. Results suggest that both RBT and SBT checkpoints can play an important role in preventing alcohol-related crashes and associated injuries.
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Background: Cannabis is the most prevalent illicit drug identified in impaired drivers. The effects of cannabis on driving continue to be debated, making prosecution and legislation difficult. Historically, delays in sample collection, evaluating the inactive Δ(9)-tetrahydrocannabinol (THC) metabolite 11-nor-9-carboxy-THC, and polydrug use have complicated epidemiologic evaluations of driver impairment after cannabis use. Content: We review and evaluate the current literature on cannabis' effects on driving, highlighting the epidemiologic and experimental data. Epidemiologic data show that the risk of involvement in a motor vehicle accident (MVA) increases approximately 2-fold after cannabis smoking. The adjusted risk of driver culpability also increases substantially, particularly with increased blood THC concentrations. Studies that have used urine as the biological matrix have not shown an association between cannabis and crash risk. Experimental data show that drivers attempt to compensate by driving more slowly after smoking cannabis, but control deteriorates with increasing task complexity. Cannabis smoking increases lane weaving and impaired cognitive function. Critical-tracking tests, reaction times, divided-attention tasks, and lane-position variability all show cannabis-induced impairment. Despite purported tolerance in frequent smokers, complex tasks still show impairment. Combining cannabis with alcohol enhances impairment, especially lane weaving. Summary: Differences in study designs frequently account for inconsistencies in results between studies. Participant-selection bias and confounding factors attenuate ostensible cannabis effects, but the association with MVA often retains significance. Evidence suggests recent smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers. Future cannabis-and-driving research should emphasize challenging tasks, such as divided attention, and include occasional and chronic daily cannabis smokers.
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Objective: India reported the highest number of road traffic crashes, related injuries, and deaths among all countries in the world, with 105,725 road traffic fatalities and 452,922 nonfatal road traffic injuries in 2007. In this report we present a systematic review of available literature on the use of psychoactive substances (alcohol and drugs) among road users, particularly those involved in road traffic crashes (RTCs). Methods: MEDLINE, EMBASE, Ind Medica, and several other databases were searched for reports published between 1980 and 2011 that present data on the prevalence or extent of substance use among road users in India. Results: Among the 23 studies eligible for the review, alcohol was reported by all, but only 2 mentioned the use of drugs. Most of the studies were hospital based, included injured or killed road users, and belonged to southern parts of India. Seven studies did not report any method for detecting alcohol use, whereas 7 used analytical testing, 7 used self-reporting, and 2 used observation. Utilizing the various means of verification, the studies reported that 2 to 33 percent of injured and 6 to 48 percent of killed RTC victims had consumed alcohol or drugs; only 2 mentioned drugs without specifying which types. Most studies did not distinguish between drivers, passengers, bicyclists, and pedestrians, and none investigated alcohol or drug use among those responsible for the accident. Conclusion: A significant proportion of injured or killed road users in India had used alcohol before the accident. However, the existing studies cannot be used to estimate the risk of accident involvement among drunk drivers. There is a need for more rigorous research and capacity building on substance use vis-à-vis road traffic crashes.
Article
Blood alcohol concentrations (BACs) over 0.04% are definitely associated with an increased accident rate. The probability of accident involvement increases rapidly at BACs over 0.08%, and becomes extremely high at BACs above 0.15%. When drivers with BACs over 0.08% have accidents, they tend to have more single vehicle accidents, more severe (in terms of injury and damage) accidents and more expensive accidents than sober drivers. BACs of 0.04% and below apparently are not inconsistent with traffic safety. Many factors other than alcohol are related to the probability of accident involvement. The driver classes with the worst accident experience, in addition to the alcoholically impaired, are the young or very old, the inexperienced and those with less formal education. Persons with the most education, those with better jobs and the middle aged, have better than average accident experience. The effects of alcohol are consistent within the various socioeconomic classes considered. High BACs are always associated with bad accident experience. At the higher BACs, the difference in the accident potential between the various classes of drivers is unimportant. An important aspect of the applied survey technique is that it is adaptable to assessing the effect of various policies directed at the drinking driver. Drinking and driving is clearly associated with the frequent use, or abuse, of alcohol. Many drivers with BACs overestimate the number of drinks that it is safe to have before driving. The tendency to drive after drinking is related significantly to the socioeconomic categories appearing most frequently in the drinking driver class.
Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011-2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.