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Alcohol and Tobacco Use Among 

Undergraduate and Postgraduate 

Medical Students in India: 
A Multicentric Cross-sectional Study 
 

 

Nidhi Goel, Vivek Khandelwal, 

Kapil Pandya, Atul Kotwal 
Armed Forces Medical Services, India 

 

 

 

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Abstract 

Background: Substance use among medical fraternity is a well-known phenomenon among both undergraduate (UG) and 

postgraduate (PG) medical students. Yet, there have been very few multi-centric studies to estimate the actual burden of this 

problem in this important population group in India. This study was conducted to estimate the prevalence of alcohol and tobacco 

use, assess the knowledge and attitudes towards this issue, and identify factors associated with substance use among UG and PG 

medical students in India. 

Methods: A pre-tested, self-report, anonymous questionnaire was administered to medical undergraduates and post graduate 

medical residents of eight medical colleges across India. This study used a convenience sample of medical colleges with random 

selection of study participants within each college for each group, UG and PG. 

Results: Prevalence of alcohol and tobacco use among UG students was 16.6%, 95% CI [14.5, 18.9] and 8.0%, 95% CI [6.4, 9.6], 

respectively, whereas prevalence was 31.5%, 95% CI [26.3, 37.0] and 14.5%, 95% CI [10.7, 18.9], respectively for PGs. For both 

substances, males had a higher prevalence of use compared to females in both groups (p < 0.001). Positive family history of 

substance use (p < 0.001 for both groups) and early age of initiation (p = 0.011 for tobacco; p > 0.05 for alcohol) were associated 

with a greater difficulty to quit the habit. Over 90% of study participants felt that substance use adversely affected their skills and 

reported not using substances prior to managing their patients.  

Conclusions: Since substance use is a relatively common phenomenon among UG and PG medical students in India, future 

prospective studies and interventions are required to better understand the pattern of substance use and reduce its prevalence.  

Keywords: alcohol, tobacco, undergraduate medical students, postgraduate medical students, cross-sectional 

 

 

Alcohol and Tobacco Use Among 

Undergraduate and Postgraduate 

Medical Students in India: 
A Multicentric Cross-sectional Study 
 

 

Nidhi Goel, Vivek Khandelwal, Kapil 

Pandya, Atul Kotwal 
Armed Forces Medical Services, India 

Research 

Undergraduate (UG), as well as postgraduate 

(PG), medical students are exposed to daily stressors, 

which can lead to substance use and abuse. Substance 

abuse remains a covert yet well-known phenomenon 

among medical students and medical practitioners 

globally.1,2 Substances that have been documented as 

being used recreationally among medical students in 

India include alcohol, tranquillizers, and psychedelics.3 

Recreational drug use has become more popular and may 

be representative behavior of the youth lifestyle; thus, 

increasing the need to monitor drug use trends, especially 

among UG and PG medical students.1 

Substance abuse is any maladaptive pattern of 

substance use leading to clinically significant impairment 

or distress. Impairment in social and occupational 

functioning is often associated with substance use, which 

includes the inability to control use of or to discontinue 

use of the substance. Additionally, substance use may be 

associated with the development of serious withdrawal 

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symptoms after cessation of or reduction in use for 

