Drinking practices and alcohol-related problems among Nigerian students

Abstract

Background: Alcohol-related problems are increasing among Nigerian University students. However, very few studies have explored the ways in which hazardous drinking practices facilitate these problems in Nigerian University students, aside from quantitative studies focussing on students in South-Western Nigeria.

Methods: Drawing on qualitative semi-structured interviews involving students from a South-Eastern Nigerian University, this study begins to address these gaps. The participants were recruited through convenience and snowballing sampling techniques, and the data were analysed thematically.

Results: The findings show that 24 out of 31 participants engaged in heavy drinking by consuming between 3 and 9 bottles of beer/stout or flavoured spirits regularly. These heavy drinkers had suffered financial, academic, and health problems. Some lost valuable personal items such as mobile phones, wallets, and money as a result of drinking, while others missed examinations because drinking had rendered them either too ill or had caused them to oversleep and missed the examination. Almost all participants had suffered multiple health-related problems such as hangovers, accidents and injuries, liver enlargement, stomach ache, attempted suicide (under the influence of alcohol), and sex with strangers.

Conclusion: Evidence-based public health interventions to address easy alcohol availability and heavy drinking should be implemented in Nigerian Universities.

Keywords:

• Alcohol
• alcohol-related problems
• drinking practices
• Nigeria
• students

Introduction

University students’ alcohol use continues to constitute a public health problem in many parts of the world. In Western countries such as Australia, New Zealand, the UK and USA, alcohol consumption is popular among students, and students commonly suffer from various alcohol-related problems (Gill, 2002; Knight et al., 2002; Kypri et al., 2009; White & Hingson, 2013). Research conducted among university/college students in these nations reveals that drunkenness is not only expected and tolerated, but also encouraged within social context that values intoxication as an integral part of campus leisure (Davoren, Demant, Shiely, & Perry, 2016; Kypri, Cronin, & Wright, 2005; Supski, Lindsay, & Tanner, 2017). Diverse drinking practices, such as consuming mixed beverages (Marczinski, 2011; O’Brien, McCoy, Rhodes, Wagoner, & Wolfson, 2008), pre-loading and drinking games (Fairlie, Maggs, & Lanza, 2015) are common among students, and have been found to cause and exacerbate alcohol-related problems (Davoren et al., 2016; Hingson, Zha, & Smyth, 2017). Heavy drinking facilitates unprotected and often subsequently – regretted sexual activity, dangerous activities such as drink – and/or impaired driving (Burns et al., 2015), accidents and injuries (Caamaño-Isorna et al., 2017), and it can also contribute to poor academic performance (El Ansari, Stock, & Mills, 2013; Singleton & Wolfson, 2009).

Gender and alcohol scholars from Western countries have argued that heavy drinking among men (students and non-students) is a means of enacting masculine gender norms (De Visser & Smith, 2007; Iwamoto & Smiler, 2013). Peralta (2007), for instance, notes that the ability to hold one’s drink is a marker of masculinity as well as a badge of honour among American male students. Gender theorists have emphasised the performative (Butler, 2009; West & Zimmerman, 1987), nature of gender. One of the ways men perform or do ‘appropriate’ masculine gender is by engaging in risky activities such as heavy and/or fast drinking (De Visser & Smith, 2007; Peralta, 2007). This can, of course, facilitate negative outcomes.

Similarly, studies among women have shown that heavy drinking and intoxication have similarly become part of the contemporary feminine leisure culture (Palmer, 2015; Young, Morales, McCabe, Boyd, & d'Arcy, 2005). Although men continue to drink more than women in most parts of the world (Bratberg et al., 2016; Holmila & Raitasalo, 2005), there is an increasing evidence showing gender convergence in alcohol use and related problems (Bratberg et al., 2016; McPherson, Casswell, & Pledger, 2004; White et al., 2015). Given that the ‘social relations of gender’ shape drinking patterns, performing gender norms with alcohol consumption often leads to heavy drinking and the ‘normalisation of hedonism’ (Blackman, Doherty, & McPherson, 2015, p. 45), and as a result, a variety of alcohol-related problems (Bratberg et al., 2016).

In Africa, research from Botswana (Moitlakgola & Amone-P’Olak, 2015), South Africa (Nkoana, Sodi, & Darikwa, 2016; Reddy, Resnicow, Omardien, & Kambaran, 2007), and Uganda (Choudhry, Agardh, Stafström, & Östergren, 2014) indicates that university students also engage in heavy and hazardous drinking practices. Additionally, studies conducted in Kenya, (Boitt, Boitt, Othieno, & Obondo, 2016) and Zambia (Swahn et al., 2011) found that alcohol-related problems are common among students. Zambian students, for example, missed classes due to drinking, and alcohol consumption also facilitated bullying and other anti-social behaviours among students (Swahn et al., 2011). In Ghana, Hormenu, Hagan, and Schack (2018) found that drunkenness was common among students. They noted that contextual factors, such as community festivals, and the ease with which alcohol could be acquired, facilitated alcohol misuse.

