The Dark Side of MBBS – Increasing Trend of Alcohol and Smoking Among Medical Students

Addiction to substances such as alcohol and cigarettes is becoming increasingly common among the young population. Many students leave their homes for the first time and are drawn towards smoking and drinking to look “cool,” especially under the influence of peer pressure and social media. Platforms like Instagram and Snapchat often showcase a party culture where drinking and smoking are portrayed as symbols of confidence and popularity. This social media pressure to appear trendy encourages many young people to try these substances just to post pictures or stories that make them seem socially active and accepted. The culture of songs and movies that glorify alcohol, smoking, and drugs further pushes them in the same direction. However, most of these students are unaware of the long-term side effects caused by such substance abuse. These incidents have been on the rise among students in engineering, medical, and other professional colleges.

Many young MBBS students are becoming increasingly addicted to such substances. One such cross-sectional study was conducted on MBBS students of PGIMS, Rohtak, by the faculty of the Department of Pharmacology, PGIMS Rohtak, Haryana, on 940 MBBS students between May and July 2023. The results were published in the Asian Journal of Medical Sciences on 1st January 2025.

How was the study conducted?

Students who consented to participate in the study were assessed for their pattern and prevalence of substance abuse with the help of a structured, self-administered questionnaire titled “Pattern of Substance Abuse Among Medical Students,” which was used as the tool for data collection. The questionnaire had three main sections. The first section included demographic characteristics of the participants such as age, gender, and year of study. The second section used the Short Michigan Alcohol Screening Test (SMAST) to assess the severity of alcohol abuse among students. The third section used the Fagerström Test for Nicotine Dependence (FTND) to measure the severity of nicotine dependence among students.

Apart from these three main sections, the WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) version 3 scale was also used to assess the students’ experience of using these substances over their lifetime and during the past three months.

What is SMAST?

The Short Michigan Alcoholism Screening Test (SMAST) is a brief questionnaire designed to identify possible alcohol-use problems. It is derived from the longer Michigan Alcoholism Screening Test (MAST), which contains 25 questions, but is shorter and quicker to administer. Being a screening test, it does not diagnose alcoholism by itself but indicates when a deeper evaluation is required. The original SMAST contains 13 yes-or-no questions, with each “yes” response scored as 1 point.

A total score of 0 to 1 generally indicates no apparent alcohol problem, while a score of 2 to 3 suggests a possible alcohol issue and warrants further evaluation. Scores of 4 or higher strongly indicate probable alcohol dependence, and the individual should undergo a more detailed clinical assessment.

What is the FTND test?

The Fagerström Test for Nicotine Dependence (FTND) is a simple and widely used questionnaire designed to assess the level of physical dependence on nicotine among smokers. It consists of six questions that evaluate factors such as how soon a person smokes after waking up, the number of cigarettes smoked per day, and the difficulty in refraining from smoking in restricted areas.

The total score helps classify dependence from very low to very high. A score of 1 to 2 shows low dependence, 3 to 4 indicates low to moderate dependence, 5 to 7 indicates moderate dependence, and a score of 8 or more indicates high nicotine dependence.

What is the ASSIST version 3 scale?

The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) version 3, developed by the World Health Organisation, is a simple and reliable tool used to identify individuals who may be at risk of substance abuse. It includes eight questions covering substances such as tobacco, alcohol, cannabis, cocaine, sedatives, opioids, and others. The test assesses how often a person uses these substances, the problems caused by their use, and the risk of dependence. Based on the responses, each substance receives a score that classifies the person’s risk as low, moderate, or high, helping healthcare professionals decide whether to offer brief advice, regular follow-up, or specialised treatment.

Results of the study

The study revealed that substance abuse was observed among nearly one-third of the students. Students residing in hostels were found to abuse a greater number of substances compared to day scholars. Alcohol and smoking emerged as the most commonly used substances among the students. Most students reported using only a single substance, while a smaller proportion indulged in both alcohol and smoking. The prevalence of substance use increased progressively with each academic year, with the highest rates observed among final-year students.

A considerable number of students admitted that they began using substances due to mental stress during their studies, while peer pressure was identified as the major influencing factor for initiation. A positive family history of substance abuse was also noted as a contributing factor. Many final-year students reported continuing substance use in an attempt to improve academic performance during examinations, whereas a large proportion of students across all years consumed substances mainly for enjoyment. Although several students attempted to quit, most were unsuccessful due to lack of willpower, fear of withdrawal symptoms, and the absence of motivation or support to overcome addiction.

In terms of the SMAST, the majority of students scored between 0 and 2, indicating little to no alcohol-related problems. However, a small group of students from the third and final years showed borderline scores, suggesting early signs of alcohol-related issues that required further attention for their well-being and academic stability.

Regarding the Fagerström Test for Nicotine Dependence, most respondents demonstrated a low level of nicotine dependence, with only a few students showing moderate dependence levels. This suggests that while nicotine use exists among medical students, severe addiction remains relatively limited to a smaller subset of users.

Limitations of the study

As this was a descriptive cross-sectional study, a cause-and-effect relationship could not be established. The data were collected based on self-reports from the participants, which may have been influenced by recall bias and underreporting of substance use due to social desirability and fear of consequences. Since the study was conducted by faculty members of the same institution, some students may have hesitated to report their actual substance use habits honestly, fearing disciplinary action or negative judgement. This could have led to an underestimation of the true extent of substance abuse among the participants.

The study also did not include newer or less commonly discussed substances such as designer drugs, ephedrine, cannabis, cough syrups, prescription medications like alprazolam, and other hardcore drugs that are increasingly being misused by young people. Their exclusion limits the understanding of the evolving pattern of substance use among students.

Another limitation was the absence of gender-based comparison. The study did not present findings showing differences in the incidence or severity of substance abuse between male and female students, which could have provided a clearer view of gender-specific patterns and risk factors. As the study was limited to a single institution, the findings may not be fully applicable to medical students in other colleges or regions where social, cultural, or academic pressures may differ.

Recommendations to NMC and medical college administrations across India

Considering the alarming rise in substance use among medical students, there is a strong need for nationwide preventive and supportive measures. The National Medical Commission should take a proactive role in addressing this growing concern by introducing structured programmes across all medical colleges. Mandatory awareness sessions on substance abuse, mental health, and stress management should be conducted for every batch of students from their first year onward. The NMC could also recommend incorporating topics related to addiction, coping mechanisms, and peer influence into the medical curriculum under AETCOM modules, helping students understand both the health and social consequences of such behaviour.

Medical college authorities should establish confidential student wellness and counselling centres to provide psychological support and early intervention for those struggling with stress, anxiety, or substance use. Regular screening using validated tools such as ASSIST, SMAST, and FTND can help identify at-risk students early, followed by counselling rather than punishment to encourage openness. Colleges should also organise mandatory interactive workshops and peer-support initiatives led by senior students and mental health professionals to promote a healthy, substance-free campus culture.

Strict monitoring and random checking of hostel campuses and rooms should be carried out routinely to prevent the storage or use of alcohol, cigarettes, or illegal substances within the premises. The concerned authorities and local administrations should ensure that cigarette stalls, alcohol outlets, and wine shops are not located near or within medical college areas. Such preventive environmental measures can significantly reduce easy access and temptation among young students.

At a broader level, multicentric studies under NMC guidance should be encouraged to monitor the prevalence and patterns of substance use among medical students nationwide. This would help in framing evidence-based policies and tailoring interventions according to regional and institutional needs. With collective efforts from the NMC, medical college administrations, faculty, and students, the medical community can take a decisive step towards curbing substance abuse and fostering a healthier learning environment for future doctors.