recreational or medical purposes.4 

In the developed countries, studies have shown 

that alcohol impairment is one of the leading reasons for 

disciplinary action against physicians.5 However, this 

problem and effective interventions to reduce substance 

use among physicians have not been sufficiently 

explored in published research studies. Numerous studies 

conducted in the field of substance use around the world 

have focused mainly on the general population and adult 

age groups.6,7 Most of the Indian studies in this field are 

regional in nature, representing a large research gap 

which our study is aiming to address. There is a dearth of 

large multi-centric efforts in India to evaluate this 

important public health concern.8-11 

Global prevalence rates of alcohol abuse 

disorders among adults were estimated to range from 0-

16.0% with highest prevalence rates in Eastern Europe.12 

Tobacco consumption and nicotine addiction is a major 

global concern, popularly known as the “brown 

epidemic.”13 The prevalence of smoking is as high as 

51.0% in men (WHO Western Pacific Region) and 22.0% 

in women (WHO European Region) with an increasing 

trend in adolescent girls and boys globally.13 

In India, alcohol use figures vary widely from 

3.8% to 21.0%, with men 9.7 times more likely to 

regularly use alcohol as compared to women.8,9,14 

Prevalence of smoking has been estimated as 26.0% in 

males and 4.0% in females. For youth, the prevalence is 

19.0% and 8.3%, respectively.15 In previous studies, men 

were 25.5 times more likely than women to report regular 

smoking and 3.7 times more likely to regularly chew 

tobacco.13 

There are few studies to date that have examined 

the prevalence of tobacco and alcohol use among UGs 

and PGs. Out of the available studies, tobacco and 

alcohol use prevalence was 9.0% in UGs and 7.1 in 

PGs.10,11,16 Young physicians had a prevalence of 16.7% 

for alcohol use.17 

Thus, geographic variation and changing trends 

in substance use around the globe warrant new 

epidemiologic investigations that can be used to inform 

policy changes. Medical fraternity (UG as well as PG) is 

no different from the general population when it comes 

to substance use; however, they may be at a higher risk 

of substance use problems due to higher stress levels.  

This study was conducted to estimate the 

prevalence of alcohol and tobacco use, to assess the 

knowledge and attitudes towards this issue, and to 

explore possible risk factors associated with substance 

use among UG and PG medical students in India. An 

effort was also made to gather suggestions from the 

fraternity for tackling this problem. Use of illegal drugs 

and psychoactive substances were not studied due to 

ethical concerns as well as the potential lack of 

willingness to participate in the study. 

 

Methods 

Participants and settings 

Twelve medical colleges were recruited for 

participation in the study; however, four colleges did not 

have a sufficient sample of students for participation. The 

resulting 8 medical colleges participated in a multi-

centric, cross-sectional survey. There were four medical 

colleges from Maharashtra and one each from New 

Delhi, West Bengal, Madhya Pradesh, and Kerala. The 

selection of medical colleges was convenience based, as 

per logistics and staff availability. For each selected 

college, a sample size was calculated using an estimated 

alcohol use prevalence of 25.0%. With alpha as 0.05 and 

an error margin as 7.5%, the appropriate sample size was 

128. A sample of 150 final year Bachelor of Medicine, 

Bachelor of Surgery (MBBS) degree students and 55 PG 

residents was drawn from each college by simple random 

sampling. 

Ethical clearance for the study was obtained 

from Institutional Ethical Committee of Armed Forces 

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Medical College, Pune, India. Informed consent was 

obtained from each participant. A self-report, 

anonymous, pretested questionnaire covering multiple 

domains of substance use was used for data collection. 

Statistical analysis was performed using SPSS (version 

14.0). 

 

Data Analysis 

Descriptive statistics were obtained to describe 

basic characteristics of the study participants. Descriptive 

statistics were also used to estimate the prevalence of 

alcohol and tobacco use. Inferential statistics were used 

to compare male and female substance use and for 

differences between UG and PG for age of initiation of 

substance use. Age of initiation was compared amongst 

two groups, greater than 16 years of age and 16 years of 

age or younger at initiation, and then further analyzed to 

assess impact on difficulty in quitting the habit. Chi-

Square test was used to measure the risk associated with 

family history of substance use and current substance use 

and to assess the knowledge and attitudes towards 

substance use. P-values lower than 0.05 were considered 

significant. 

 

Results 

The mean age of the participating UGs was 21.5 

± 1.6 years and PGs was 29.0 ± 3.7 years. 46.2% of UG 

students and 72.7% of PG students were male. Table 1 

shows the distribution of participant characteristics and 

prevalence of substance usage in each college.  

 

Table 1. Distribution of alcohol and tobacco use among 

participants stratified by college and student group 

 

Out of the 1,455 participants, males were 

significantly more involved in substance use as compared 

to females (p < 0.001 for alcohol as well as tobacco). Age 

of initiation was significantly lower in UGs as compared 

to PGs (p = 0.003) for alcohol as well as tobacco. When 

this age was dichotomized into 16 years or less and 

greater than 16 years, younger age of initiation was 

significantly associated with more difficulty in quitting 

tobacco (p = 0.011) but not alcohol. 

Positive family history was significantly 

associated with increased prevalence of substance use, as 

shown in Table 2. Those who had a positive family 

history also found it more difficult to quit (p < 0.001). 

Table 3 shows the percentages of participants who 

attempted to quit. 

 

Table 2. Association of a positive family history with 

consumption of substances among UGs and PGs 

 

Table 3. Proportion of participants who tried to quit the 

habit 

 

‘Feeling psychologically upset’ (30.8% alcohol; 

45.2% tobacco) and ‘pressure by friends’ (41.0% 

alcohol; 19.0% tobacco) were the most common reasons 

reported for resumption of the habit in those who quit but 

relapsed. A significant association between respondents’ 

“thinking substance abuse was a growing problem” and 

their “thinking that something should be done about it” 

(p = 0.003) was also found. Alcohol use affecting overall 

performance as a physician was mentioned by 65.6% of 

PGs. 