In the Nigerian context, alcohol consumption among young people has traditionally been regulated via traditional culture norms (Heap, 1998). Drinking has traditionally been gendered and male-dominated (Heap, 1998). Recent research illustrates that men continue to dominate drinking spaces and practices in contemporary Nigeria, but women are beginning to engage with these spaces and drinking styles (Dumbili, 2015). While young adult males in Nigeria use heavy drinking to construct a range of masculine social identities, their female counterparts are deconstructing traditional feminine norms and identities by engaging in traditionally masculine drinking practices (e.g. drinking games) (Dumbili, 2015). This can be attributed to a range of inter-related factors, such as the aggressive marketing practices of alcohol producers that equate drinking with women’s independence, and also the more general globalisation of the cultures of intoxication, in which heavy drinking and drunkenness are normalised and celebrated (Obot, 2013).

Alcohol use and misuse are on the rise among Nigerian students, and studies (e.g. Abikoye & Adekoya, 2010; Adelekan, Abiodun, Imouokhome-Obayan, Oni, & Ogunremi, 1993; Adewuya et al., 2007) have highlighted the diverse alcohol-related problems that are emerging as a result. Chikere and Mayowa (2011) reported that 26.7% of 482 male undergraduate students in Owerri were heavy drinkers. They found that students consumed alcohol because they wanted to feel high and because it enabled them to build and maintain their friendship network (i.e. ‘drinking to belong’) (Chikere & Mayowa, 2011). A number of alcohol-induced social and health risks were noted: some students drank for sexual enhancement, and students also reported that alcohol caused memory loss, absenteeism and poor academic performance, drowsiness, hangovers, depression and accidents.

In a similar study, Abayomi, Onifade, Adelufosi, and Akinhanmi (2013) revealed that 31.1% of the students they surveyed engaged in heavy episodic drinking, while 8.9% had suffered alcohol-related injury. In a more recent study from the same Western region, Abayomi, Babalola, Olakulehin, and Ighoroje (2016) reported that 10.7% of 431 students had driven under the influence of alcohol. Drinking, they note, also increased risky driving behaviours, such as using mobile phones to send text messages or make calls while driving, ‘driving against traffic,’ and neglecting to use helmets and seat belts (Abayomi et al., 2016, p. 330). Such research confirms the findings of Adewuya et al. (2007), who report that alcohol abuse, dependence, and alcohol use disorder are some of the common problems among university students in South-western Nigeria. Recently, a survey of 1119 participants found that 39.5% had alcohol use disorder (Lasebikan et al., 2018).

Nigeria is currently the highest beer-consuming nation in Africa (Dumbili, 2019), and it is the country with the second highest levels of heavy episodic drinking (World Health Organization, 2018). Indeed, following the fairly recent merger of the world’s two largest alcohol producers (i.e. SABMiller and AB InBev), alcohol-related problems are expected to rise particularly in Nigeria (Hanefeld, Hawkins, Knai, Hofman, & Petticrew, 2016). This is because of the continued expansion of alcohol marketing, especially on and around Nigerian campuses, and also because of the easy availability of alcohol (World Health Organization, 2018). It is against this backdrop that this study examines drinking practices and alcohol-related problems among undergraduate students of a South-Eastern Nigerian University. In doing this, the paper will also examine how the gendering of alcohol related to these problems. The remainder of this paper is divided into three sections. The first outlines the methodology used in data collection and analysis. The subsequent section presents the key findings and is divided according to the three subthemes that were developed from the data: alcohol-induced risks, alcohol and poor academic performance, and heavy drinking and health-related consequences. The paper then closes with a discussion of these themes.

Methods

The participants for this study were recruited on and around the campus of a South-eastern Nigerian University, using convenience sampling and snowballing approaches (Atkinson & Flint, 2001). Ethics approval was granted by the Nigerian University, and also by the author’s UK University Research Ethics Committee. The study began with a pilot phase, during which students’ leisure sites and public television viewing centre were observed¹, and four interviews were undertaken. The resulting data informed the design of the main study which forms the basis of this paper. Data collection for the main data study took place between September 2013 and December 2013.

The researcher approached potential participants on campus and introduced them to the study. Those potential participants who self-identified as current alcohol drinkers (defined as having consumed alcohol at least once in the last 30 days) were then asked if they would consider participating in the study to share their experiences of alcohol consumption. While twenty-six (20 males and 6 females) participants were recruited via this approach, additional three females and two males were recruited via snowballing technique (i.e. interviewees recommended and introduced friends to the researcher). Written informed consent was obtained from those who accepted to participate in the study. The participants’ real names have been replaced with pseudonyms.

