Determinants of illicit substance use among young adults in a coastal town of South India: A mixed-methods study

Background: Illicit substance use is a major social issue affecting youth worldwide. Early identification of its drivers is essential to implement effective interventions and protect youth from its harmful consequences. Aim: To examine patterns and risk factors of illicit substance use among young adults and explore perceptions of students and teachers on the issue. Methods: An explanatory sequential mixed-method study was conducted over 2 years, among 2,170-degree college students in Udupi taluk. A cross-sectional study identified risk factors, followed by four focused group discussions with students and teachers to explore perceptions. Tobacco and alcohol use was excluded. Binomial logistic regression analysed the factors associated with substance use, while deductive thematic analysis was applied to qualitative data; findings were integrated through data triangulation. Results: 1.8% participants reported lifetime illicit substance use. The mean initiation age was 19 (SD 1.4) years, with cannabis used by 74.3%. Substance use was associated with male gender, lack of parental awareness of children’s whereabouts, poor knowledge, and negative attitudes. Drivers included curiosity, pleasure-seeking, festivities, stress management, relationship breakups, peer pressure, career stress, pre-sport use, and social media influence. Conclusions: Illicit substance use among young adults arises from a complex interplay of factors. The findings highlight the need for screening and brief intervention, along with educational interventions to improve awareness among adolescents and teachers to prevent substance use.