Beverage preferences associated with alcohol 

and mode of tobacco consumption are depicted in Table 

4. When questioned about the description of occasions 

when they consumed alcohol or tobacco, the highest 

number of participants answered ‘with close friends’ 

followed by ‘during parties.’ However, for the occasion 

‘during exams,’ frequency of tobacco use increased more 

than that of alcohol. “Batch-mates” (or classmates), 

which refers to a cohort of students of the same entrance 

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year in medical school, were the most common people to 

encourage the participants use either of the substances, 

followed by “seniors.”   

 

Table 4. Alcohol types and tobacco modes used for 

consumption 

 

Discussion 

Our study was conducted in 8 medical colleges 

across India. It revealed that prevalence of alcohol 

consumption for UG students and PG students was 

16.6%, 95% CI [14.5, 18.9] and 31.5%, 95% CI [26.3, 

37.0], respectively. Tobacco usage for UG students and 

PG students was found to be 8.0%, 95% CI [6.0, 9.6] and 

14.5%, 95% CI [10.7, 18.9], respectively. 

The former are thought to be especially 

vulnerable to prescription drug use due to greater access 

and the professional culture that favors pharmacological 

approaches to the management of occupational stress.3,9 

Studies have shown an alarming increase in drug, 

alcohol, and tobacco consumption among doctors in the 

latter half of 20th century globally.11 Personal use of 

addictive substances by doctors has the potential to 

jeopardize their professional performance, as well as care 

of patients with addictions,18 thus, it is important to 

investigate this area of concern.  

82.5% medical students in previously published 

Irish study were current alcohol consumers,18 whereas 

the prevalence was only 16.6% in our study. For resident 

doctors, the prevalence of 31.5% in our sample was 

higher than 16.7% as brought out in previous studies on 

young Indian physicians.17 The prevalence of alcohol use 

among our study participants is higher when compared 

with prevalence among adult Indian general population, 

which ranges between 3.8% to 4.5%.8,12 

For medical students, the prevalence of current 

tobacco usage has been previously reported to be 10% in 

the Indian population17 and 15.3% in Western 

populations.18 In our study, the prevalence of current 

tobacco usage is 8% and 14.5% among medical students 

and doctors, respectively, which is almost equal to the 

national medical fraternity figures. The prevalence of 

tobacco use in any form is much lower in medical 

students (17.5%) as compared to students in general 

(21.6%).19 Tobacco was consumed in smoking form by 

the majority of its users, which is consistent with national 

as well as global trends.  

Our study highlights the finding that for medical 

fraternity, the overall prevalence of tobacco usage is 

lower than the national figures. This is true in some other 

countries, including China.20 In countries like the United 

States of America, Greece, Japan, and Australia, the 

trends of substance use in medical fraternity follows the 

national prevalence rates.20 The overall low prevalence 

of tobacco usage may be attributed to bans on smoking 

in campuses in the government medical colleges. 

For both substances, males had a higher 

prevalence of consumption compared to females. This 

was true for medical students, as well as resident doctors 

(p = 0.001). This trend is similar to other published 

studies conducted in India and across the world.1,20 

Though alcohol use rates have been increasing in females 

according to some studies,18 no such trends were found 

in this study due to its cross sectional design. Future 

prospective studies may be able to more thoroughly 

examine temporal trends in substance use. 

One of the interesting findings of this study is 

that medical students and doctors who had a positive 

family history of substance use had higher prevalence of 

substance use. Though this factor is not commonly 

analyzed in previously published investigations, this 

finding is very important for India, where family values 

greatly influence the behaviors of younger people as 

reported in previous Indian study.3 Thus, families can 

potentially play a role in reducing substance consumption 

in the medical community. 

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Another factor which is scarcely reported in the 

literature on substance use among medical professionals 

is the age of initiation of substance usage. In our study, 

we found that current UG students are beginning the 

usage of alcohol or tobacco much earlier than current PG 

students (p = 0.01). Also, for tobacco, earlier age of 

initiation (less than 16 years) was associated with 

difficulty in quitting. This means that the efforts to 

educate and counsel the medical students on problems 

associated with substance use must start much earlier 

than previously thought, preferably at the very beginning 

of their medical curriculum.  