Interviews and data analysis

Thirty-one in-depth interviews lasting 33–90 min were conducted with 22 male and nine female undergraduate students, all of whom were of legal drinking age (i.e. 18 years and above). The participants were invited to share their views about their motives and reasons for drinking, their preferred types, and brands of alcohol (including whether or not they use the brand alone or mix brands/drinks), the rationale for choosing such brands, the quantity they drink per drinking session, and their drinking practices (e.g. who they drink with and why). Some of the specific questions and probes used to elicit data from the participants were: ‘is there any situation you find yourself drinking more alcohol than you would have liked to?’ ‘what led to that?’ ‘in your experience, what can you say are the possible outcomes of drinking too much alcohol?’ ‘are the same outcomes applicable to females/males?’ ‘please tell me, have you experienced any such outcomes?’. Those who answered yes were then asked: ‘can you mention the ones that have occurred to you?’

The interviews were digitally recorded with the permission of the participants. They were then transcribed verbatim, and the transcripts were subjected to thematic analysis following the steps recommended by Braun and Clarke (2006): familiarising with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. Combining theory-driven and data-driven codes (Fereday & Muir-Cochrane, 2006), the process involved conducting analysis immediately after the first interview was completed. Notes taken during the interview were read repeatedly, and the audio file was cross-checked for accuracy. This facilitated the development of some tentative coding schemes (Braun & Clarke, 2006; Syed & Nelson, 2015) that were later refined and used for the identification of nuanced patterns of meanings in the data (Campbell, Quincy, Osserman, & Pedersen, 2013).

In order to ensure analytical rigour from the onset, the analyst’s initial thoughts and ideas about coding were assessed by two qualitative experts (Syed & Nelson, 2015). When all the interviews had been transcribed, the transcripts were read several times and crosschecked and reconciled with the audio recordings before being imported into NVivo 10. Drawing on a social constructionist approach – which focuses on people’s shared meaning-making as achieved through language (Burr, 2015), patterns of meaning were identified among the key themes that emerged from the data. These themes are presented in the following sections.

Findings

Negotiating alcohol-related risks

The participants were asked to share their perspectives on their drinking practices and the drinking practices of their friends, and they were asked to share their experiences of drinking alcohol. The analysis reveals some important findings regarding how both male and female participants engaged in diverse ritualistic drinking practices (such as drinking games and intentional drunkenness), and how these drinking practices normalise intoxication. The data show that the majority of the participants engage in heavy drinking² (24 out of 31). Among the males who engage in heavy drinking, consuming up to nine (or more) bottles of beer and/or stout per drinking occasion was used to demonstrate superior masculinity (see Table 1). Three of the six females drank between three and five bottles of flavoured spirit and/or red wine, and they used alcohol to (de)construct multiple femininities. One of the female participants explained she consumes a bottle of liquor when she wants ‘to get high quick’.

Table 1. Quantity of alcohol consumption per drinking occasion.

Name of participants	Sex F/M	Quantity of alcohol per drinking occasion
Genny	F	Sweetened beverage = 2 bottles
Chichi	F	Wine = 2 bottles; stout = 3 bottles
Chimanda	F	Spirit = 1 bottle; sweetened beverage = 4 bottles
Patience	F	Sweetened beverage = 2 bottles
Chisalum	F	Sweetened beverage = 2 bottles
Pretty	F	Sweetened beverage = 4 bottles
Ada	F	Stout = 1 bottle
Agatha	F	Champagne = 1 bottle
Chioma	F	Sweetened beverage = 2 bottles
Diogor	M	Beer = 3 bottles
Ejike	M	Stout = 3 bottles
Chikere	M	Beer = 8 bottles
Okezie	M	Beer = 2 bottles
Femi	M	Beer = 3 bottles
Achike	M	Stout = 4 bottles
Kelechi	M	Beer = 4 bottles
Ekene	M	Beer = 4 bottles
Dozie	M	Beer = 5 bottles
Buchi	M	Beer = 3 bottles
Jacob	M	Beer = 5 bottles
Boniface	M	Beer = 4 bottles
Chike	M	Beer = 4 bottles; stout = 3 bottles
Las	M	Spirit = 1 bottle a day
Peter	M	Beer = 2 bottles; spirit = a glass
Favour	M	Beer = 3 bottles
Kelly	M	Beer = 3 bottles
Collins	M	Spirit = half a bottle; wine = 2 bottles
Fred	M	Beer = 2 bottles
Edulim	M	Beer = 9 bottles
Levin	M	Spirit = 1 bottle; beer = 5 bottles
Okey	M	Beer = 8 bottles

Spirits: (17–43% ABV); beer: (5%–5.1% ABV) and stout (7.5% ABV); sweetened drinks: (5%–5.5% ABV); wine: (12%–17% ABV).

A striking part of the data is that the majority of the participants lived in off-campus hostels. This appears to encourage heavy drinking among them, probably because the University authority does not regulate such off-campus environments and because alcohol outlets are common. The analysis revealed how these and other drinking practices facilitate diverse financial and health burdens among these students.

