There are high rates of drug use among university students in Yemen and Saudi Arabia. Over half of the students (56.9%) were distributed in the first level (no problem) of the DAST-10, and 44.1% of students stated that they had abused drugs at least once in their lives, which is undoubtedly high. Our results found that approximately one third of those who had problems with drugs were on the second level “the low level.”
These students do not need therapeutic interventions as much as they need psychological counseling to avoid the risk of drug addiction. This may be due to university students’ awareness of the risks of drug exposure and its negative effects on the individual, the family, and society.
On the other hand, the percentage of students distributed among the dangerous levels in the DAST-10—i.e., the moderate, substantial, and severe levels—was 13.71%. These are high prevalence rate. Significant differences were observed between Yemeni and Saudi students in terms of the prevalence of drug use. Although the proportions of students who had no problems with drugs in both countries were equal, the differences were relatively clear in the other four levels of the DAST-10. Yemeni students had higher prevalence rates than did Saudi students at the low, moderate, and substantial levels, while the prevalence rates at the severe level were relatively close in both countries.
These results indicate an alarming prevalence of drug abuse among university students in Yemen and Saudi Arabia. A significant percentage of the respondents of this study had serious problems with medication and will need psychological intervention.
These results are consistent with those of studies that have found high prevalence rates of drug use among students. For example, Brandt, Taverna, and Hollock [27] reported a high prevalence rate for non-medical use of prescription medications.
Meanwhile, the results of this study differ with the study of Kounenou [28], who found low prevalence rate where the percentage of students who used drugs ranged between 1.4 and 4.1%.
The results of the current study revealed a variation in the prevalence rates of smoking among university students in Yemen and Saudi Arabia. The percentage of Yemeni students who smoked cigarettes was significantly higher than that of Saudi students who smoked cigarettes, while prevalence rates were close in both countries in terms of smoking hookah and shisha and chewing tobacco. With respect to the misuse of sedatives, inhalers, energy drinks, and soft drinks, the prevalence was high among Saudi students, with significant differences.
The researcher believes that cultural factors play an important role in creating the difference between students of both countries in terms of smoking and substance abuse, as most Yemeni smokers prefer to use tobacco while using khat, while Saudis prefer to consume soft drinks with meals. However, what is striking about these results is the high rate of abuse of inhalants and sedatives among the participants in this study. These results indicate that much effort must be made to combat the spread of psychotropic substances among university students in both countries.
Some previous studies pointed to low prevalence rates. For example, the percentage of students who misused sedatives was 3.4% [28]. This percentage increased to 48% [27], while Ghandur, Sayed, and Martins [29] found that 15.1% of university students use sedatives. Osman et al. [2] reported a high prevalence of substance abuse (31%) among university students. According to the results of the current study, the prevalence of poor sleep quality among the participants was high and the differences between the two countries were not significant. Low sleep quality may be attributed to the fact that some university students need more time to complete their tasks and assignments, so they use part of the time allocated to sleep to complete these tasks. This was confirmed by studies that indicated a low quality of sleep among college students [30,31,32,33,34]. Although the differences between Yemeni and Saudi students in terms of quality of sleep were not significant, other studies—for example, Peltzer and Pengpid [35]—found differences between countries in terms of the prevalence of sleep disorders among university students.
There is evidence of a high prevalence of sleep disorders and poor sleep quality among university students [30,31,32,33,34, 36]. Peltzer and Pengpid [35] conducted a study of 20,222 undergraduate students from 26 countries in Asia, Africa, and the Americas and found that 10.4% of students had severe sleep problems, which were associated with tobacco use and poor academic performance, and that the prevalence of sleep problems varied from one country to another.
Our results indicate that poor sleep quality had an effect on the level of drug use among university students. According to Table 4, there is a significant relationship between sleep quality and drug use. A high score on the DAST-10 was offset by a decrease in sleep quality. It is as if poor sleep quality is an etiological factor of drug use, especially because students who do not use drugs had a high quality of sleep. The relationship between the overall PSQI score and drug use was significant; when the level of drug use rises, the overall PSQI score increases, which means that drug users have poor sleep quality more often than non-users do. The relationship between sleep quality, overall PSQI score, and substance abuse was also significant. Sleep quality was poor and the overall PSQI score was high in students who misused sedatives, inhalants, tobacco, energy drinks, or soft drinks. On the other hand, non-users of these substances enjoyed good sleep quality and had low overall PSQI scores.
These results complement those of previous studies that found a significant relationship between poor quality of sleep and drug use or substance abuse [37,38,39,40,41,42]. For example, Alamir et al. [41] found a significant relationship between misuse of medicinal drugs (non-medicinal use of drugs, substance abuse, and pain relievers) and poor sleep quality in university students. Goodhines et al. [42] reported a high prevalence of substance abuse among university students, and substance abuse was associated with poor sleep quality and insomnia. Some university students reported a decrease in the amount and quality of sleep on days when they consumed alcohol or energy drinks [40]. The relationship was significant between increased alcohol intake, sleep disturbances, and sleep quality [42], while poor sleep quality predicts the consequences of alcohol use among university students [38, 43]. Sleep quality decreased with increased alcohol or cigarette use by students [39]. Poor sleep quality was associated with cigarette smoking, while the prevalence of sleep disturbances among smokers was high compared to that of non-smokers [44]. There were also significant relationships between smoking and poor sleep quality, sleep disturbances, increased use of sleep medications, and daytime sleepiness [21].
Afandi et al. [45] found that 67.2% of university students in the United Arab Emirates suffer from a lack of sleep, while 75% of smokers have poor sleep quality. In a study with a large sample (2230) of university students, it was found that 52.7% had poor sleep quality and that cigarette smoking and chewing khat were significantly associated with poor sleep efficiency and increased use of sleep medications [46].
With regard to poor sleep quality and its relationship to drug and substance abuse, studies have indicated a relationship between the use of over-the-counter psychological stimulants and poor sleep quality among university students, who suffered from sleep disturbances and, often, got poorer ratings on sleep quality tests as compared to students who do not use these stimulants [37, 41]. Other reports have also shown that people who suffer from sleep disorders without having substance use disorders will misuse substances in the future and that most people who suffer from substance addiction also suffer from sleep disorders [12, 47].
In contrast, other studies did not find significant differences between smokers and non-smokers in terms of sleep quality [48, 49]. It appears clear from the results of the current study that the poor quality of sleep is associated with drug use and substance abuse among university students in Yemen and Saudi Arabia. This subject needs more attention from researchers and decision-makers in both countries.