Prevalence of Substance Use and Associated Factors Among Secondary School Students in Marrakech Region, Morocco

Abstract

Adolescence is a phase characterized by reckless and risky behaviors, including the initiation and use of various illicit substances such as cannabis and alcohol. When ingested or administered, these substances affect mental processes by delivering pleasure, inner peace, and satisfaction. The aim of this study was to determine the prevalence and associated factors of psychoactive substance (PAS) use among adolescents. A cross-sectional study was conducted, including 300 participants surveyed using a structured questionnaire. Data were collected using the Mediterranean School Survey Project on Alcohol and Other Drugs (MedSPAD) to assess substance use, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose substance use disorders (SUDs), and the Early Trauma Inventory Self-Report Short Form (ETISR-SF) to identify childhood maltreatment, as well as socio-demographic characteristics. During the study period, 300 secondary school students participated. Their mean age was 17.92 ± 1.40 years, ranging from 15 to 22. There were slightly more males (56.7%) than females. A total of 40.67% of participants admitted to using at least one PAS at least once, while the prevalence of current use was 26%. Tobacco was the most commonly used substance (22.1%), followed by cannabis (7.33%). According to the DSM-5, 40.2% of users met the criteria for severe addiction. Factors associated with PAS use included the father’s level of education; place of use (e.g., home); poor relationships with parents, siblings, and teachers; and childhood maltreatment. Psychoactive substance use was found to be prevalent among adolescents in this study.

1. Introduction

Psychoactive substances (PAS) are a class of licit and illicit substances that, when ingested or administered, affect mental processes by delivering sensations of pleasure, inner peace, and satisfaction [1]. Despite these seemingly pleasing effects, PAS use is associated with numerous negative consequences for adolescents’ health and has been classified as a major global health problem [2]. The World Health Organization (WHO) highlights the risks posed by these substances to adolescent health, identifying them as the second top risk factor for the global disease burden after high blood pressure [3].

Adolescence is characterized by a phase of reckless and risky behavior, often involving the initiation and use of various illicit substances such as cannabis and alcohol [4]. According to the United Nations Office on Drugs and Crime (UNODC), 5.6% of the global population aged 15–64, or approximately 284 million people, used at least one illicit substance in the past 12 months, including alcohol, cannabis, ecstasy, and cocaine. Furthermore, 38 million people worldwide are estimated to suffer from substance use disorders (SUDs) [5]. The global prevalence of substance use continues to rise, especially in low- and middle-income countries, where it is increasingly prevalent among adolescents. This trend highlights a significant treatment gap, particularly in these regions, where access to drug treatment services is often restricted due to economic challenges and sociocultural barriers [6].

The effects of PAS use on adolescent health are wide-ranging and can be particularly detrimental during this critical developmental period. Physical health consequences include damage to the liver, lungs, and cardiovascular system, as well as an increased risk of developing chronic diseases in adulthood. Additionally, the use of psychoactive substances has been shown to negatively impact brain development, particularly in areas responsible for decision-making, impulse control, and emotional regulation, which are still maturing in adolescence [7,8].

Psychologically, adolescents who engage in PAS use are at a higher risk of developing mental health disorders such as anxiety, depression, and psychosis. The use of substances like cannabis and alcohol has been linked to an increased likelihood of experiencing mood swings, irritability, and difficulty coping with stress. In some cases, these substances can exacerbate underlying mental health conditions, leading to a cycle of substance dependence and psychological distress [9,10]

In Morocco, findings from the national report of the Mediterranean School Survey Project on Alcohol and Other Drugs (MedSPAD) reveal that lifetime substance use prevalence among high school students is 40.5% for boys and 13.5% for girls. These proportions vary depending on the type of substance, ranging between 20% and 40% [11,12,13,14]. The physical and psychological effects of substance use during adolescence are well-documented. PAS use can lead to substance dependence, impaired neurocognitive functioning [15], increased anxiety and depression [16], and disruptions in family and social relationships [17].