Alcohol induced-risks

The interviewees recognised a diverse range of alcohol-induced risks and problems associated with their drinking. Two important problems identified were the impact upon their education and their health – these issues are addressed in the following sections. Here, I focus on accounts of the risks associated with the potential to lose control in the moment of drinking and the immediate aftermath. More intense drunkenness experiences were often associated with the act of mixing different alcoholic beverages, especially spirits, wine and beer, a practice shared by the majority of the participants. This often facilitated loss of control, as exemplified in the following two examples:

Chimanda: I was taking red wine and I mixed it with Baileys [Irish liqueur with 17% alcohol by volume-ABV] and Amarula [South African cream liqueur with 17% ABV]. They don’t really go together but I took it, and the reaction [consequence] was severe. I was now high, hyperactive and I laughed loud and danced… The action was just like someone that’s having increased libido. The action increased into joyless laughter; you laugh so excitedly when it is not called for. I could not control my actions and at the end of the day I vomited.

Patience: On my birthday, I took ‘Magic Moments’ [vodka with 37.5% ABV]. I was actually gulping it down from the bottle… Before then, we had mixed different kinds of alcoholic drinks… so I was very ‘tipsy’ and was extremely aggressive. I was screaming, shouting, and my friends and neighbours had to hold me… I was aggressive to a point that I wanted to just start hitting everybody around me.

The female participants shared their experiences of how mixing drinks heightened the risk of getting ‘messed up’ (i.e. getting extremely drunk to the point of losing control), to the extent that some of them could not go home on their own without being carried by their friends. Indeed, the data reflected how this increases the risks of being sexually assaulted. They spoke of how, on several occasions, they had exceeded their limits after consuming mixed drinks. It is notable that not only is alcohol gendered in Nigeria; someone’s gender also determines the type of alcoholic beverages the society expects them to drink (Dumbili, 2015). The reproduction of these drinking norms makes men think that it is appropriate to consume beer, spirit, and other so-called men’s drink while women are expected to drink sweetened beverages (Dumbili, 2015). As the above accounts revealed, it is obvious that women are doing gender by drinking the so-called men’s alcohol such as vodka.

Indeed, men’s accounts also demonstrate the relationship between consuming mixed drinks and its effects:

Dozie: Actually, I’ve got drunk with my friends… I mixed drinks, instead of my own brand. I mixed ‘‘Don-Simon’’ [flavoured spirits] with my normal brand… That night was devastating because I had to sleep in the gutter. I didn’t feel well because I ended up lying in the gutter, and it was not fun…

When he was probed to unpack how the friends that he drank with on that particular night fared, he said:

Dozie: They were also messed up that night. Everybody got sort of like really drunk. Some of them lost their phones; some lost their wallets and all that.

Another participant described another negative experience related to alcohol-induced sleep, in an instance when a thief entered her room, knowing that she was too drunk to recognise the intruder:

Agatha: I slept off, and someone came and took something in my room, and I didn’t know that the person came in. If I had not taken alcohol, I would have known when the person entered my room.

The analysis highlights the fact that many participants were aware of potential alcohol-induced risks. They had experienced alcohol-related problems themselves, and they had witnessed their friends experience them. They also recognised that consuming mixed beverages heightens intoxication and other negative outcomes, but this seemingly did not constrain them from engaging in the practice. Indeed, this suggests that individuals may ignore the consequences of alcohol misuse because of the momentary pleasure they aim to derive from heavy drinking.

Alcohol and poor academic performance

Interviewees’ accounts also emphasised the relationship between drinking, drunkenness, and poor academic performance. For example, the female participants spoke of how drinking and drunkenness affect students’ academic endeavours:

Pretty: Taking alcohol can make students go astray because when you take alcohol and you begin to get addicted to it, you can miss your lectures. For example, you can take alcohol in the evening and have a hangover until the next day, and you’ll miss your lectures.

Patience: Drinking alcohol damages you academically… I can remember what happened during my friend’s birthday. It was the period I was writing my exam; I could not read because I was just high. I was useless, and I could not just do anything.

Pretty’s and Patience’s views were supported by Chisalum:

Chisalum: People that drink too much are not focused; they are restless; they are always scattered, and they don’t perform really well in their studies…

When the male participants were interviewed, similar but more nuanced views were expressed. They not only revealed their perception of how drinking alcohol might negatively affect their academic performances, they also provided a reason for such:

Peter: Alcohol is addictive, so it really does affect academic performance. It affects one’s academics because someone that drank yesterday and had hangover will definitely not go to lectures today. And if you don’t go to lectures, you’ll miss so many things like quiz [test]…

Ejike: Too much alcohol might cause academic failure because when you take too much alcohol, you tend not to be yourself again; you’ll be a kind of totally off…

Interviewees also spoke of how regular visits to alcohol venues could result in acquiring ‘bad’ friends, which were directly or indirectly detrimental to their academic performance. Due to the gendering of alcohol in Nigeria, men are more likely to visit bars and other public leisure spaces than women. This is reflected in the data: only the men stated that, when students are always visiting bars, they acquire all kinds of friends, some of whom might encourage them to drink larger quantities of alcohol or drink more regularly. They added that this may, in turn, affect their academic work negatively. Again, they drew on their personal experiences or those of their friends to demonstrate how alcohol use/misuse can hinder students from doing their academic work, especially in terms of preparing for an examination:

Dozie: I went out with friends to drink; we all actually drank more [than we had planned]… One of my best friends took like three bottles [of beer]. The next day, he ended up wasting, and could not do anything…

Kelly: Drinking affected me about 9 times. As in, there was a week I went out to drink. I was going to the bar every day and throughout that week, I wasn’t myself. I lost concentration, especially in my studies because once I go out to drink, I will be feeling dizzy when I return. I will sleep off until the next morning, only to wake up and discover that I had a lot of things undone, like preparing for a quiz [test].