Among the reasons for initiation, “curiosity” 

was the most common reason reported by the respondents 

in our study. This response is consistent with most studies 

on this subject.8-11 The implication is that if the concepts 

of neuro-physiological mechanisms involved in 

substance use and addiction are explained to the students 

at the time of entry into the medical colleges, the curiosity 

factor and the experimentation tendency might be 

reduced. Other reasons for initiation of alcohol use were 

‘pleasure’ and ‘stress/anxiety relief.’1 

The individuals most commonly encouraging or 

influencing initiation of substance use were ‘batch-

mates.’ Also, for most of those who tried to quit, it was 

their friends that pressured them to relapse. Thus, if we 

are able to reduce substance use rate in a small group of 

students, they potentially would be able to influence 

others to change their behaviors and reduce substance 

use. However, a large number of students reported that 

no one encouraged them, indicating that a significant 

group of students were self-motivated to initiate the 

habit. Thus, this group can particularly benefit from 

Behavior Change Communication (BCC) activities. 

An interesting finding is that among doctors 

using any substance, 92.0% - 95.0% had never consumed 

the respective substance prior to managing their patients 

or conducting a medical/ surgical procedure, suggests 

that respondents understand that substance use may 

influence their professional performance.  

Strengths and limitations 

The main limitation of this study was the 

convenience sampling method used to select the medical 

colleges. The other limitation was a low response rate in 

a few of the medical colleges or lack of willingness to 

answer questions related to alcohol consumption. 

Additionally, cross-sectional nature of this study did not 

allow us to make conclusions about substance use trends 

over time, limitation that will be addressed by future 

research studies.  

The key strength of this study was its multi-

centric approach, since medical colleges from different 

parts of the country were involved. Also, this study 

examines various risk factors and correlates for substance 

use in UGs as well as PGs, which can potentially guide 

counseling efforts or other interventions. This study 

provides a foundation for future prospective studies can 

be conducted regarding the role of BCC approach 

targeted at specific points in a medical student’s career. 

 

References 

1. Newbury-Birch D, Walshaw D, Kamali F. 

Drink and drugs: From medical students to 

doctors. Drug Alcohol Depend. 

2001;64(3):265-270. 

2. Domenighetti G, Tomamichel M, Gutzwiller F, 

Berthoud S, Casabianca A. Psychoactive drug 

use among medical doctors is higher than in the 

general population. Soc Sci Med. 

1991;33(3):269-274. 

3. Kumar P, Basu D. Substance abuse by medical 

students and doctors. J Indian Med Assoc. 

2000;98(8):447-452. 

4. American Psychiatric Association. Diagnostic 

and statistical manual of mental disorders: 

DSM-IV. Washington D. C.: American 

Psychiatric Association; 1994. 

5. Holtman MC. Disciplinary careers of drug-

impaired physicians. Soc Sci Med. 

2007;64(3):543-553. 

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6. Baptista T, Uzcàtegui E. Substance use among 

resident doctors in Venezuela. Drug Alcohol 

Depend. 1993;32(2):127-132. 

7. Ghosh S, Samanta A, Mukherjee S. Patterns of 

alcohol consumption among male adults at a 

slum in Kolkata, India. J Health Popul Nutr. 

2012;30(1):73-81. 

8. Neufeld KJ, Peters DH, Rani M, Bonu S, 

Brooner RK. Regular use of alcohol and tobacco 

in India and its association with age, gender, and 

poverty. Drug Alcohol Depend. 

2005;77(3):283-291. 

9. Murthy P, Manjunatha N, Subodh BN, Chand 

PK, Benegal V. Substance use and addiction 

research in India. Indian J Psychiatry. 

2010;52(5):189-199. 

10. Ramakrishna GS, Sankara Sarma P, 

Thankappan KR. Tobacco use among medical 

students in Orissa. Natl Med J India. 

2005;18(6):285-289. 

11. Seshadri S. Substance abuse among medical 

students and doctors: A call for action. Natl Med 

J India. 2008;21(2):57-59. 

12. World Health Organization (WHO). Global 

Health Observatory: Prevalence of alcohol use 

disorders. 2012; 

www.who.int/gho/substance_abuse/burden/alc

ohol_prevalence/en/index.html. Accessed July 

8, 2012. 

13. Agrawal A, Lynskey MT. Tobacco and 

cannabis co-occurance: Does route of 

administration matter. Drug Alcohol Depend. 

2009;99(1-3):240-247. 

14. Deepa M, Pradeepa R, Anjana RM, Mohan V. 

Noncommunicable diseases risk factor 

surveillance: Experience and challenge from 

India. Indian J Community Med. 2011;36(Suppl 

1):S50-S56. 