Furthermore, PAS use in adolescence can have a profound impact on academic performance and school attendance. Substance use is often associated with lower grades, absenteeism, and a lack of motivation to engage in school activities. These effects can contribute to long-term educational disadvantages, limiting future opportunities for adolescents and increasing the likelihood of early school dropout [18,19].

Family dynamics also suffer when adolescents engage in PAS use, as family members may experience emotional distress, breakdown in communication, and conflicts over substance use. The parental role can be disrupted, especially in cases where family members themselves have substance use issues, creating a cycle of dysfunction and abuse that perpetuates substance misuse among the younger generation [20].

Factors associated with substance use among adolescents include socio-demographic elements such as low family socioeconomic status, parental education and occupation [21], insufficient financial resources, and family history of substance use [15]. Additionally, negative childhood experiences, including physical, sexual, or emotional trauma, as well as school-related elements such as poor relationships and low commitment, are also significant contributors [17]. Substance use may also serve as a coping mechanism for adolescents dealing with stressors such as bullying, peer pressure, and identity struggles, further exacerbating the potential harms of early substance initiation [22]. Despite the seriousness of the issue, knowledge of PAS prevalence and its associated factors among Moroccan adolescents remains limited. This study aimed to bridge that gap by providing a deeper understanding of the factors associated with PAS use in this demographic. The findings are expected to inform health care providers and policymakers in developing targeted programs to address PAS use among adolescents.

2. Subjects and Methods

2.1. Study Design and Population

This cross-sectional study, conducted in 2022, surveyed 300 participants using a standardized, structured questionnaire. Eligible participants were high school students enrolled during the 2021–2022 academic year in the common core, first year, or second year of baccalaureate programs from various schools in urban Marrakech. A multi-stage sampling technique was employed to ensure the representativity of the target population, granting all selected participants an equal chance of inclusion through random selection [11]. In the first stage, to guarantee geographical distribution, 60 participants were equally allocated across the five zones of Marrakech city (Gueliz, Daoudiat, Sidi Youssef Ben Ali, Massira, and Medina). In the second stage, high schools were divided equally into private and public institutions. In the third stage, two high schools were randomly selected from each zone (one public and one private). Finally, individuals meeting the inclusion criteria were randomly selected as study participants.

2.2. Data Collection

The study questionnaire was designed to collect comprehensive data on socio-demographic variables, including age, gender, education level, family income, parental education, and family history of substance use. Participants were asked to indicate whether they had used psychoactive substances (PAS) such as tobacco, alcohol, cannabis, cocaine, heroin, ecstasy, and psychotropic medications used without a prescription. Responses were collected regarding lifetime use, use in the past 12 months, use in the past month, and current usage.

2.3. Measures

The study questionnaire was designed to collect comprehensive data on sociodemographic variables, including age, gender, education level, family income, parental education, and family history of substance use. In addition, the questionnaire assessed the use of psychoactive substances (PAS), including tobacco, alcohol, cannabis, cocaine, heroin, ecstasy, and psychotropic medications used without a prescription. Participants were asked to indicate whether they had used any of these substances at least once in their lifetime, in the past 12 months, in the last month, and whether they were current users.

Substance use disorder (SUD) was assessed using the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), with severity categorized as follows: no SUD (<2), mild SUD (2–3), moderate SUD (4–5), and severe SUD (>6) [23]. Data were collected using the 2017 Moroccan version of the MedSPAD questionnaire, which was specifically adapted for this study. This version included variables such as socio-demographic information, economic status (categorized as ‘high’, ‘moderate’, or ‘low’ based on self-reported data), and family history of substance use.

The questionnaire also included a comprehensive list of psychoactive substances, such as tobacco, alcohol, cannabis, hashish, inhalant solvents (initially designed for industrial use), waterpipe, cocaine, heroin, ecstasy, and psychotropic medications used without a prescription. Participants were asked whether they had used any of these substances during their lifetime, in the past 12 months, in the past month, or as current users.