Indeed, the data indicate that the participants were not only aware of how drunkenness hampers the act of taking one’s studies seriously: some interviewees also shared their personal experiences of how they were unable to write their examinations as a result of drinking the previous night. To illustrate this, I will draw largely on Chichi’s account. Her nuanced view is worth reflecting upon in some detail because it is a useful exemplar of the dangers associated with drinking during examination:

Chichi: Alcohol can do a lot of [bad] things to students in many ways. It can make you to lose concentration… Imagine someone who has an exam to write the following morning, and you go out to drink alcohol, you will just end up sleeping the whole night. And by the time you wake up in the morning, you will be so disorganized and confused.

Interviewer: Have you in any way experienced what you just said?

Chichi: Yes, personally, it has happened to me… when I was in year two. It happened that the day before the exam, my cousin came to [name of town], and was like, Chichi, let’s hang out… So, we went out, and I started drinking red wine… I drank so much that night… Do you know that I saw myself sleeping till the next morning? My waking up was just one hour before that exam and there was no time to even read again. Then, when I got to the university, it happened that the examiner came immediately, and there was no time to even do the last minute catching up. So, I was weak; it was very bad because I couldn’t really write… My head was just empty because I did not read.

The analysis further shows that drinking the previous night not only negatively affects the ability to write well, but can also make some students entirely miss their examination. For example:

Chimanda: After drinking, I wasn’t really happy because my day was messed up. I was supposed to write an exam the next day being Monday morning because it was on Sunday night that I drank alcohol… When I woke up, I was so weak; I was seriously down and before I could know it, the time had gone. So I went to my exam late. At the end of the day, I didn’t write the exam, so I wasn’t happy… Alcohol made me to miss my exam… It’s just a drawback to me…

Although Chimanda and many other participants expressed regrets due to the fact that they had either missed their examination or quizzes, the majority reported that they had suffered similar alcohol-related consequences subsequently.

Together, these accounts suggest that alcohol use negatively affects students’ quality of academic performance, and that both male and female students were aware of this. The accounts not only show the participants’ awareness of the association between alcohol use/misuse and academic problems, but also point to the ways in which this awareness did not seem to restrain many students’ drinking and drunkenness on and around the campus.

Heavy drinking and health-related consequences

The analysis also shows that drinking and intoxication can result in multiple mild and serious health burdens. One of the insightful parts of this is that, while all of the interviewees were aware of diverse alcohol-related health consequences, almost all of them had suffered at least one of these harms. The accounts below show some of the negative consequences that had been experienced by female participants:

Pretty: I couldn’t sleep, and it disturbed me. Alcohol has this after-effect which is hangover. You can’t sleep; you’ll keep rolling on the bed, wishing you could throw up all you had taken. I felt tired… I felt like throwing up all night. It was really a bad experience.

Chichi: I had a serious hangover, and the next day, I vomited like three times in the morning. I couldn’t even stand properly. So, my friend was just helping me to stand. She had to hold me because I was just shaking; the whole of my body was so disorganised and shaking. It was that bad. And what actually caused it was that I did not eat before taking alcohol which is very bad.

Interestingly, Pretty and Chichi, who use alcohol to construct gender, were among the heaviest female drinkers in this study: Pretty consumes five bottles of Smirnoff Ice (flavoured spirit with 5% ABV) while the Chichi uses two bottles of red wine and/or three bottles of stout per drinking session (Dumbili, 2015). In fact, while Pretty had bragged about how consuming more than men constitutes her ‘badge of honour’, Chichi had questioned the social construction of drinking in Nigeria, where women who drink and get drunk are stigmatised due to the inherent patriarchal norms (Dumbili, 2015). From these and earlier accounts, it is clear that although young Nigerian women may use heavy drinking to (de)construct social identity, such a practice does not go without some negative consequences.

Among the male participants, diverse heavy drinking and other risky drinking practices were revealed. While many played drinking games, others used heavy drinking to do gender. This facilitated alcohol-related problems. For example:

Buchi: I was very drunk. When I came home, I was vomiting and I wasn’t myself that night. I was totally wasted, and it was a wasted night. Drinking makes you have slight headache [hangover]. If I drink, the next morning, I’ll have a slight headache. It happens almost every time I drink more than four bottles [of beer].

Chike: It was a friend’s birthday party; I haven’t taken spirit before, so I thought it was where you could take one or two bottles [of spirit]. While other people were mixing spirits with yoghurt, I was just taking it [raw] like that but before you knew it, I wasn’t myself; I found myself sleeping around, falling down and throwing up.