15. World Health Organization (WHO). Global 

Health Observatory: Prevalence of tobacco use. 

2012; www.who.int/gho/tobacco/use/en/. 

Accessed July 10, 2012. 

16. British Medical Association. The Misuse of 

Alcohol and Other Drugs by Doctors. London: 

British Medical Association; 1998. 

17. Ray R. The Extent, Pattern and Trends of Drug 

Abuse in India: National Survey. Ministry of 

Social Justice and Empowerment, Government 

of India & United Nations Office on Drugs and 

Crime, Regional Office for South Asia; 2004. 

18. Boland M, Fitzpatrick P, Scallan E, et al. Trends 

in medical student use of tobacco, alcohol and 

drugs in an Irish university, 1973-2002. Drug 

Alcohol Depend. 2006;85(2):123-128. 

19. Reddy KS, Shah B, Varghese C, Ramadoss A. 

Responding to the threat of chronic diseases in 

India. Lancet. 2005;366(9498):1744-1749. 

20. Smith DR, Leggat PA. An international review 

of tobacco smoking among medical students. J 

Postgrad Med. 2007;53(1):55-62. 

  

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http://www.who.int/gho/substance_abuse/burden/alcohol_prevalence/en/index.html
http://www.who.int/gho/substance_abuse/burden/alcohol_prevalence/en/index.html
http://www.who.int/gho/tobacco/use/en/


 

 

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Table 1:  Distribution of alcohol and tobacco use among participants stratified by college and 

student group 

Medical 

College 

UG Students PG Residents 

N 

Prevalence (95% CI) 

N 

Prevalence (95% CI) 

 

Alcohol Tobacco 

 

Alcohol Tobacco 

1 100 

 

16(9.4,24.6) 11(5.6,18.8) 41 

 

29.3(16.1,45.5) 17.1(7.1,32) 

2 151 

 

38.4(30.6,46.6) 21.9(15.5,29.2) 35 

 

40(23.8,57.8) 22.9(10.4,40.1) 

3 151 

 

17.2(11.5,24.2) 7.9(4.1,13.4) 35 

 

40(23.8,57.8) 22.9(10.4,40.1) 

4 148 

 

4.1(1.5,8.6) 0 50 

 

22(11.5,35.9) 0 

5 150 

 

7.3(3.7,12.7) 2.7(0.7,6.6) 50 

 

30(17.8,44.6) 8(2.2,19.2) 

6 151 

 

17.2(11.5,24.2) 7.9(4.1,13.4) 0 

 

0 0 

7 148 

 

4.1(1.5,8.6) 0 50 

 

22(11.5,35.9) 0 

8 145 

 

28.3(21.1,36.3) 13.1(8.0,19.7) 50 

 

42(28.1,56.8) 36(23,50.8) 

TOTAL 1,144 

 

16.6(14.5,18.9) 8(6.,9.6) 311 

 

31.5(26.3,37.0) 14.5(10.7,18.9) 

Grand 

Total 

N=1,455 

Total prevalence among med fraternity: 

Alcohol – 19.8(17.8, 21.9); Tobacco – 9.4(8.0, 11.0) 

Note. * indicates that the number of participants enrolled were less than the required sample size 

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Table 2: Association of a positive family history with consumption of substances among UGs 

and PGs 

Family History 
Self-consumption 

p-value* Yes No 

Alcohol 
+ 156 245 

< 0.001 
- 132 922 

Tobacco 
+ 52 171 

< 0.001 
- 84 1,148 

Note. *Based off Chi-square analyses. 

  

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Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2015.187  |  http://cajgh.pitt.edu 

 

 

Table 3:  Proportion of participants who tried to quit the habit 

 Alcohol Tobacco 

No answer 11 (3.8%) 12 (8.8%) 

No 237 (82.3%) 82 (60.3%) 

Yes 40 (13.8%) 42 (30.9%) 

 

  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 

 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 

This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 4, No. 1 (2015)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2015.187  |  http://cajgh.pitt.edu 

  

 

Table 4: Alcohol types and tobacco modes used for consumption 

Type of Substance N 

Alcohol  

     Beer 226 

     Vodka 175 

     Whisky 162 

     Rum 100 

     Other 146 

     Total 288 (19.8%) 

  

Tobacco  

     Smoking 120 

     Chewing 3 

     Sniffing 1 

     Total 136 (9.3%) 

Note. Discrepancy in totals is due to multiple responses for some options and no response by some users. 

 
 

 

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