The validity and reliability of the MedSPAD questionnaire, specifically the Moroccan version used in this study, was previously established in earlier research. The Substance Use Disorder (SUD) classification was based on DSM-5 criteria, which was widely validated in clinical and epidemiological studies.

Childhood maltreatment was assessed using the Early Trauma Inventory Self-Report Short Form (ETISR-SF), a 27-item questionnaire that covers four categories: general trauma, physical abuse, emotional abuse, and sexual abuse. Each item was answered with ‘yes’ (coded as 1) or ‘no’ (coded as 0) [24]. The reliability of the ETISR-SF was demonstrated in prior studies, and it is a well-established tool for assessing early trauma in populations similar to those in this study.

2.4. Psychometric Properties of Instruments

The Moroccan version of the MedSPAD questionnaire established validity and reliability based on previous research. The reliability of the MedSPAD questionnaire was assessed using Cronbach’s alpha, and it showed satisfactory internal consistency. Specific alpha coefficients for the subscales were reported in earlier studies. The questionnaire was adapted from the original version, which was validated across various cultural contexts and languages, ensuring its applicability in the Moroccan adolescent population. Similarly, the ETISR-SF’s reliability was demonstrated in prior studies, with reported alpha coefficients that indicate strong internal consistency for each subscale. The instrument was validated in diverse populations, and the Moroccan version used in this study was culturally adapted to ensure its relevance for the participants.

2.5. Statistical Analysis

Data were entered into Microsoft Excel for coding and filtering, then analyzed using SPSS version 25.0. Categorical data were summarized using frequencies and percentages, while continuous variables were summarized using mean and mode. Descriptive statistics, frequencies, percentages, and rates were calculated. Logistic regression was employed to assess risk factors through univariate analysis. Factors with a p-value of less than 0.05 in univariate analysis were considered for multivariable analysis to identify factors associated with substance use and minimize confounders. Ninety-five percent confidence intervals (CIs) were estimated to evaluate the association between substance use and explanatory variables. A p-value of less than 0.05 was considered statistically significant. The variables included in the multivariable analysis were selected based on their theoretical relevance, as supported by prior research on substance use among adolescents, and their significance in univariate analysis (p < 0.05). This approach ensures the inclusion of meaningful factors while minimizing the impact of confounding variables.

2.6. Ethical Considerations

Participation in this study required verbal informed consent from all participants. Participants were provided with detailed information about this study’s objectives, procedures, and assurances of anonymity. The study protocol was approved by the Ethics Committee of the Regional Academy of Education (REF 9365/21). Informed consent was obtained from participants before administering a self-designed, structured questionnaire during individual interviews conducted in isolated spaces. Clarifications and instructions were provided as needed. Privacy and confidentiality were maintained through the use of anonymous data collection tools. Response bias was minimized by conducting data collection outside classrooms, in the absence of teachers and staff, and outside exam periods. Verbal informed consent was documented by the researchers through a written record, which was confirmed by the interviewer and participant to ensure the validation of the consent process.

3. Results

3.1. Socio-Demographic Characteristics of Participants

During this study, 300 secondary school students completed the survey. The participants had a mean age of 17.92 ± 1.40 years, with ages ranging from 15 to 22. Slightly more than half were male (56.7%). Regarding economic status, 56.3% of participants reported a moderate economic situation, followed by 32% who identified as having a high economic status. The majority (87.35%) lived in urban areas.

In terms of education level, 22.3% of participants were in the common core, 28.3% in the first year of baccalaureate, and 49.3% in the second year of baccalaureate.

As for parental characteristics, 20% of participants reported that their parents were divorced, while 14.7% indicated that one parent was deceased. University-level education was the highest level of education attained by participants’ fathers (41.7%) and mothers (35.3%) (

Table 1. Socio-demographic characteristics of participants.