Fred: I got myself by 3A.M. in the morning, after I must have vomited a lot. The next day my head was kind of low; I was ashamed of myself. Most people were like surprised; most people were like I disappointed them.

Consuming four or more bottles of beer on a drinking occasion constitutes heavy drinking, mainly because beer in Nigeria is highly potent: they contain 5% ABV or more. As Buchi’s account reveals, he suffers a hangover any time he drinks four or more bottles of beer – it is clear that heavy drinking facilitates alcohol health problems. Research has shown that while drinking and drunkenness are expected and tolerated among young people (Merrill, Rosen, Boyle, & Carey, 2018), others frown at those who break their social group’s consumption norms (MacLean, Pennay, & Room, 2018). Fred, for example, stated that most people were like I disappointed them. It can be inferred from this that his friendship group perform gender with heavy drinking, and belittle men who are perceived to be unable ‘to hold their drinks’.

Furthermore, being heavily inebriated can facilitate the loss of control which may lead to more embarrassing situations. This is clearly seen in the account below:

Jacob: Since I’ve been drinking, I’ve found myself in one weird situation. I drank on an empty stomach and tried to control myself because I know that I was kind of drunk. I went to sleep and somehow my roommate woke me up in the middle of the night… I imagined myself urinating in the bathroom, but I was actually urinating at the back of our door [to the room]. This is just one of those weird things alcohol can do. I didn’t do it intentionally. Alcohol was responsible. It was just embarrassing.

While urinating in the room may be ‘weird’ as this interviewee indicated, one notable part of his account reveals that he drank without eating. Given that a similar view was shared above among the females, it is clear that some students drink alcohol without eating food. This often heightens the effects of ethanol in their body.

The findings also point to the ways in which heavy drinking is associated with engaging in casual sex:

Edulim: …I think we drank until 11p.m. So my guys decided to pick one, two or three of the ‘call girls’ [sex workers] around so they would spend the night with them. All of them left with different girls to spend the night with them…

Edulim is among the participants who reside at off-campus hostels where there are likely no time restrictions for hanging out in such an environment. Interestingly, when he was probed further to unpack the reason why alcohol use facilitates casual sex, he noted that when one is inebriated, it becomes difficult to say no to sexual advances. He then shared his personal experience, narrating how he could not resist sleeping with a prostitute because he was heavily inebriated:

Edulim: I had sex with someone [a stranger]. I wouldn’t have done such a thing [if I was sober]. I went to a very big bar and normally you’ll see these call girls around… They are not like the regular girls [prostitutes] you see around. So with alcohol in the system and girls on provocative dresses at your eyesight as well as masculine peer pressure, [I slept with a prostitute]. We went out to drink and there was this girl, the other boys went in with her [had sex with her], and they said that I have not gone anywhere [taken my turn]… So, with the drunkenness, I did it… The girl held me, and said: ‘let’s go….’ Normally, I would have resisted, but for the alcohol…

Engaging in sexual activity with sex workers under the influence of alcohol is risky because it may facilitate unprotected sex, increasing the possibility of contracting sexually transmitted infections. This finding is insightful because it appears that boys use the practice of having sex with multiple girls when they are inebriated to construct masculinity. Edulim spoke of how he was pressured into engaging in casual sex just to protect his manliness: this illustrates that gender and identity constructions predispose men to risky behaviours that may impact their health negatively.

Peer pressure not only affected casual sex among the male participants. It also encouraged drunkenness among the females to the extent that those who may not have consumed large quantities of alcohol were pressured to do so. For example, Chimanda described how her friend was pressured to drink beyond her limit. In the account below, she showed how this act of ‘drinking to belong’ contributed to heightened drunkenness, which resulted in her friend’s behaviour that could be likened to a suicide attempt:

Chimanda: …She was hitting her head on the wall and on the bathroom tiles. At a point she started vomiting, we bathed her, but she didn’t recover. We gave her some ‘stuff’ [medicine] so that it will calm her down, but she still didn’t recover. She was so active that night vomiting; she didn’t sleep throughout the whole night. She was just rolling from one corner of the bed to another and was hitting her head on the wall. Even in the morning, she was not okay; she started vomiting again. We gave her many things [medicine]; we have to give her drip with injections and some drugs before she was now okay. She couldn’t even remember any of her actions; it was so tremendous that we now started videoing her because we got scared of what is happening. She got drunk because of the friends around her and the environment.

From this account and others, it is obvious that students who are intoxicated receive support from other students, but this support might open doors for other health problems. For example, students administer medicinal substances such as drips and other drugs to their intoxicated friends. Because they are not trained doctors and/or nurses, this may result in serious health complications. It is also certain that some students resort to self-medication in a bid to ameliorate the effects of alcohol:

Jacob: I was sick; my tummy started aching the next day, and I had a headache or hangover and all that. I was kind of really weak. So I went to the ‘chemist’ [patent medicine store or local Pharmacy] and they gave me ‘Alabukun’ [a popular local drug for pain/fever]…

Further discussion with the interviewees revealed that while some of them engage in self-medication by purchasing drugs from vendors, others self-medicate by using alcohol in a bid to ameliorate depression. This, they noted, has some serious consequences. For example:

Chioma: …I was depressed; like I was home alone… so I just started taking alcohol. I was drinking but I now took more than my body could take. At first I was okay, but I slept and when I woke up like in the next 30 minutes; that was when alcohol started disturbing my system. I found out that I even ‘peed’ on my bed; I was throwing up; I was restless. I was hitting my head on the wall. If not for the fact that somebody came in, I would have died… I know I could have died because according to what they told me, I was hitting my head on the wall…

The fact that many participants had engaged in heavy drinking was a major theme in the data. As the accounts below show, many of these heavy drinkers got injured under the influence of alcohol:

Chioma: I got a scar on my body because of alcohol. As in, I took alcohol and I fell down when I was climbing the staircase. The next day, my entire body was aching. As in, I couldn’t stand up. I felt pain all over my body.

Patience: Another extraordinary crazy stuff I did was that I came out of my room, went to my neighbour’s room and hit my head on the iron door, which of course, I couldn’t have done on a good day. I woke up the next day with a swollen face, and I had some injuries all over me.

Ejike: The experience was funny because I lost it totally; for like 8 hours, I didn’t get myself. It was just like my brain was off and I also injured myself.

Boniface: We returned from drinking and I was running into my room, and I fell down and injured myself on my hand. Actually, I shouldn’t have fallen down [if I was sober]…

The analysis also shows that some of these heavy drinkers have experienced health complications and were either advised by medical personnel to cut down their drinking or to abstain completely. For example, Chikere – who drank up to 8 bottles of beer/stout on a drinking occasion – described what made him reduce his drinking:

Chikere: Before now, I drink as much as I can afford or whoever is paying can afford. I don’t think I had a limit… But there was a day I went for scan and the Lab Attendant asked me when I last took alcohol? I told him it was like some days ago; he said he can notice it from my liver, that it seems the amount of alcohol stresses my liver, making it to enlarge and overwork. He now said that I should cut down my intake of alcohol.

Similarly, Chioma, a female participant, emphasised how her alcohol use almost resulted in a complicated medical procedure:

Chioma: There was a time I had appendicitis operation, so the doctor told me that he had to give me overdose of anaesthesia because alcohol content in my body was too much and that was really risky because I would have died…

Together, these accounts have shown how the interviewees encounter diverse (mild and more serious) health-related problems as a result of heavy drinking and drunkenness. The findings suggest that alcohol-related problems may be high among students on this campus, and they were not only aware of these problems, but had suffered multiple harms.

Discussion

This is the first qualitative study to provide empirical evidence of the roles that the gendering of alcohol, and heavy and other risky drinking practices play in facilitating alcohol-related problems among University students in Nigeria. The key findings of the study show that the interviewees had suffered financial, academic, and health problems as a result of engaging in heavy and other hazardous drinking practices. The study not only reveals the interviewees’ awareness of alcohol-related problems and their perceptions of the causes, but also shows that some of them had suffered multiple problems due to heavy drinking and intoxication. These findings support studies conducted elsewhere (Gill, 2002; Knight et al., 2002; Kypri et al., 2009; White & Hingson, 2013).

One of the findings of this study casts light on the normalisation of alcohol-related risks through the popular practice of consuming different mixed alcoholic beverages among students. The interviewees often mixed spirit, beer, and ready-to-drink (alcopops) beverages, but this often heightens heavy drinking and alcohol-related problems. Although previous studies (Marczinski, 2011; O’Brien et al., 2008) have shown that students consume mixed drinks that facilitate heavy drinking and alcohol-related problems, no study has reported such findings in Nigeria. As stated earlier, alcoholic beverages are divided along gender lines in Nigeria; all females in this study drank the so-called women’s beverages (at least in the public). But there is another narrative: some of them used spirits mixed with other beverages. This act of consuming men’s drinks (believed to be more potent) points towards what other scholars (e.g. MacDonald & Marsh, 2002; Measham, 2002) have referred to as differentiated normalisation. Factors such as gender affect drug/substance normalisation significantly. This is especially illustrated by the fact that female interviewees, who used alcohol to deconstruct gender identity, reported more alcohol-related problems.

The finding is significant and worth reflecting upon because, as indicated earlier, alcohol control policies do not currently exist in Nigeria (World Health Organization, 2018). Therefore, there are no definitions or specification of standard units of drinks in Nigeria. Although alcohol by volume is inscribed on most alcoholic beverages sold in the country (World Health Organization, 2018), the lack of drinking guidelines means that consumers will find it harder to determine how many standard drinks they consume per drinking occasion. Given the popularity of this practice of consuming mixed drinks, and the growing globalisation of the culture of intoxication that is spreading via popular media (Dumbili & Henderson, 2017), students may continue to perform gender with alcohol and thus, normalise heavy drinking and drunkenness. This will heighten alcohol-related health and other consequences.