Variable	Modality	n (%)
Age	17.92 ± 1.40	15–22
Gender	Male	170 (56.7)
	Female	130 (43.3)
Economic situation	Low	35 (11.7)
	Moderate	169 (56.3)
	High	96 (32)
Residence area	Urban	262 (87.3)
	Rural	38 (12.7)
Year of study	Common core	67 (22.3%)
	1st baccalaureate	85 (28.3)
	2nd baccalaureate	148 (49.3)
Parent’ situation	Live together	195 (65)
	Divorced	61 (20.3)
	One parent died	44 (14.7)
Father’ education	Does not know	18 (6)
	Illiterate	53 (17.7)
	Primary	19 (6.3)
	Secondary	85 (28.3)
	University	125 (41.7)
Mother’ education	Does not know	3 (1)
	Illiterate	94 (31.3)
	Primary	10 (3.3)
	Secondary	87 (29)
	University	106 (35.3)
Brotherhood	0	87 (29)
	1–2	116 (38.7)
	3–4	73 (24.3)
	More than 5	24 (8)

).

3.2. Prevalence and Patterns of PAS

A total of 40.67% of participants reported having used at least one PAS at some point in their lifetime, with a current use prevalence of 26%. Tobacco was the most commonly used substance, with a lifetime use rate of 22.1% and a current use rate of 17.33%. Cannabis followed as the second most frequently used substance, with 7.33% reporting lifetime use and 8% reporting current use.

For alcohol, 5% of participants reported lifetime use, while 2.33% were current users. Non-medical use of psychotropic substances was less common, with 2% reporting lifetime use and 1.66% reporting current use (Figure 1).

Among participants who reported substance use, curiosity was the most commonly cited reason, accounting for 21.33% of responses, followed by the desire for euphoria (13.30%) and using substances to forget problems (6%).

For current users, the primary motivation was having fun (16%), followed by the pursuit of euphoria (14.7%) and the need to escape or forget problems (11.33%). A smaller proportion of participants (4.33%) identified addiction as their reason for current substance use (Figure 2).

3.3. PAS Risk Factors

Several factors were significantly associated with PAS use among adolescents. Economic class played a role, with adolescents from higher economic classes being less likely to use substances compared to those from middle-class backgrounds (OR 0.45 [95% CI 0.26–0.78]; p = 0.004). Father’s education was also a key factor, as lower paternal educational levels increased the likelihood of substance use. Adolescents whose fathers had a primary education (OR 2.81 [95% CI 1.05–7.53]; p = 0.03), were illiterate (OR 2.47 [95% CI 1.28–4.77]; p = 0.003), or had unknown educational levels (OR 7.17 [95% CI 2.22–23.15]; p < 0.001) were more likely to engage in PAS use compared to those whose fathers had a university education (

Table 2. Factors associated with substance use in the study area.