Regarding academic performance, the findings suggest that students were highly knowledgeable of the fact that heavy drinking and regular visits to alcohol-consuming environments affect school work. Some of the students missed their examinations/quizzes because they were drinking the previous nights. Indeed, this corroborates Chikere and Mayowa's (2011) study in Nigeria. It also confirms research in Zambia (Swahn et al., 2011) and elsewhere, which revealed that alcohol use resulting in oversleeping, truancy, and other similar behaviours, facilitating weak Grade Point Average (GPA) (Singleton & Wolfson, 2009) and overall poor academic performance (El Ansari et al., 2013).

Most importantly, the study is replete with evidence showing that the majority of the interviewees had suffered multiple health-related problems. Many students suffered what can be categorised as mild (e.g. hangovers and stomach ache) and extreme health consequences. While many fell and sustained injuries, others portrayed aggressive behaviours that were suicidal. Although previous research in Nigeria has reported on alcohol-induced accidents and injuries (Abayomi et al., 2013), this current study develops this finding, by providing evidence regarding alcohol-related suicide attempts. Relatedly, I found that students engaged in self-medication in a bid to soothe alcohol-induced negative consequences by purchasing drugs from local vending stores. This is worrisome because many of these vendors (popularly called ‘chemists’ in Nigeria) are not trained experts or pharmacists. As such, people who patronise them are at risks of further health complications.

The study also shows that students engaged in sex with strangers under the influence of alcohol. Elsewhere, accumulated evidence shows that many students who engage in sexual intercourse under the influence neither use contraception nor practice safe sex (Hingson, Heeren, Winter, & Wechsler, 2003; Moure-Rodriguez et al., 2016). In fact, this calls for concern because many Nigerian students, especially males, have been found to use alcohol-induced sexual exploits to construct superior masculine identity (Dumbili 2016).

Again, it was found that students have suffered financial consequences as a result of drinking and intoxication, like some lost valuable personal belongings. While Dimah and Gire (2004) reported that drinkers suffered economic consequences, resulting from non-productivity (because they were farmers and civil servants), this current study develops this finding, by qualitatively exploring the direct financial consequences encountered by interviewees.

A striking part of the findings described above is that many heavy drinkers lived off-campus, where alcohol marketing is common and where little or no limitations apply to the time they spent at leisure sites. Indeed, this supports the fact that students who live off-campus are riskier drinkers than their on-campus counterparts (Benz et al., 2017). Previous research has provided evidence demonstrating that alcohol marketing activities are popular around Nigerian campuses and students are susceptible to them (Umoh, Obot, & Obot, 2012), and this may be partly responsible for heavy drinking among students.

Conclusions

This study has a number of limitations. As an exploratory study, drawing conclusions based on the results should be done with caution. The study is limited by the number of females that were included and the sample size more generally. As such, the generalisability of the findings cannot be guaranteed. Again, the study covers only a university from one region of the country. Similar research should be conducted in other parts of Nigeria to obtain more empirical evidence. Despite these limitations, the study has provided some evidence regarding heavy drinking and its consequences among Nigerian youths.

Given that industry-driven marketing, particularly promotional activities, influence youths to drink alcohol (Scott, Muirhead, Shucksmith, Tyrrell, & Kaner, 2017), evidence-based regulatory and preventive measures should be implemented in Nigeria to reduce alcohol availability on and around campuses. Interventions that can reduce the density of alcohol outlets should be implemented around campuses. Despite the mixed results regarding the effectiveness of drinking guidelines, such should be provided in Nigeria as these may support responsible consumption. It has been shown that assessments and counselling provided by health professionals helped to check participants’ alcohol consumption. This suggests a need for brief interventions to detect and prevent alcohol misuse and potential harms, especially at the primary and secondary healthcare levels in Nigeria. Also, given that gender construction with heavy drinking is normalised among students, public health initiatives that encourage more reorientation of gender and drinking are imperative. Public health measures which focus on the short/long term consequences of heavy drinking should be designed and implemented on this and other Nigerian campuses. This may help to reduce the growing culture of intoxication and alcohol-related burdens in the country.

Acknowledgements

I wish to thank the interviewees, without whom this study would not have been possible. I also thank Drs Neil Stephens, John Gardner and Melissa Mialon, for their contributions, comments and suggestion on the earlier draft of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

Additional information

Funding

This work was supported by Tertiary Education Trust Fund (TETFUD), Nigeria.

Notes

1 The data from the pilot phase were not included in the analysis of this paper. They only informed the design of the main study protocol.

2 In this study, ‘heaving drinking’ is defined as consuming 3 or more bottles of beer (beers in Nigeria contain between 5 and 5.5% ABV), stout (7.5% ABV), wine (12–17% ABV) or spirit (17+ ABV). As there are no alcohol policies in Nigeria (World Health Organization, 2018), standard drinks are not defined, hence the use of number of bottles of alcoholic beverages and the ABV they contain.