Variable	Modality	User 122 n (%)	Non-User 178 n (%)	OR	p Value
Age		18.07 ± 1.47	17.81 ± 1.35	F 0,11	Ns
Gender	Male	76 (62.3)	94 (52.800	1
	Female	46 (37.7)	84 (47.2)	Ns	Ns
Economic situation	High class	27 (22.1)	69 (38.8)	0.45 (0.26–0.78)	0.004
	Middle class	78 (63.9)	91 (51.1)	1
Father’ education	Do not know	14 (11.5)	4 (2.2)	7.17 (2.22–23.15)	0.001
	Illiterate	29 (23.8)	24 (13.5)	2.47 (1.28–4.77)	0.007
	Primary	11 (9)	8 (4.5)	2.81 (1.05–7.53)	0.03
	University	41 (33.6)	84 (47.2)	1
Parents PAS	Yes	57 (46.7)	72 (40.4)	Ns	Ns
	No	65 (53.3)	106 (59.6)	1
Place of use	House	21 (17.2)	18 (10)	2.02 (1–4)	0.04
	Outside	40 (32.8	54 (30.3)	1
Relation parent	Bad	16 (13.1)	11 (6.2)	3.03 (1.30–7.08)	0.01
	Moderate	37 (30.3)	26 (14.6)	2.97 (1.60–5.49)	0.001
	High	24 (19.7)	47 (26.4)	Ns	Ns
	Very high	45 (36.9)	94 (52.8)	1
Relation brotherhood	Bad	15 (12.3)	5 (2.8)	8.64 (21.84–26.20)	<0.001
	Moderate	31 (25.4)	22 (12.4)	4.05 (1.99–8.26)	<0.001
	High	38 (31.1)	55 (30.9)	1.99 (1.07–3.68)	0.02
	Very high	25 (20.5)	72 (40.4)	1
Relation professors	Bad	34 (27.9)	5 (2.8)	27.20 (8.99–82.24)	<0.001
	Moderate	47 (38.5)	49 (27.5)	3.83 (1.88–7.79)	<0.001
	High	27 (22.1)	68 (38.2)	Ns	Ns
	Very high	14 (11.5)	56 (31.5)	1
Teaching program	Easy	22 (18)	69 (38.8)	0.40 (0.22–0.73)	0.003
	Moderate	61 (50)	78 (43.3)	1
Early trauma	Mean	2.5 ± 1.84	1.09 ± 1.09	F 69.45	<0.001

).

Parental substance use and the place of use, particularly at home, were also associated with adolescent substance use (OR 2.02 [95% CI 1–4]; p = 0.04). Relationships within the environment were another critical factor. Adolescents who reported poor relationships with their parents (OR 3.03 [95% CI 1.30–7.08]; p = 0.01), siblings (OR 8.64 [95% CI 21.84–26.20]; p < 0.001), and professors (OR 27.20 [95% CI 8.99–82.24]; p < 0.001) were significantly more likely to use substances.

Additionally, general trauma emerged as a strong predictor. Adolescents who used substances had higher trauma scores (2.5 ± 1.84) compared to non-users (1.09 ± 1.09), according to the Early Trauma Inventory Self Report (ETISR). A one-way ANOVA followed by Tukey’s post hoc test revealed a statistically significant difference in trauma scores between the two groups (F = 69.45; p < 0.001). These findings underscored the multifaceted nature of PAS use among adolescents and emphasized the need for targeted prevention and intervention strategies. However, no significant associations were observed in the multivariable regression analysis (p > 0.05), and thus adjusted odds ratios were not presented (Table 2).

3.4. PAS Characteristics Among Users

Substance use characteristics among participants revealed notable patterns. Nearly half of the users (49.2%) reported initiating substance use between the ages of 12 and 15, with 8.2% starting before the age of 13. Family and friends were the primary sources of information about psychoactive substances (59%), followed by personal experimentation (24.6%). Regarding methods of obtaining substances, parents were identified as the main source (41.8%), followed by purchasing substances independently (36.9%), using credit (14%), and stealing (7.4%). A significant majority of users (78.7%) described psychoactive substances as easily accessible. These substances were provided by students (23.8%) or employees (34.4%), while 41.8% of respondents chose not to specify their source. The average expenditure on substances was 54.3 ± 43.9 USD.

In terms of substance use severity as measured by the DSM-5 criteria for SUD, 40.2% of participants had a severe SUD, 18.9% had a moderate SUD, and 17.2% exhibited low SUD. Only 5.7% of participants did not meet any criteria for a psychoactive substance disorder. These findings underscored the early onset, accessibility, and significant severity of substance use issues among adolescents (

Table 3. Substance use characteristics in the present study.

Variable	Modality	n (%)
Age first use	<12 years old	10 (8.2)
	12–15	60 (49.2)
	16–18	52 (42.6)
PAS information source	Family friends	72 (59)
	Experimentation	30 (24.6)
	Research	20 (16.4)
Ways to get PAS	Parents	50 (41.8)
	Credit	17 (14)
	Own	45 (36.9)
	Steal	9 (7.4)
PAS provider	Student	29 (23.8)
	Employee	42 (34.4)
	Non-specified	51 (41.8)
PAS availability	Easy	96 (78.7)
	Difficult	26 (21.3)
Spending	(USD)	54.3 ± 43.9 (8–250.0)
DSM score	No addiction	7 (5.7)
	Low	21 (17.2)
	Moderate	23 (18.9)
	Severe	49 (40.2)

).

4. Discussion

This study revealed a high prevalence of psychoactive substance (PAS) use among secondary school students, with 40.67% having used a substance at least once in their lifetime and 26% being current users. Tobacco emerged as the most commonly used PAS, with lifetime and current use rates of 22.1% and 17.33%, respectively. These findings are consistent with the MEDSPAD Morocco 2013 survey [12] but indicate higher use compared to students in Morocco’s North Center, where 16.1% was reported [14]. The early onset of PAS use is concerning, highlighting the urgent need for prevention programs targeting younger adolescents. Such initiatives should prioritize substances like tobacco, which are easily accessible, and enforce substance-use policies in schools to curb this growing issue.

Cannabis was the most consumed illicit substance, with 7.33% of participants reporting lifetime use and 8% reporting current use. These rates align with the 2013 MEDSPAD findings and underscore cannabis’ status as the second most used PAS after tobacco, despite its legal prohibition. Morocco’s role as a leading cannabis resin producer may explain its accessibility. However, the prevalence of cannabis use in Morocco remains lower than in Europe and North America, where last-year use rates among young adults (15–34 years) are 11.2% and 10.7%, respectively.

Alcohol ranked third, with lifetime and current use rates of 5% and 2.33%, respectively. These rates are lower than the national prevalence of 8% [25] and findings from other regions of Morocco, such as Benimellal (5.9%). Psychotropic substance use was reported by 2% of participants for lifetime use and 1.66% for current use, which is consistent with other local studies but remains a significant concern.

Risk factors for PAS use included economic situation, parental education, family substance use, and poor relationships with family and professors. These findings are consistent with other studies that highlighted the role of socio-economic factors in shaping substance use behaviors among adolescents. For example, economic hardship was linked to higher substance use among adolescents due to limited access to recreational and support activities, often leading to substance use as a coping mechanism for stress. Additionally, low parental education levels were associated with increased substance use among adolescents, as these households may have fewer resources for preventive education and lack the skills to address substance use behaviors [26,27].

The importance of cohesive family relationships cannot be overstated. Higher levels of family cohesion were consistently identified as protective factors against substance use and other behavioral addictions, such as gambling. Research highlighted that adolescents who perceive strong familial bonds and caring behaviors from parents are less likely to engage in substance use [28]. Moreover, cohesive family functioning moderates risk factors like alexithymia and dissociation, reducing vulnerability to behavioral addictions [29]. These insights reinforced the need for family-centered interventions that enhance cohesion and support within households as part of a holistic approach to PAS prevention.

Family substance use is also a well-documented risk factor for PAS use, with children of parents who use substances being more likely to experiment with drugs themselves [30]. This is particularly concerning because such behaviors can normalize substance use and reduce the likelihood of seeking help [31]. Poor relationships with family and professors are similarly critical, as adolescents in unstable home environments or those who experience academic failure may be more vulnerable to peer pressure and substance use as a form of escape or self-medication [32].

Interestingly, no significant gender differences were observed, which contradicts previous national and international studies showing higher PAS use among males [11,14,33]. This discrepancy may reflect under-reporting by females due to stigmatization associated with PAS use in developing countries. Additionally, reporting bias could play a role, as social and cultural factors may influence the willingness of individuals, particularly females, to disclose PAS use.

Significant risk factors also included substance use by family members and poor family relationships, with ORs of 2 and 3.03, respectively. These findings align with previous research emphasizing the role of unstable households and family substance use in adolescent experimentation, regular use, and addiction [34]. Interventions should incorporate family-based programs, as family dynamics significantly influence PAS use and recovery. Further research should explore the specific nature of family dynamics, as the quality of parent–child relationships, family communication, and supervision may serve as protective factors that mitigate substance use.

Given the growing prevalence of substance use and its significant impact on adolescent health, healthcare providers and policymakers play a critical role in addressing this issue. The potential of integrated physical activity and behavioral interventions in enhancing recovery from SUDs among adolescents was shown to reduce cravings, improve mood, and enhance overall well-being, making it a vital component of SUD treatment [35,36]. Combining physical activity with behavioral strategies such as goal setting, self-monitoring, and social support, as well as integrating cognitive–behavioral therapy and motivational interviewing, further enhances treatment adherence and long-term recovery outcomes [35,37]. Policymakers should prioritize the integration of exercise into treatment protocols, advocating for inclusive policies and fostering community-based interventions to engage individuals and reduce dropout rates.

Furthermore, governmental bodies should invest in educational campaigns to raise awareness about the benefits of physical activity in addiction recovery, especially within schools and local communities. Educational institutions can incorporate preventive programs that promote healthy lifestyles, physical activity, and early intervention strategies to address substance use before it escalates. Healthcare providers can use these insights to design holistic programs that address both the physical and psychological aspects of addiction, promoting sustainable recovery practices that are culturally sensitive and accessible for adolescents. Collaboration across sectors, including health, education, and social services, is essential to develop comprehensive strategies that not only treat but also prevent substance use among young people, ensuring long-term positive outcomes [38,39].

This study also found that 40.2% of users met DSM-5 criteria for severe substance use disorder. This aligns with existing literature, which associates severe SUD with negative outcomes such as poor academic performance, school dropout, interpersonal violence, risky sexual behavior, mental health problems, and suicidal tendencies [40,41,42]. Furthermore, childhood maltreatment emerged as a critical risk factor, with higher rates of traumatic experiences reported among users. Stress from early adversity may impact neurodevelopment and lead to substance dependence as a means of emotional regulation [43].

This study has several limitations that should be considered when interpreting the findings. Firstly, the cross-sectional design limits the ability to establish causal relationships between variables, as all data were collected at a single point in time, preventing the assessment of temporal sequences. Future research could benefit from using a longitudinal design to better understand how substance use behaviors evolve over time and the factors that influence these changes. Secondly, the reliance on self-reported data introduces the possibility of social desirability bias, where participants may under-report or over-report certain behaviors. To mitigate this bias, future studies could incorporate more objective measures or triangulate self-report data with other data sources, such as parental or school reports. Lastly, the potential for non-response bias must be considered, as those who did not participate in this study may differ systematically from those who did. Future research could address this limitation by employing strategies to increase response rates and ensure a more representative sample. By addressing these limitations, future studies can provide more robust and nuanced insights into substance use among adolescents.

5. Conclusions

This study’s results highlighted the heightened vulnerability of adolescents to psychoactive substance (PAS) use during a critical developmental period. The findings underscored the urgent need to implement prevention strategies at an early age, particularly targeting schools, families, and communities. Recognizing the influential role that family dynamics and peer relationships play in shaping adolescents’ PAS behaviors is crucial for designing effective interventions. Therefore, the first step in addressing substance use disorder (SUD) is to enhance awareness and education about the risks of PAS use, particularly in the context of the adolescent environment. Additionally, the regular monitoring of PAS use among secondary school students is essential, not only to understand the factors contributing to reckless behaviors but also to gather data that can guide tailored prevention and intervention programs. Policymakers, educators, and healthcare providers must collaborate to create a supportive framework that addresses the underlying causes of substance use and provides resources for early intervention. By prioritizing prevention and building strong support systems, we can help safeguard future generations from the harmful effects of substance use.